Managing Transient Nonspecific Medical Conditions - An Advocacy - A Legacy
Since I started my private practice in 1982, I have been advocating the recognition of the phenomenon of "nonspecific pain" or "transient nonspecific medical conditions" to avoid medicalization. Medicalization is defined as the process of identifying or categorizing a condition as being a disorder requiring medical treatment or intervention and if fact, there is no requirement.
In the practice of medicine, a physician will encounter two categories of medical conditions. One is the so-called transient non-specific medical condition and the other is the specific medical condition.
A transient non-specific medical condition is a phenomenon in which the patient feels ache or pain or anything in his body but which is transient lasting for a short period of time, spontaneously resolving and which does not indicate a specific disease entity. In contrast, a specific medical condition is a phenomenon in which there the patient feels something in his body and which is indicative of a specific disease entity.
The exact cause or mechanism of the symptom in a transient non-specific medical condition is not readily and exactly identified. It may be caused by mild hormonal, chemical, physical or temperature changes. It may be psychogenic. The symptom spontaneously disappears and no specific disease entity can be identified.
What to do with the transient non-specific medical conditions? Just monitor. Just do watchful waiting. If the symptom is persistent, increasing in intensity, and falling within known symptoms of a disease, shift and look for a diagnosis of a specific medical condition.
Physicians should be aware of the existence of such a category (transient non-specific medical condition) aside from that of specific medical condition. Otherwise, there will be tendency for medicalization. Medicalization is defined as the process of identifying or categorizing a condition as being a disorder requiring medical treatment or intervention and if fact, there is no requirement.
I have written several posts on this issue. See links and excerpts below.
I am advocating that all physicians pick this up (recognize this phenomenon, adopt or consider a wait and watch stance initially rather than order for a diagnostic test or treatment right away; etc.).
I am also advocating that all persons (potential patients) pick this up and recognize this phenomenon and know what to do and what to expect when physicians tell them they have nonspecific pain.
This advocacy is related to my advocacy in avoiding unnecessary operations and procedures. See link: https://sites.google.com/site/rojoson70memoir/avoiding-unnecessary-operations-and-procedures---an-advocacy---a-legacy
This advocacy is a legacy that I am and will behind for the physicians and the patients.
Diagnosis, Clinical Diagnosis, and Diagnostic Labels (with Focus on “Non-specific” Labels)
Transient Non-specific Medical Conditions
https://rojosonmedicalclinic.wordpress.com/2017/03/19/transient-non-specific-medical-conditions/
Non-specific Pain – A Reflection Again
https://rojosonfacebooknotes.wordpress.com/2018/11/21/non-specific-pain-a-reflection-again/
Diagnosis, Clinical Diagnosis, and Diagnostic Labels (with Focus on “Non-specific” Labels)
Diagnosis, Clinical Diagnosis, and Diagnostic Labels (with Focus on “Non-specific” Labels)
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
July 9, 2014
When a patient consults a physician, the first thing that the latter will and should do is to diagnose or to make a diagnosis. The diagnosis should precede the treatment. The diagnosis should serve as the basis for formulating the treatment plan.
Thus, diagnosis is the identification of the disease, condition or problem that a patient may have through a systematic analysis of data derived from medical history, physical examination, and other diagnostic tests or procedures.
A “clinical” diagnosis is a diagnosis made on the basis of the data obtained by medical history and physical examination alone, without the benefit yet of laboratory tests. This is the foremost type of diagnosis that all physicians make, the others being called laboratory diagnosis, operative diagnosis, etc.
A diagnosis, particularly a clinical diagnosis, should be as specific as possible as this will serve as a basis for formulating the treatment plan. A diagnosis comes in the form of a label, or diagnostic label. As mentioned, the diagnostic label should be clearly stated. It may contain the name of a particular disease, if a disease is suspected after a systematic analysis of data by the physician. It may also not contain the name of a particular disease, if a disease is not suspected. An example of a situation in which the diagnostic label does not contain the name of a particular disease is when the physician decides the findings are all within normal limits. The other situation in which the diagnostic label does not contain the name of a particular disease is when the physician decides that for the symptoms presented by the patient, there is no identifiable underlying disease as well as no serious disease at that. Examples of diagnostic labels in such a situation are the following: non-specific neck pain; non-specific chest pain; non-specific right lower quadrant abdominal pain; non-specific back pain; non-specific dizziness; non-specific headache; etc.
