When Symptoms Are Real But Tests Come Back Normal

Some of the most frustrating experiences in medicine involve symptoms that are unmistakably real to the person having them, but which investigations cannot account for. Persistent pain, exhaustion, dizziness, gut problems and many others fall into this category. People are often sent from one specialist to another, and many eventually pick up the impression that they are not believed. They are real symptoms. What is missing is an explanation, not the experience. One line of thinking suggests part of the answer may lie in how the brain processes bodily sensation, and that distressing experiences which were never fully processed can keep the nervous system tuned to produce and amplify physical symptoms. If that is right, a therapy designed to process such experiences might help. A systematic review by Staton and colleagues, published in the Journal of EMDR Practice and Research (2022), gathered the evidence. The researchers searched six databases without date limits and identified 28 studies in which EMDR was used for persistent physical symptoms, with courses ranging from a single session to twenty. The findings were consistent. Every study reported significant improvement in physical symptoms by the end of treatment. Where effect sizes were reported, they ranged from moderate to large. Anxiety and depression improved alongside the physical symptoms, often substantially. Dropout was low, at around 11% in studies with representative samples, which suggests people found the treatment acceptable rather than overwhelming. The authors are careful about how far this can be pushed. Study quality varied considerably, many of the 28 were not randomised trials, and the different conditions studied are difficult to compare directly. They conclude that the evidence is promising but that firm conclusions about efficacy cannot yet be drawn, and they call for larger, better-designed trials. They also note where the evidence is strongest. Studies of pain and of tinnitus had the most robust methods, and the findings there were the most compelling. Regular readers will recognise several of these conditions from earlier articles on this blog, including chronic fatigue, fibromyalgia, phantom limb pain and tinnitus. This review is useful because it places them in one frame rather than treating each as a curiosity. The practical message is a reasonable one. If you are living with persistent physical symptoms that medicine has struggled to explain, and particularly if difficult experiences sit somewhere in the background, EMDR is worth asking about. Source: Staton, A., Wilde, S., & Dawson, D. L. (2022). The effectiveness of EMDR for medically unexplained symptoms: A systematic literature review. Journal of EMDR Practice and Research, 16(4), 170 to 201.