Anges in their health that spanned physical, psychological, and social dimensions. These were largely positive and included a rise in physical andor mental power, as well as feelings of greater personal handle, calmness, and relaxation. 3 interviewees reported worsening health but did not ascribe this to acupuncture. Lots of patients who had been treated with fiveelement acupuncture perceived a variety of good effects and appeared to take on a extra active part in consultations and self-care.Design and style and settingacupuncture therapy; frequent attenders; patient participation; key care; qualitative investigation; unexplained symptoms.Conclusion KeywordsINTRODUCTION The higher incidence and expense of caring for people today with medically unexplained physical symptoms (MUPS) is well documented,1 as could be the connected distress experienced by each patients6 and GPs.102 Sufferers with MUPS are generally `frequent attenders’ in main care4 and analyses of audiotaped consultations illustrate how tricky it really is for GPs to provide acceptable explanations and to engage with psychosocial cues.two,10,13 Sufferers with MUPS generally — but not always — have symptoms of anxiety and depression: so-called `somatisation’.9,14,15 Investigation has shown that, while quite a few patient-focused psychological and behavioural interventions are potentially powerful for individuals with somatisation problems, they’re often unacceptable to these individuals.169 Other interventions have PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/21330930 focused on the medical doctor atient communication in every day consultations, and Morriss et al demonstrated that GP training inside the use of their `reattribution model’ is effective, but of restricted acceptability to GPs.202 Other effective treatment alternatives for patients with MUPS contain structured exercise23 and intensive nurse-led or multidisciplinary therapy programmes,24,14 but such programmes usually are not extensively out there. Testimonials of this range of interventions have identified some frequent variables that appear to become related with profitable management.25,26 These consist of:S Rugg, MSc, PhD, DipCOT, study fellow; C Paterson, PhD, MRCGP, senior analysis fellow; N Britten, PhD, FRCGP (Hon), professor of applied overall health care, Institute of Wellness Service Study, University of Exeter, Exeter. J Bridges, PhD, MSN BNurs(Hons), RN, senior research fellow, School of Community and Health Sciences, City University, London. P Griffiths, PhD, RN, professor of overall health solutions investigation, College of Health Science, University of Southampton, Southampton, on behalf with the CACTUS study team. Address for correspondence Dr Charlotte Paterson, Institute of Health Service15 September 2010; final acceptance: 23 September 2010.Submitted: 5 July 2010; Editor’s response:Research, Peninsula Healthcare School, University of Exeter, Veysey Creating, Salmon Pool Lane, Exeter EX2 4SG. �British Journal of Common Practice This really is the full-length article (GSK1278863 site published on the internet 31 Might 2011) of an abridged version published in print. Cite this article as: Br J Gen Pract 2011; DOI: 10.3399bjgp11X577972. E-mail: charlotte.patersonpms.ac.uknegotiating therapy.making links (explanatory models that hyperlink physical and psychological challenges); andbroadening the agenda;A primary-care-based evaluation identified the following practitioner expertise as essential: helping the patient to really feel understood;In the existing context of pressurised general-practice consultations, it is actually evident that there remains a considerable gap in practical and efficient treatment options, especiall.