ROJoson’s Thoughts, Perceptions, Opinions, and Recommendations (TPORs) on “Non-specific” Clinical Diagnostic Labels –
Assuming there are three (3) types of clinical diagnostic labels that can arise after a patient evaluation, namely, 1) a label with name of a particular disease [1st Label]; 2) a label of “normal” or equivalent word or phrase [2nd Label]; and 3) label with “non-specific” symptoms or equivalent word or phrase [3rd Label].
My observation and perception from the past 38 years of my practice in medicine is that the “non-specific” diagnostic labels [3rd Label] are uncommonly, if not rarely, used by physicians. Why? I don’t know the exact reason. My thought, perception and opinion is that there is lack of emphasis on the use of the 3rd Label during earlier and formative years of medical training.
That a third kind of clinical diagnostic label consisting of the phrase “non-specific”symptom or equivalent is present and is allowable in medical practice can be seen in medical publication and also in International Classification of Diseases (ICD).
Below are some quotes from the medical publication:
Nonspecific (simple) neck pain is the commonest cause of neck symptoms and results from postural and mechanical causes.
http://www.ncbi.nlm.nih.gov/pubmed/17369782
About 8 in 10 people have one or more bouts of low back pain. In most cases, it is not due to a serious disease or serious back problem, and the exact cause of the pain is not clear. This is called nonspecific lower back pain. The usual advice is to keep active, and do normal activities as much as possible.
http://www.patient.co.uk/health/nonspecific-lower-back-pain-in-adults
Some children will have a cause found, however a significant number of children will be diagnosed with “nonspecific abdominal pain”.
http://www.rch.org.au/clinicalguide/guideline_index/Abdominal_pain
NON-SPECIFIC NECK PAIN-disorders there is an absence of an identifiable underlying disease or abnormal anatomical structure.
eujournal.org/index.php/esj/article/download/727/776
Nonspecific neck pain (NSNP)—neck pain without specific underlying disease—is a serious public health problem that has become a major cause of disability around the world. Each year, 27% to 48% of workers suffer NSNP.
http://www.bcmj.org/worksafebc/what%E2%80%99s-new-literature-nonspecific-neck-pain
Below are some quotes from ICD:
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified R00-R99
The conditions and signs or symptoms included in categories R00-R94 consist of:
(a) cases for which no more specific diagnosis can be made even after all the facts bearing on the case have been investigated; (b) signs or symptoms existing at the time of initial encounter that proved to be transient and whose causes could not be determined;
R10.9 Unspecified abdominal pain
Example: A patient is seen in a physician’s office with complaints of upper abdominal pain that has been present intermittently for several months. Findings at that time are non-specific and the patient is referred for further work up of the conditions including laboratory studies and abdominal x-rays. At the time the patient is seen, an “unspecified” code is appropriately used.
Majority of the patients consulting physicians present with symptoms for medical evaluation. If the physicians have only two diagnostic label options, i.e. 1st and 2nd Labels, then, the tendency is for the patients to be given the 1st Label (label with a name of a particular disease), as they present with symptoms for evaluation.
What will be the potential negative consequences in the absence of a 3rd Label option?
If majority of the aforementioned patients in reality have “non-specific” symptoms with no identifiable and no disease afterall, then they will be subjected to unnecessary anxiety associated with a given disease label. Furthermore, chances are, they will also be subjected to laboratory tests which most of the time will turn out to be negative.
My opinions and recommendations are:
Physicians and the patients should be made aware:
Of a possible 3rd diagnostic label after a medical consultation, one that contains the phrase “non-specific” symptoms or equivalent. The 3rd Label usually come in the following forms: non-specific neck pain; non-specific chest pain; non-specific right lower quadrant abdominal pain; non-specific back pain; non-specific dizziness; non-specific headache; etc. (depending on the symptoms).
Of the meaning of the 3rd diagnostic level when used. “Non-specific” symptom or symptoms are those presented by the patients in which after analysis of the data from the medical history and physical examination, the physician decides there is no identifiable underlying disease and there is high chance that there is no serious disease and the symptoms may resolve in due time.
That oftentimes, “non-specific” symptom or symptoms does not require diagnostic tests other than watchful monitoring.
That oftentimes, “non-specific” symptom or symptoms just requires allayment of fear and anxiety accompanied by conservative management such as prevention of potential and identified triggering factors; rest; proper diet; and non-pharmacological control measures for the symptoms with the use of drugs, only when needed.
ROJ@14jul9
Transient Non-specific Medical Conditions
https://rojosonmedicalclinic.wordpress.com/2017/03/19/transient-non-specific-medical-conditions/
In the practice of medicine, a physician will encounter two categories of medical conditions. One is the so-called transient non-specific medical condition and the other is the specific medical condition.
