16.1.1  Physical complaints without an identifiable medical cause: what can you do to help?

When somebody from your local community has physical complaints that don’t seem to have a medical cause, the first things you need to do are:

• make sure that the person has been properly medically assessed
• screen for depression, anxiety and alcohol misuse/abuse.

If any of these conditions are present then refer for treatment.

If the physical complaint doesn’t seem to be due to a medical cause, or to depression, anxiety or alcohol abuse, it might be due to somatisation. In this situation there are a few things that you can do to help:

• Reassure the person that there doesn’t seem to be a serious or dangerous cause for their symptoms.
• It can be difficult to explain to people that their physical symptoms may come from mental distress. They may think that you don’t believe them or that you are saying they are crazy. Instead, ask them about any life difficulties.
• You can explain that:
  • Physical symptoms can be made worse by worrying about life’s problems.
  • Worry can make people tense their muscles which in turn can lead to pain, e.g. tension headaches.
  • If we feel sad, worried or frightened then we become more sensitive to pain.
• If the person is repeatedly attending different health facilities or looking for treatment from traditional healers, build up their trust and encourage them to come to you first if they have any new physical complaints.
• Be prepared to review the assumption that symptoms are due to somatisation. If an underlying physical condition is present then it will usually progress and become easier to detect with time.
• Medication is not indicated unless the person also develops depression. In that case, the health centre staff may prescribe antidepressant medication (see Study Session 12).