Treatment for persistent body symptoms

Good treatment for persistent body symptoms looks at the whole person. It aims to help you do more and feel more in control, and it can ease the symptoms themselves. Being offered therapy or exercise does not mean your doctor thinks your symptoms are imagined. It means these treatments work on real processes in the body and brain.

This page explains the main options, how well they work and what to expect. The badges show how strong the research is (see how we rate evidence).

Options at a glance

Good care starts with a steady relationship

A review written for family doctors describes a set of basic steps for people with persistent body symptoms:¹

• Regular, short visits on a schedule, so you do not need a new symptom or an emergency to be seen
• Listening and accepting that what you feel is real
• Explaining the mind–body connection rather than saying "there is nothing medically wrong with you"
• Limiting tests and specialist referrals to those likely to help, after a proper check for other medical and mental health conditions
• Setting goals around daily function, such as walking farther or returning to a hobby, rather than only around cure
• Working with mental health professionals when needed

A Cochrane review looked at six studies in which family doctors, with 1,787 patients in all, were trained to give this kind of enhanced care. The studies differed too much to combine. The authors concluded that enhanced care may help, and that more intensive programs may work better than very brief ones. Effects on mental health were unclear.³

Cognitive behavioral therapy (CBT)

CBT is a structured talk therapy that looks at the links between symptoms, thoughts, attention, feelings and daily habits. For body symptoms, CBT does not try to argue you out of your symptoms. It may help you:

• Understand how stress, sleep, attention and activity affect your symptoms
• Cut back on checking, searching and reassurance-seeking
• Build activity back up in a steady, paced way
• Handle worried thoughts about what symptoms mean
• Return to things that matter to you, even with some symptoms

How well does it work? A Cochrane review included 21 trials of talking therapies with 2,658 adults. Fourteen tested CBT. CBT reduced the severity of body symptoms more than usual care or a waiting list. The effect was small, and it differed a lot between studies, but it lasted through a year of follow-up.⁴ CBT did not work better than enhanced care from a well-trained family doctor. The evidence was of low to moderate quality, and the trials only included people who were willing to try therapy.⁴

Guidelines also support CBT for specific conditions. U.K. guidelines suggest CBT or acceptance and commitment therapy (ACT) for chronic primary pain.⁵ Guidelines for irritable bowel syndrome (IBS) recommend CBT or gut-directed hypnotherapy, though the evidence is of low quality.⁶ For fibromyalgia, CBT received a weaker recommendation than exercise.⁷

CBT usually means weekly sessions for several weeks to a few months, in person, by video or in a group. In the Cochrane trials, the number of sessions ranged from 1 to 13.⁴ See CBT and ACT.

Physical therapy for functional neurological disorder

Physical therapy and talk therapy are the two main treatments for FND, ideally given by a team that works together.² Specialist physical therapy aims to help people retrain movement and get back to daily activities.

In a large U.K. trial, 355 adults with functional movement problems were assigned to either a specialist nine-session physical therapy program or a referral to regular community neurological physical therapy. After a year, the main measure of physical function did not differ between the groups. More people in the specialist group said their movement symptoms had improved, and they reported better mental health. Both approaches were safe and valued by patients.⁸

CBT for functional seizures. A trial of 368 adults with functional (dissociative) seizures compared CBT plus specialist medical care with specialist medical care alone. After a year, seizure frequency was not clearly lower with CBT. But people who had CBT found their seizures less bothersome, had longer seizure-free stretches, reported better quality of life and less distress, and had fewer body symptoms overall.⁹

These trials show that FND treatment helps some people, while research continues on who benefits most.^8,9

Exercise therapy

For fibromyalgia, European guidelines gave aerobic or strengthening exercise a "strong" recommendation, the only treatment to receive one.⁷ U.K. guidelines advise a supervised group exercise program for people with chronic primary pain, and staying active over the long term.⁵ Exercise is also advised for everyone with IBS.⁶ A physical therapist can help you start at the right level. See Self-help for body symptoms and Exercise for mood.

ME/CFS needs a different approach to activity. See Functional disorders.