A transient non-specific medical condition is a phenomenon in which the patient feels ache or pain or anything in his body but which is transient lasting for a short period of time, spontaneously resolving and which does not indicate a specific disease entity. In contrast, a specific medical condition is a phenomenon in which there the patient feels something in his body and which is indicative of a specific disease entity.
The exact cause or mechanism of the symptom in a transient non-specific medical condition is not readily and exactly identified. It may be caused by mild hormonal, chemical, physical or temperature changes. It may be psychogenic. The symptom spontaneously disappears and no specific disease entity can be identified.
What to do with the transient non-specific medical conditions? Just monitor. Just do watchful waiting. If the symptom is persistent, increasing in intensity, and falling within known symptoms of a disease, shift and look for a diagnosis of a specific medical condition.
Physicians should be aware of the existence of such a category (transient non-specific medical condition) aside from that of specific medical condition. Otherwise, there will be tendency for medicalization. Medicalization is defined as the process of identifying or categorizing a condition as being a disorder requiring medical treatment or intervention and if fact, there is no requirement.
Recommended Reading:
http://ask.metafilter.com/241173/Aches-And-Pains-How-Often-How-Normal-What-is-it-to-be-human
Non-specific Pain – A Reflection Again
https://rojosonfacebooknotes.wordpress.com/2018/11/21/non-specific-pain-a-reflection-again/
NONSPECIFIC PAIN
18nov21 - this morning, I suddenly experienced mild to moderate sharp pain on my left hand. I was alarmed and asked myself - why and what caused this pain. I just waited and watched for what would follow. After 5 minutes, the pain subsided and eventually disappeared. It had not come back yet after 6 hours.
In my 69 years of life, I think I have experienced such sudden onset of pain in all parts of my body. After a stance of waiting and watching (wait and watch or observe and monitor or wait and see), the pain would just subside (some after a few seconds and few minutes, some after several hours and some after a few days) spontaneously without me taking any medicine, without me having to see a physician and have diagnostic tests done, and lastly, without me being able to identify the exact cause.
I think all persons have experienced such a phenomenon - sudden pain, spontaneously disappearing and without knowing the exact cause. This is a reality in life - a reality that we should be aware of and know what to do.
I have been looking for the medical term to use to diagnose such a phenomenon. I also have been looking for a scientific explanation for such a phenomenon. I am still searching up to now, particularly on the explanation.
For the moment, I use "nonspecific pain" or "transient nonspecific medical condition" as the medical term to use to diagnose such a phenomenon. There are reports on this term but it is not commonly used by physicians (majority of physicians are not aware of this - there is no emphasis in teaching on this phenomenon in medical school - thus, physicians usually look for specific cause and try to order a lot of diagnostic tests rather than rely on wait and watch.) As I said, there is no emphasis on the teaching of this phenomenon among physicians. There is no long treatise on this phenomenon if one searches the Net. There are scattered articles on "nonspecific chest pain;" "nonspecific low back pain;" "nonspecific neck pain;" "nonspecific abdominal pain;" etc. The general concept for this "nonspecific pain" is that there is a pain not attributable to a recognizable, known specific pathology and the pain usually regresses spontaneously.
As to the explanation, for the moment, I use "nerve irritation" for those experiencing nonspecific skin and soft tissue pain;
"strain" for those experiencing nonspecific muscular pain; and other terms that I would coin (as mentioned, I am still searching for a more scientific explanation) to connote there is most probably no serious conditions going on and the pain could be managed by wait and watch.
I have written on this topic in the past -
Diagnosis, Clinical Diagnosis, and Diagnostic Labels (with Focus on “Non-specific” Labels)
Transient Non-specific Medical Conditions
https://rojosonmedicalclinic.wordpress.com/2017/03/19/transient-non-specific-medical-conditions/
I hope to be able to expound on this phenomenon in the future with further research.
For the moment, I hope all physicians would pick this up (recognize this phenomenon, adopt or consider a wait and watch stance initially rather than order for a diagnostic test right away; etc.).
For the moment also, I hope all persons (potential patients) would also pick this up and recognize this phenomenon and know what to do and what to expect when physicians tell them they have nonspecific pain. Note: all persons should learn how to closely monitor their pain so that they know when it is time to seek medical consult already.
I will include this infosharing and advocacy on transient nonspecific medical condition as one of my legacies.
ROJ@18nov21