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Top-10 Research Priorities for Medically Not Yet Explained Symptoms - UK

September 24th, the James Lind Alliance Priority Setting Partnership launched the research priorities for symptoms not yet medically understood

After 18 months of surveys and consultations with the public, a priority setting partnership of patients, clinicians and carers prepared research priorities aiming to discover more about conditions affecting patients that doctors can find no medical explanation for. The partnership was supported by the James Lind Alliance (JLA), several charities such as FND Hope, FND Action, FND Networks, INCLUDE, the Universities disability network, Guts UK, Pain UK, Carers UK, POTS-UK, Graham Hughes International, Fibromyalgia Association UK, the British Thyroid Foundation, clinical networks and the Royal College of Psychiatry Liaison Faculty. Patients, their carers and clinicians contributed from the domains of cardiology, neurology, gastroenterology, endocrinology, general practice, physiotherapy, occupational therapy, psychology, neuropsychology, and rheumatology.

The partnership was led by Professor Christina van der Feltz - Cornelis from the Department of Health Sciences of the University of York. The partnership is international as a Dutch Priority Setting group supported by Tilburg University is running a similar process simultaneously. They will present research priorities for the Netherlands next year. The Anglo-Dutch partnership will enable exploration of international and intercultural differences that might be of interest for future development of services and the co-design of research to develop better treatment and care of MNYES.

Medically Not Yet Explained Symptoms (MNYES) represent up to 10 to 30 percent of cases in general medicine. They can include fatigue, pain, dizziness, bowel problems, unexplained blackouts, seizures or sudden loss of awareness and functional neurological symptoms.

When asked why they wanted to be involved in this project, a workshop participant responded saying: I have lived with MNYES since 2009 with various admissions to hospital. In last 6 years I have had to give up my job and am still seeking a diagnosis.

Professor van der Feltz - Cornelis said: “People may have a diagnosis such as Functional Neurological Disorder (FND), Fibromyalgia, Irritable Bowel Syndrome (IBS) or Chronic Pain without fully understanding what has been the cause of these problems or the best way to treat them.

Patients diagnosed with such symptoms, although care may be taken to explain their condition properly, often do not feel that they are taken seriously. They visit many clinics for diagnostic procedures to hear ‘it is all in your head’. Treatments may pay little attention to their patient experiences and have limited effect.”

Researchers identified several different areas of study including: what treatments work best for patients, how clinicians can collaborate effectively to form the most appropriate care pathways for MNYES sufferers; and what outcomes matter most to patients.

This project received funding from The Centre for Future Health Partnership Fund, a collaboration between the Wellcome Trust and the University of York that is committed to nurturing excellent research in the area of health and wellbeing across all disciplines.

  1. What are the most effective treatment strategies for different symptoms of MNYES?
  2. How can clinicians collaborate effectively to form the most appropriate care pathway and service model to offer assessment and treatment for patients with MNYES?
  3. What are the most effective methods for training clinicians to diagnose and treat their patients with MNYES with compassion, empathy and respect?
  4. What outcomes matter most to patients with MNYES?
  5. What are the most effective ways to support patients with MNYES and their carers to live with their symptoms?
  6. How can the most appropriate treatment be selected, dependent on different MNYES symptoms, that a person with MNYES is most likely to benefit from?
  7. What symptoms are commonly reported by people with MNYES and what links them?
  8. What factors affect outcomes for MNYES?
  9. What strategies are effective at promoting awareness and up to date clinical knowledge about MNYES amongst healthcare professionals?
  10. Which self-management techniques are effective in MNYES?

For more on the research priorities see the James Lind Alliance