EURONET-SOMA

The European Research Network to Improve Diagnosis, Treatment and Health Care for Patients with Persistent Somatic Symptoms (EURONET-SOMA) is a research collaborative that aims to address the needs of patients with somatic unexplained symptoms. EURONET-SOMA was created in 2016 during two meetings with 29 researchers at Hamburg. The meetings were organized by Bernd Löwe and funded by the Ministry of Science and Research of Hamburg. Other prominent members include Per Fink, Chris Burton, Francis Creed, Peter Henningsen, Omer van den Bergh and Judith Rosmalen.

According to EURONET-SOMA different concepts of persistent somatic symptoms (PPS) across medical specialties, clinical psychology and in psychosomatic medicine impede early diagnosis and treatment in this patient population. One of the major objectives of the group is to define a commonly accepted definition and conceptualization of PPS and to develop new and effective treatments.

Annual meetings
EURONET-SOMA meets twice a year: a brief meeting takes place during the annual conference of the European Association of Psychosomatic Medicine (EAPM), which is open to all attendees of the EAPM conference. The second, more extensive meeting takes place in autumn in one of the EURONET-SOMA member institutions and is by invitation only.

Delphi Study on Somatic Symptom Disorders
From 2016 to 2017 EURONET-SOMA organized a large Delphi study involving 75 experts to determine the research needs for patients suffering from Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD). A research agenda with the following priorities was agreed on: "(1) Assessment of diagnostic profiles relevant to course and treatment outcome.""(2) Development and evaluation of new, effective interventions.""(3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in the context of SSD, BDD, and FD.""(4) Research into patients preferences for diagnosis and treatment of Somatic Symptom Disorders and related disorders (SSRD).""(5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes.""(6) Translational research exploring how psychological and somatic symptoms develop from somatic conditions and biological and behavioral pathogenic factors. Such translational research is needed to improve knowledge that may be helpful to develop conceptual models and classification further.""(7) Development of new, effective interventions to personalize treatment.""(8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital and specialty mental health settings. Such research should explore how interventions can best be implemented in the various health care settings and health services systems all over Europe."

The need for a consistent diagnosis
During the fourth EURONET-SOMA meeting in Riga, Latvia in October 2017 it was concluded that patients with persistent somatic symptoms (PPS) are diagnosed and treated differently in European countries. The same patient description resulted in a diagnosis somatoform disorder in Belgium, functional disorder in Denmark and Germany and medically unexplained symptoms (MUS) in the UK or the Netherlands. The experts identified three key challenges in the care for patients with PPS:"(1) Defining a clinically useful, acceptable, and non-stigmatizing diagnostic term.""(2) Implementing guideline recommendations into routine care.""(3) Developing effective dissemination strategies."

Perceptual dysregulation
In 2018 Henningson et al. published a neuropsychobehavioral model of Persistent physical symptoms as perceptual dysregulation on behalf of EURONET-SOMA. The model assumes that the brain makes prediction errors in interpreting sensory information and that PPS can be understood as "failures of inference." In this model peripheral physiological dysfunction is neither necessary nor sufficient for bodily symptoms to be experienced, meaning that “disabling bodily symptoms can develop out of “normal” bodily complaints.”

EURONET-SOMA summer school
In July 2019 a EURONET-SOMA summer school was organized in Allersmaborg near Groningen. This included an educational program on diagnostics and conceptualization of PPS where young researchers could learn from more established experts in the field. The content also focused on challenges in communicating with patients and treatment approaches both in primary care and in specialized settings.

Publications

 * Weigel, A., Hüsing, P., Kohlmann, S., Lehmann, M., Shedden-Mora, M., Toussaint, A., & Löwe, B. (2017). A European research network to improve diagnosis, treatment and care for patients with persistent somatic symptoms: Work report of the EURONET-SOMA conference series. Journal of psychosomatic research, 97, 136-138.
 * Rief, W., Burton, C., Frostholm, L., Henningsen, P., Kleinstauber, M., Kop, W. J., Löwe, B., Martin, A., Malt, U., Rosmalen, J., Schröder, A., Shedden-Mora, M., Toussaint, A., van der Feltz-Cornelis, C., on behalf of the Euronet-Soma Group (2017). Core Outcome Domains for Clinical Trials on Somatic Symptom Disorder, Bodily Distress Disorder, and Functional Somatic Syndromes: European Network on Somatic Symptom Disorders Recommendations. Psychosomatic Medicine, 79(9), 1008-1015.
 * van der Feltz-Cornelis, C.M., Elfeddali, I., Werneke, U., Malt, U. F., Van den Bergh, O., Schaefert, R., Kop, W., Lobo, A., Sharpe, M., Söllner, W.,  & Löwe, B. (2018). A European Research Agenda for Somatic Symptom Disorders, Bodily Distress Disorders, and Functional Disorders: Results of an Estimate-Talk-Estimate Delphi Expert Study.Frontiers Psychiatry, 9:151.
 * Kohlmann, S., Löwe, B. Shedden-Mora, M. & on behalf of the EURONET-SOMA group (2018). Health Care for Persistent Somatic Symptoms Across Europe: A Qualitative Evaluation of the EURONET-SOMA Expert Discussion.Frontiers Psychiatry, 9:646.
 * Henningsen, P., Gundel, H., Kop, W. J., Löwe, B., Martin, A., Rief, W., Rosmalen, J., Schröder, A., van der Feltz-Cornelis, C.,  Van den Bergh, O. & on behalf of the EURONET-SOMA group  (2018). Persistent Physical Symptoms as Perceptual Dysregulation: A Neuropsychobehavioral Model and Its Clinical Implications. Psychosomatic Medecine 80(5), 422-431.