Approaches to management

• Recognition - early recognition of the importance of psychological factors can save time and avoid unnecessary investigations and treatments

• Engagement - good management should facilitate the acceptance of appropriate treatment

• Rational approach to treatment - investigations and interventions should have clear indications and not be pursued indefinitely

• Appropriate communication - communication should be clear, honest and should address psychosocial factors to the extent that the patient will tolerate

• Appropriate attribution of aetiology - "facultative somatisers" may benefit from a "reattribution approach" which reformulates their distress in psychosocial terms

• Symptomatic psychological treatment - other patients may accept a "psychotherapeutic approach" to alleviate the psychological distress caused by their physical symptoms

• Palliative and supportive interventions - "chronic somatisers" may accept a "directive approach" involving a rehabilitation program or help in coping with disability

• Treatment of psychiatric illness - underlying or concomitant psychiatric illness should be treated appropriately

• Empirical treatment - some patients without manifest psychosocial distress improve with psychotropic medication