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Understanding Functional Neurological Disorder
Functional Neurological Disorder (FND) is most commonly associated with symptoms such as seizures, tremor, limb weakness, movement problems, or speech difficulties. But for many people living with FND, another symptom may be just as significant — chronic pain.
Recent research published in the European Journal of Pain suggests that pain may actually be the most common symptom experienced by people with FND, even though it is not currently included in the core diagnostic criteria for the condition. The study, titled “Characterisation of Chronic Pain Syndrome in Patients with Functional Neurological Disorder,” examined a group of 63 patients diagnosed with FND. Remarkably, 86% of those patients reported chronic pain.
You can read more about FND in the Neurosymptoms.org guide to Functional Neurological Disorder, an internationally recognised patient information resource.
Chronic pain in FND: What the research found
For many clinicians and patients alike, that finding may not be surprising. People with FND frequently describe widespread pain that affects multiple parts of the body and significantly interferes with daily life.
In the study, the average pain intensity was rated at around 5–6 out of 10 — moderate pain, but enough to disrupt activity, mobility, sleep, and quality of life.
Interestingly, pain was often not confined to a single body area. In most patients, it affected several regions at once, and in some cases, it was widespread across the body. Many participants also reported that their pain began around the time of a physical or psychological trauma, with 41% linking the onset of pain to such an event.
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Why pain in FND may be overlooked
One reason is that pain in FND may be underestimated or overlooked during diagnosis and treatment.
FND is typically identified by neurological symptoms such as non-epileptic seizures, abnormal movements, or sensory disturbances. Because chronic pain is not part of the formal diagnostic criteria, it can sometimes be treated as a separate issue — or not addressed fully at all.
However, the study’s authors suggest this separation may not reflect patients’ real experiences. For many people with FND, pain is deeply intertwined with other symptoms and can have a major impact on mobility, mood, and daily functioning.
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The complex nature of pain in FND
Researchers also found that the nature of pain in FND is complex. It often does not fit neatly into traditional categories of pain, such as nociceptive pain (caused by tissue damage) or neuropathic pain (caused by nerve injury).
Instead, it may involve multiple mechanisms, including processes related to how the brain processes and amplifies pain signals. This helps explain why chronic pain in FND can feel very real and disabling, even when conventional medical tests do not identify clear structural damage.
Treating FND and chronic pain together
This complexity may help explain why treatment can be challenging. No single therapy works for everyone, and pain relief rates in the study were relatively modest overall. Nevertheless, the findings reinforce the importance of a multidisciplinary approach to treatment.
Many specialists now recommend a biopsychosocial approach, which means addressing the biological, psychological, and social factors that contribute to symptoms. For patients with both FND and chronic pain, treatment may include a combination of neurological care, pain management, physiotherapy, psychological therapies, and rehabilitation strategies tailored to the individual.
A key message for patients and clinicians
The key message from this research is simple but important: pain in FND is real, common, and potentially disabling. Recognising and treating it properly may be essential to improving outcomes for many patients.
As understanding of FND continues to evolve, studies like this highlight the need for clinicians to look beyond the most visible neurological symptoms and consider the full range of difficulties patients experience — including chronic pain.