Antidepressants for some conditions

Some antidepressants are used for pain and bowel symptoms, not only for mood. U.K. guidelines say that, for chronic primary pain, certain antidepressants may help quality of life, pain, sleep and distress even in people who are not depressed.⁵

What the evidence shows:

• IBS. Low-dose tricyclic antidepressants, an older group of antidepressants, are a recommended second-line treatment, backed by moderate-quality evidence.⁶ In a U.K. trial of 463 adults whose IBS had not improved with first treatments, low-dose amitriptyline for 6 months improved IBS symptoms more than a placebo pill, and more people reported relief. The average difference was smaller than the researchers had set as clearly noticeable. Slightly more people stopped because of side effects (13% vs. 9%), though most side effects were mild.¹⁰
• Fibromyalgia. European guidelines give a weak recommendation for low-dose amitriptyline, duloxetine and milnacipran. They give a weak recommendation against SSRIs, another common type of antidepressant, for this condition.⁷
• Somatic symptom disorder and other persistent symptoms. A Cochrane review of 26 short trials found very low-quality evidence that newer antidepressants reduce symptoms. Side effects led many people to stop. The trials lasted 12 weeks at most.¹¹

Side effects can feel like new body symptoms, which matters when symptoms are already a concern.¹¹ Your doctor usually starts with a low dose and goes slowly. Do not start, stop or change a medicine on your own. Talk with your doctor or pharmacist before changing anything. See Antidepressant medicines.

Medicines that usually do not help. For chronic primary pain, U.K. guidelines advise doctors not to start opioids, gabapentin-type medicines, benzodiazepines, anti-inflammatory painkillers or acetaminophen, because evidence of benefit is lacking.⁵ If you already take one, ask your doctor to review it with you. Stopping some of these suddenly can be harmful.

Treating depression and anxiety alongside body symptoms

Depression and anxiety often come with persistent body symptoms, and treating them is part of good care. A U.S. trial tested a stepped program in 250 primary care patients with long-term back, hip or knee pain and depression. People first had 12 weeks of carefully adjusted antidepressant treatment, then a 6-session pain self-management program. A nurse care manager, supervised by a depression specialist, guided the treatment and kept in touch, mostly by phone.¹²

After a year, about 37% of people in the program had their depression cut by at least half, compared with about 17% with usual care. About 42% had a meaningful drop in pain, compared with about 17%.¹² This team approach is often called collaborative care. It is also stepped care, because treatments are added in planned steps. See Treatment for depression and Anxiety treatment.

What to expect

• Progress is gradual. Most people notice change over weeks to months, not days.
• Goals focus on life, not just symptoms. Your care team may ask what you want to get back to doing.
• Flare-ups happen. A setback does not mean treatment has failed. A plan for flares helps.
• More than one approach is common. Many people combine exercise, therapy and, when needed, medicine.
• Your doctor keeps watching your body. New or changing symptoms are still checked.

How to find care

Start with your primary care doctor. Ask about:

• A psychologist or counselor with experience in chronic pain or persistent physical symptoms
• A pain management program that combines physical and psychological care
• A physical therapist, and for FND, a neurologist and a neurological physical therapist
• A gastroenterologist or dietitian for IBS

See How to find a therapist, Paying for therapy and our therapy finder.

Common questions

My doctor suggested therapy. Does that mean they think it is all in my head?

No. Therapy works on real links between the brain, nervous system and body, such as attention, stress and sleep. It is offered for many physical conditions, including chronic pain and IBS.^5,6

Why would I take an antidepressant if I am not depressed?

Some antidepressants are used for pain and bowel symptoms, not only for mood. For long-term pain with no clear cause, they may help pain and sleep even in people without depression.⁵

How long will treatment take?

It varies. In trials, CBT ranged from a single session to several months.⁴ Exercise and pacing are long-term habits. In the IBS trial above, people took the medicine for 6 months.¹⁰

When to get help now

New, severe or sudden symptoms need medical care, even during treatment. Call 911 for chest pain, trouble breathing, fainting or signs of stroke. See Getting checked. If you feel hopeless or have thoughts of suicide, call or text 988 any time.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.