Medically Unexplained Symptoms (MUS), Medically Unexplained Physical Symptoms (MUPS) or
Unexplained Symptoms are the terms used to describe symptoms that remain unexplained after an
appropriate medical assessment that includes focused diagnostic testing. Patients are often given
multiple labels that lack a well-defined disease explanation. Usual clinical features include
a relative lack of objective signs and a chronic symptom course often marked by exacerbations, remissions,
and recurrences. Therefore, clinical management must be based largely upon patient report, rather than specific
findings on clinical examination or diagnostic testing. A compassionate approach to patients with medically
unexplained symptoms (MUS) is essential.
In 2002 the Veterans Administration (VA) and the Department of Defense (DoD) developed the
VA/DoD Clinical Practice Guideline for Management of Medically Unexplained Symptoms (MUS): Chronic Pain and Fatigue, which was
designed to assist clinicians in primary care settings in all aspects of patient care related to medically unexplained symptoms
involving chronic pain and fatigue.
According to the Institute of Medicine (IOM) Report: Gulf War and Health Volume 9: Treatment for Chronic Multisymptom Illness, 2013 about one-third
of the 1991 Gulf War veterans suffer from an array of long-term medically unexplained symptoms known as chronic multisymptom illness (CMI). CMI is
defined in the report as: "The presence of a spectrum of chronic symptoms experienced for 6 months or longer in at least two of six categories - fatigue,
mood and cognition, musculoskeletal, gastrointestinal, respiratory, and neurologic - that may overlap with but are not fully explained by known
syndromes (such as irritable bowel syndrome, chronic fatigue syndrome, and fibromyalgia) or other diagnoses." In addition, the report indicates
that many symptoms reported by Iraq and Afghanistan war veterans overlap with symptoms experienced by 1991 Gulf War veterans. The report contains
a comprehensive review and evalution of treatments for CMI.
In 2014, the VA/DoD MUS Clinical Practice Guideline was updated and renamed the VA/DoD Clinical Practice Guideline for the Management
of Chronic Multisymptom Illness.
Table of Contents
- Brochures and Fact Sheets
- Self Care of Medically Unexplained Symptoms Brochure (PDH 010), Jul 02 (Information for the patient and/or family members. Explores common medically unexplainable symptoms such as headaches, fatigue, memory loss, joint pain, skin rash, unexpected weight changes and insomnia. Order from QMO Shopping Cart, Replacement Parts for Post-Deployment Health Clinical Practice Guideline ToolKit Item PDH 010.)
- VA War-Related Injury and Illness Study Center (WRIISC), Information on Medically Unexplained Symptoms, A Resource for Veterans, Service Members and Their Families, Dec 12
Other Related Information
Education and Training
- Institute of Medicine (IOM) Report, Chronic Multi-symptom Illness in Gulf War Veterans: Case Definitions Reexamined, Mar 14 (In this report, the IOM comprehensively reviewed, evaluated, and summarized the available scientific and medical literature regarding symptoms for CMI among the Gulf War veterans. Additionally, the IOM evaluated the terminology currently used in referring to CMI and provides a recommendation for appropriate usage.)
- Institute of Medicine (IOM), Gulf War and Health: Treatment of Chronic Multisymptom Illness Consensus Study (Information on the activities of the committee convened by the IOM to comprehensively review, evaluate, and summarize the available scientific and medical literature regarding the best treatments for chronic multisymptom illness among Gulf War Veterans and recommend the best way to disseminate the information, additional studies that are needed, and any needed legislative or administrative actions.)