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  • Principal Investigator: Athula Sumathipala
  • 1 October 2015 to 30 June 2016
  • Project No: 254
  • Funding round: FR 9

‘Medically unexplained symptoms’ (or MUS) is a term used by doctors when patients present with symptoms which may be difficult to understand, where repeated investigations are negative, and which do not have a clear explanation in terms of a demonstrable physical cause. This term includes conditions such as Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), chronic pelvic pain, fibromyalgia, facial pain and non-cardiac chest pain. Patients who have a diagnosed physical condition can also experience MUS.

MUS are thought to account for a fifth of consultations in general practice, half of new referrals to out-patient clinics, and increase the risk of patients seeking emergency care. There are a few treatments known to be effective in managing patients with MUS (such as cognitive behavioural therapy, CBT), but availability is limited due to lack of appropriately trained practitioners (doctors and psychological therapists), and unacceptability of the label of ‘mental health’ and mental health services to people with MUS.

Prof Sumithapala has completed two studies in Sri Lanka showing that CBT informed by metaphors can be helpful for patients with MUS. A metaphor is an analogy, using one scenario to explain another, and analogies can be used to explain the principles of CBT in a simple way. Metaphors can be quite powerful. For example, the metaphor ‘a rubber ball in the water’ can illustrate how worrying thoughts can keep surfacing and how the person suffering needs to keep suppressing the thought to stop it returning. So, in working with a patient, instead of talking about ‘automatic negative thoughts’ the practitioner can use the metaphor of ‘a rubber ball in the water’ to convey the message. We aim to determine whether metaphors to explain CBT principles and to help patients understand and manage their symptoms are acceptable to practitioners and patients in the UK. We will do this using a series of focus groups with patients and practitioners. 

Evidence synthesis working group

The collaboration will be conducting 18 high impact systematic reviews, under four workstreams.

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Bursaries in systematic review training

The NIHR SPCR Evidence Synthesis Working Group (ESWG) made a commitment to build capacity in the field of systematic reviews through teaching and training. The Group is offering 2 bursaries,  covering the full course fees of attending a Masters level module from the postgraduate programme in Evidence Based Healthcare at the University of Oxford.

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Developing a realist review lens

Blog by Dr Sophie Park