In daily medical practice, doctors often encounter a particular challenge: patients whose physical recovery seems complete, yet they continue to suffer from persistent discomfort. Today, I want to share a case about "Psychogenic Somatic Symptoms" to raise awareness among both doctors and patients, helping to avoid misdiagnosis and prevent potential doctor-patient conflicts.
Case Study: A 66-Year-Old Woman's Journey with Varicose Vein Treatment
This is the story of a 66-year-old woman who underwent traditional great saphenous vein stripping and phlebectomy for varicose veins at local hospital. Although her symptoms initially improved after surgery, the varicose veins recurred several years later, with even more severe symptoms.
Subsequently, she sought treatment from a doctor at Dr. Smile Medical Group, where a hemodynamic ultrasound examination revealed two sources of reflux (EP). The patient underwent CHIVA，a minimally invasive procedure with two small incisions, and three months later, the varicose veins had significantly improved in both appearance and function.
However, the patient continued to report leg discomfort, particularly during the night. She described a broad area of discomfort with unclear boundaries, though it did not affect her ability to walk. This ongoing sensation caused her significant distress, impacting her sleep and raising fears about underlying vein issues.
Follow-Up and Diagnosis: No Physiological Abnormalities, But Anxiety Persists
Upon follow-up examination, hemodynamic ultrasound results were normal. There were no visible signs of varicose vein recurrence, the surgical incisions had healed well, arterial pulses were normal, and there were no signs of sensory abnormalities or edema. Furthermore, her symptoms did not match the characteristics of sciatic nerve compression or neuritis.
Despite the lack of physiological findings, the patient exhibited clear signs of anxiety, and her anxiety score indicated severe anxiety. This anxiety led her to remain overly concerned about her health, with subjective discomfort persisting despite normal physical examination results.
Psychogenic Somatic Symptoms: The Overlooked Psychological Factor
Psychogenic Somatic Symptoms are a type of physical discomfort caused by psychological or emotional factors. They often manifest as pain, pressure, fatigue, or other vague sensations. These symptoms are commonly associated with stress, anxiety, or depression, yet objective medical tests typically reveal no specific physiological abnormalities.
Such symptoms are widespread among patients, particularly those who have undergone major surgeries, illnesses, or traumas. Psychogenic somatic symptoms are not a sign that patients are "faking" or "overreacting." Rather, their psychological state, through complex neuroendocrine pathways, genuinely affects their bodily perception and response. This can lead to persistent complaints of pain or discomfort, even when no physiological basis is found.
In the case of this patient, her leg discomfort had no physical basis according to the examinations, but her anxiety and worries significantly impacted her quality of life. This discomfort, especially worsening at night, is often closely related to psychological conditions. Anxiety can heighten the nervous system's sensitivity to bodily sensations, causing the patient to feel increased discomfort.
The Importance of Patient Education and Psychological Intervention
For patients like this, standard medical tests and physical treatments alone may not fully resolve the issue. What they need is psychological reassurance and education on how psychological factors can influence physical symptoms. Professional psychological interventions, such as Cognitive Behavioral Therapy or anxiety management, can help patients gradually reduce their overfocus on physical symptoms and improve their overall quality of life.
Clinicians should also be mindful of the impact of psychological factors on patient recovery. Especially in cases where objective examination results are normal but patients continue to report significant symptoms, the possibility of psychogenic somatic symptoms should be considered. This can help avoid misdiagnosis, excessive medical examinations, and unnecessary treatments.
Addressing Psychological Health to Avoid Misdiagnosis and Conflict
Psychogenic somatic symptoms not only affect patients' quality of life but may also lead to misunderstandings between doctors and patients, potentially escalating into conflicts. Therefore, as healthcare providers, we must focus on both the physiological and psychological health of our patients, offering comprehensive support and care.
For patients, understanding the impact of psychological factors on physical health is crucial. If you experience persistent discomfort after surgery despite normal test results, do not ignore your emotional state. Seeking timely psychological support might be the key to resolving your symptoms.
Disclaimer: This article is intended to provide scientific and professional information and should not be used as a substitute for professional medical diagnosis or treatment. Patients are advised to consult a professional physician for personalized medical advice based on their condition.
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