It's a common scenario: You have an odd pain for weeks or are feeling too tired lately. So you head to a doctor, who may run a test or two. But no clear cause for the symptom shows up.
Despite a dizzying array of high-tech medical tests, the reality is that many symptoms, such as fatigue or headaches, are never explained. In most cases, when doctors rule out serious disease, patients are reassured. But some patients remain bothered by the mystery symptoms, returning to the doctor again and again worrying that they are missing some dire illness.
dizzying：令人昏乱的，目不暇接的 reassured：消除疑虑的，放心的 dire：可怕的，悲惨的
Now, some family doctors and internists are treating patients disturbed by medically unexplained symptoms with techniques to prompt patients to think differently about their symptoms, including cognitive behavioral therapy and relaxation strategies.
internist：内科医生 therapy：治疗，疗法
This reflects the reality that paying excess attention to symptoms can often make them feel worse. The goal is to teach patients to live with their symptoms, to see them as benign and even ignore them. Recent research shows the techniques can ease symptoms and, perhaps just as important, the distress they can cause.
Mystery symptoms can be frustrating for doctors and patients alike. Patients can feel like their concern is being dismissed as all in their heads. Doctors may feel there is little they can do -- and may resent the time these patients take.
resent：怨恨，愤恨
'Most people don't want to hear 'I don't really know,' but the truth is often we don't really know,' says Susan H. McDaniel, associate chair of the department of family medicine at the University of Rochester Medical Center in New York.
'What we consider a good outcome is not necessarily that the symptoms disappear but that they are no longer bothersome or disturbing,' says Arthur Barsky, professor of psychiatry at Harvard Medical School.
Medically unexplained symptoms are strikingly common. One 2011 study of 620 German primary-care patients published in the journal Psychosomatics found that medically unexplained symptoms made up two-thirds of all reported symptoms. Other studies estimate that anywhere from 10% to 20% of U.S. primary-care patients have medically unexplained symptoms that impair them in some way. About 5% to 7% of the population has a more serious psychiatric illness, somatic symptom disorder, where symptoms (either explained or unexplained) persist more than six months and are accompanied by a high level of anxiety.
(This is different from what was known as hypochondriasis, an illness where physical symptoms may be mild or nonexistent but where patients are fearful of having a serious disease. Hypochondriasis no longer exists as a diagnostic term: The latest edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, uses the term 'illness anxiety disorder' instead.)
hypochondriasis：疑病症 diagnostic：诊断的，特征的
Almost anything can be a mystery symptom. The most common medically unexplained ones are fatigue, back pain, headache and abdominal pain, doctors say. Dizziness, vertigo and numbness also sometimes have no identifiable medical cause.
abdominal：腹部的
Hannah Letterman was a 17-year-old high school senior when she suddenly was struck with nausea, headaches and vertigo. 'I would feel I was being dragged in circles by my feet,' says the now 19-year-old college freshman in Rochester, N.Y. 'I couldn't read. I couldn't do homework. I couldn't have conversations for more than a few minutes.'
nausea：恶心，晕船 vertigo：晕头转向，眩晕
The feeling lasted for months. She saw multiple doctors who ran many tests. Then, at the University of Rochester's epilepsy center, she was finally referred to William Watson, a psychologist there. Dr. Watson had her keep a symptom diary: She wrote down what activities, thoughts and feelings seemed to make the symptoms better or worse. In weekly therapy sessions, she worked to 'really accept my emotions for what they are,' she says. The approach worked. Ms. Letterman says she still has some residual symptoms, but is 'fully functional.' She initially thought it ridiculous that her symptoms could be psychologically generated, but has come around to that view.
residual：剩余的，残留的
Some patients with medically unexplained symptoms who return almost monthly to the doctor may have an underlying psychological issue fueling the symptoms and the 'health-seeking' behavior, says Robert C. Smith, professor of medicine and psychiatry at the Michigan State University College of Human Medicine. 'It is a red flag that there is an underlying psychiatric disorder,' such as depression or anxiety, he says.
Dr. Smith and colleagues have developed a treatment for primary-care providers to deliver. It combines antidepressant medication and the elimination of narcotic pain drugs, which can make depression worse, with relaxation techniques, exercise and other strategies.
narcotic：麻醉的，催眠的
A study published in the Journal of General Internal Medicine in 2006 examined 206 patients who averaged more than 13 visits to their doctor in the year before the study. About 60% of the patients were found to have major depression. Those who received the treatment -- provided by four nurse practitioners in 12 visits over one year -- saw decreased psychological distress and better coping skills compared with a control group.
psychological distress：心理困扰
In a study published in 2013 of 89 patients who visited their primary-care doctors frequently for medically unexplained symptoms and had a lot of anxiety about their heath, Dr. Barsky and colleagues found that both a cognitive behavioral therapy program and a relaxation training program eased symptoms, improved mental health and reduced impairment. In the year after the study, patients also visited their doctors less: About 8.8 times, compared with 10.3 times in the year before the study.
The cognitive behavioral treatment was delivered in four to eight sessions by nurse practitioners or physicians' assistants who had undergone several training seminars. In the treatment, patients are first taught to alter their 'dysfunctional beliefs' about health and symptoms, such as the misconception that 'good health is symptom-free,' Dr. Barsky says. Then patients are guided to eliminate 'maladaptive illness behavior' such as excessively researching their symptoms online or going to many doctors in search of a diagnosis.
Patients also are taught to distract themselves from their symptoms. They are asked to come up with a range of enjoyable activities to switch to as soon as they find themselves ruminating about their symptoms. The CBT patients also learn relaxation techniques like meditation.
ruminating：沉思
Wanda Filer, a family physician in York, Pa., says she is wary of sending patients with medically unexplained symptoms on a 'therapeutic misadventure' by shuttling them to multiple specialists or ordering many tests. The possibility for false positives increases. You could 'find a little cyst that is probably totally fine and then they get totally obsessed with it.'
wary of：小心翼翼的，警觉的 obsessed with：非常喜欢，着迷
Molly Cooke says some of her patients are 'really good noticers,' especially of chronic abdominal pain. Dr. Cooke, president of the American College of Physicians and a practicing internist in San Francisco, tells patients, 'You are a super good noticer of what your body is doing. The GI tract is very active and a lot of people don't really notice that.'
In these kinds of patients with vague symptoms, she'll agree on a time frame with them for further exploration. If the symptoms are still bothersome in a few months or weeks, depending on the situation, she'll pursue more testing. 'I'm hoping this will go away or be replaced by another set of symptoms,' she says. 'A lot of people don't feel good about coming to the doctor if they don't have some symptoms.'