Correspondence (letter to the editor): In Reply

We thank Dr. Brinkers for his comment on our abridged version of the S3 guideline (1). He emphasizes the need to think in terms of diagnosis and therapy of functional body symptoms in systemic contexts. In fact, a conception of disturbed “function chains”, which can also be understood by patients, can well illustrate the interplay of different localizations and influencing factors in the context of a non-dualistic explanatory model.

The choice of the term “functional” is not explained in this (deliberately succinct) abridged version but is explained in the full guideline version (2): “[…] is preferred by those affected, describes a particularly wide spectrum of symptoms and severity (also those that are of no medical significance) and best reflects international usage. As a positive term, it also allows practitioners and patients—similar to the term bodily distress—to have a helpful pathogenetic understanding, namely that in functional body disorders, it is not the structure but rather the function of organs that is affected (including in the musculoskeletal system)”. Further on, organ systems, the need for a balanced biopsychosocial approach, and the implications of vicious cycles in complex psycho-physiological contexts are discussed. It is especially typical in the musculoskeletal system that symptoms are amplified by transmission through muscle and tendon structures, bad or relieving posture, fear of movement, and tension/loss of muscle tone. The long version of the guideline points to the current evidence for the effectiveness of manual techniques in various functional syndromes (craniomandibular dysfunction, irritable bowel syndrome, tension-type headache).