Medically Unexplained Symptoms: Chronic Pain and Fatigue

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Box 1 Patient with medically unexplained symptoms [MUS]
Box 2 Obtain additional history, physical examination, Mental Status Examination and psychosocial assessment [B]
Box 3 Are unstable or urgent condition(s) present? [C] Box 4 Refer or treat, as indicated, before continuing in this algorithm
Box 5 Clarify the symptoms [see side bar], build therapeutic alliance, schedule additional appointments of longer duration [D] Side bar: Symptom Attributes. Duration of symptom, onset and triggers, location, co-morbidity, previous episodes, intesity and impact, previous treatment and medications, past medical, surgical and psychological history, patient perception of symtom [D]
Box 6 Revisit the medical record [E]
Box 7 Obtain focused diagnostic tests, if not already done [F]
Box 8 Can another condition or disease (including mood disorder) explain (cause) the symptoms? [G] Box 9 Consider treating the condition or disease
Box 8 no to box 12 Box 10 Are all symptoms resolved? Box 11 Follow-up
Box 12 Consider initiating symptom-based treatment modalities [H] Box 10 no to box 12
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