Persistent Physical Symptoms: Biomarker Gaps in Somatic Symptom Disorders
This Lancet review examines persistent physical symptoms across diagnoses, identifying inflammation, immune dysregulation, microbiome changes, and metabolic alterations as potential biological contributors. Despite these mechanistic insights, no validated laboratory biomarkers exist to objectively diagnose or monitor persistent somatic symptoms. For clinical laboratories, this represents both a gap and an opportunity: developing reliable inflammatory, metabolomic, or microbiome-based panels could transform management of these common, disabling conditions.
The original study
Persistent physical symptoms: definition, genesis, and management.
- Authors
- Löwe B, Toussaint A, Rosmalen JGM, Huang WL, Burton C, Weigel A, et al.
- Journal
- Lancet (London, England)
- Type
- Journal Article, Review, Research Support, Non-U.S. Gov't
- PMID
- 38879263
Original abstract
Persistent physical symptoms (synonymous with persistent somatic symptoms) is an umbrella term for distressing somatic complaints that last several months or more, regardless of their cause. These symptoms are associated with substantial disability and represent a major burden for patients, health-care professionals, and society. Persistent physical symptoms can follow infections, injuries, medical diseases, stressful life events, or arise de novo. As symptoms persist, their link to clearly identifiable pathophysiology often weakens, making diagnosis and treatment challenging. Multiple biological and psychosocial risk factors and mechanisms contribute to the persistence of somatic symptoms, including persistent inflammation; epigenetic profiles; immune, metabolic and microbiome dysregulation; early adverse life experiences; depression; illness-related anxiety; dysfunctional symptom expectations; symptom focusing; symptom learning; and avoidance behaviours, with many factors being common across symptoms and diagnoses. Basic care consists of addressing underlying pathophysiology and using person-centred communication techniques with validation, appropriate reassurance, and biopsychosocial explanation. If basic care is insufficient, targeted psychological and pharmacological interventions can be beneficial. A better understanding of the multifactorial persistence of somatic symptoms should lead to more specific, personalised, and mechanism-based treatment, and a reduction in the stigma patients commonly face.