Functional neurological disorder is common in patients attending chronic pain clinics 2023 Mason, McWhirter, Carson, Stone et al

Andy

Andy

Retired committee member
Background

Chronic pain is a common comorbidity in those with functional neurological disorder (FND), however the prevalence and characteristics of FND in those with chronic pain is unknown.

Methods
A retrospective electronic records review of consecutive new patients attending a chronic pain clinic of a regional service. Clinical features, medication and outcome of chronic pain, any lifetime diagnoses of functional, FND and psychiatric disorders and undiagnosed neurological symptoms were recorded.

Results
Of 190 patients attending the chronic pain clinic, 32 (17%) had a lifetime diagnosis of FND and an additional 11 (6%) had undiagnosed neurological symptoms. Pain patients with comorbid FND were more likely to have chronic primary pain (88% with FND, 44% without FND, p < 0.0001), widespread chronic primary pain (53%, 15%, p < 0.00001) and depression (84%, 52%, p < 0.005) and less likely to have a pain-precipitating event (19% vs 56%, p < 0.001). However, there was no significant difference between these patients in opiate prescription, benzodiazepine prescription or pain outcome.

Conclusions
This first study of FND in a chronic pain patient population found a remarkably high prevalence of FND (17%) and is possibly an underestimate. The size of the overlap indicates that FND and chronic pain research fields are likely to have a lot to learn from each other.

Paywall, https://onlinelibrary.wiley.com/doi/10.1111/ene.15892
 
They're probably using an extremely vague definition of FND to reach that conclusion, just like how BPS researchers use extremely vague definitions of ME. Real FND requires very careful evaluation. Their definition is probably "we found the most ableist neurologist we could, and he opined 1/6 of people with chronic pain had FND."
 
At least one FND had been diagnosed in 32 (17%) patients. The most common FND diagnoses were functional limb weakness (8%), functional sensory disorder (8%), dissociative seizures (6%), functional cognitive disorder (5%), and functional movement disorder (4%).
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Of the 32 patients with FND and chronic pain, 19 (59%) developed chronic pain before their first FND symptom, 6 (19%) developed their first FND symptom before chronic pain and 7 (22%) developed chronic pain and their first FND symptom in the same month. The median time elapsing between the onset of chronic pain and the onset of FND was 61 months (range 3-263). The median time elapsing between the onset of FND and chronic pain was 51.5 months (range 2-324).
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The median time elapsing between the onset of chronic pain and the onset of FND was 5 years (range 0-22 years).
The median time elapsing between the onset of FND and chronic pain was 4 years (range 0-27 years).
 
Chronic pain clinics are designed to manage people with chronic pain for which no cause can be found - i.e., in Stone's terminology functional pain.

Pain is neurological.

So ALL the patients should have this 'functional neurological disorder'. Why could they only find 17%? Seems they aren't that hot at making a diagnosis.

Looked at another way, since we should expect MUCH higher rates of FND in these clinics than in routine clinics doesn't this suggest that figures banded about for routine clinics are a bit exaggerated? @dave30th
 
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