In clinic we often see people living with pain, chronic fatigue, digestive discomfort, dizziness, light-headedness, chest tightness, headaches or neurological symptoms that have been present for months, sometimes for years.

They have had tests. They have seen different doctors, gathered opinions and assessments, and serious illness has been ruled out. The treatment is the right one. And yet the symptoms continue.

Medicine today calls this persistent somatic symptoms: real physical complaints, present on most days over several months, that cause distress and affect quality of life, whatever their cause (Burton et al., 2024).

An important point: this does not mean "there is nothing wrong" or that "it is all in your head". It means the process has become more complex.

Which symptoms can become persistent?

Almost any of them:

  • Fatigue that does not improve with rest
  • Continuous low back or neck pain
  • Recurrent headaches
  • Digestive symptoms such as bloating, diarrhea or urgency
  • Chest tightness or palpitations
  • Dizziness or light-headedness
  • Widespread muscle pain

What matters is not only the symptom itself but how long it lasts, the effect it has and the suffering that goes with it (Burton et al., 2024).

Why do they persist when there is no active disease?

This is where contemporary medicine has moved forward. Current evidence shows that persistent symptoms are explained neither by organ damage alone nor by psychological factors alone. They are the result of a complex interaction between body, brain and context (Burton et al., 2024).

The factors involved include:

Biological:

  • Persistent low-grade inflammation
  • Immune changes
  • Changes in the microbiota
  • Altered regulation of the autonomic nervous system
  • Central sensitization

Cognitive and emotional:

  • Negative expectations about the body
  • Excessive focus on bodily sensations
  • Catastrophic interpretations
  • Health-related anxiety

Behavioral:

  • Avoidance of physical activity
  • A gradual reduction in what the person can do
  • Constant monitoring of symptoms

Over time, the brain can learn to anticipate the symptom. When that expectation becomes strong enough, the nervous system begins to generate the physical experience even in the absence of significant active damage.

This is not imagination. It is the neurobiology of learning and perception (Burton et al., 2024).

The role of the brain: when the signal is amplified

We now know that the brain does not simply receive signals from the body. It constantly predicts what it expects to feel. When someone has been through repeated episodes of pain, whether physical or emotional, or of inflammation or crisis, the nervous system can become hypersensitive. It is as though the internal volume has been turned up too high.

The result:

  • More perceived intensity
  • More interference with daily function
  • More fear
  • More attention paid to the symptom

And so a cycle forms that keeps the problem going.

The most important point: the symptom is real

One of the deepest wounds these patients carry is the stigma.

"Your tests are normal." "It doesn't look like anything serious." "Try to relax."

The absence of visible structural damage does not invalidate the experience (Burton et al., 2024).

The suffering is real. The disability is real. The physiology involved is real.

The answer is not to deny the symptom. It is to validate it and to understand the mechanism keeping it in place.

So what can be done?

Modern management works on three levels (Burton et al., 2024):

  • Treat disease where it exists. Active organic pathology must always be ruled out and treated.
  • Offer an integrative explanation. A clear biopsychosocial model reduces anxiety and improves the outlook.
  • Use targeted interventions. The evidence shows that structured psychological interventions, including cognitive behavioral therapy and integrative models, can reduce both intensity and disability.

In specific cases, certain medications can help where anxiety or depression is also present.

The most powerful gains come from recovering:

  • Confidence in the body
  • Movement, built up gradually
  • Emotional regulation
  • Realistic expectations

A different way of understanding the symptom

Persistent somatic symptoms are not weakness, they are not invention and they are not a failure of treatment. They are what happens when a system tries to protect itself and stays on permanent alert.

At Centro IDENTA we believe integration is the way forward: internal medicine, neuropsychology and evidence-based psychotherapy together (the IDENTA Model, IBI-IDENTA v0.1).

Once we understand the whole process, we can stop fighting the body and start reorganizing it.

References

Burton, C., & Fink, P. (2023). Persistent physical symptoms: Pathophysiology and management. The Lancet, 401(10380), 1103–1115.

Written by Dr. Alejandro Luque Hernández