• Any given pathological lesion produces somatic symptoms whose Intensity varies widely among different patients, and In the same patient at different times. There is clinical and experimental evidence that a patient's level of symptomatic distress is amplified by four factors as follows: the thoughts he has about his symptom, the degree to which he pays attention to it, his mood, and the situational context. These factors can be used therapeutically in maximizing palliation and symptomatic relief for patients with chronic medical diseases. Discussing the causes of the patient's symptoms can be helpful, as can strategies to maximize distraction and focus the patient's attention away from his body. Aggressive treatment of anxiety and depression is indicated in chronically symptomatic patients, and behavioral interventions to alter the family's response to the patient's symptoms can also be palliative.
(Arch Intern Med 1986;146:905-909)