REFERENCE · CO-OCCURRING CONDITION
Persistent Pain Alongside FND
This page covers: Persistent pain, with emphasis on chronic primary pain and altered pain processing.
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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For the Person With FND
Understanding pain that continues
Persistent pain can remain after an injury has healed or occur without a single injury explaining its extent. Chronic primary pain is a clinical category in which pain itself is a major health problem and is not better accounted for by another condition. Nociplastic pain describes altered pain processing when tissue damage or a lesion of the sensory nervous system does not adequately explain the pain. These terms overlap, but are not interchangeable; several pain mechanisms can coexist. [1][2]
The shared principle with FND is that nervous-system function matters. Pain may become more responsive to ordinary sensations, and attention, expectations, sleep and bodily state can influence its impact without making it voluntary. This does not mean pain is simply fear, or that all pain in someone with FND is nociplastic. [1][2][3]
Pain may interrupt movement and sleep, while the effort of coping with several symptoms can make activity harder to sustain. Pain is common in FND studies, and it may persist even when motor symptoms improve. It therefore deserves its own treatment goals rather than being left until FND has recovered. [3]
Recovery and management options
- A shared explanation and meaningful goals: discuss the likely pain mechanisms and choose a practical target, such as sitting through a meal or returning to an enjoyable task. Comfort, access and quality of life count alongside pain reduction. [2] [Guideline-based practice]
- Individually adapted movement: supervised exercise or physical activity can help chronic primary pain. Start with what is manageable and adapt to disability and other conditions; this is not an instruction to push through every worsening. [2] [Research-supported guideline recommendation]
- Activity planning and occupational therapy: divide demanding tasks, alternate types of activity and use equipment or assistance where useful. For someone with FND, coordinate this with movement retraining so the two plans do not compete. [4] [FND clinical consensus; component efficacy uncertain]
- Pain-focused CBT or acceptance and commitment therapy: CBT explores patterns that add to pain-related distress and disability. ACT helps people make room for difficult sensations while taking workable steps toward what matters. Neither requires believing the pain is unreal. [2] [Research-supported guideline recommendation]
- Selected medicines: a clinician may consider certain antidepressants for chronic primary pain even without depression, discussing possible benefits for pain, sleep and quality of life. This is a pain-treatment use, not a judgement about the cause. Do not start or stop existing pain medicines from this page. [2] [Guideline-based practice]
- Acupuncture in appropriate services: a limited course is an option in chronic primary pain guidance. Review whether it produces a useful benefit for the person rather than assuming repeated treatment is always needed. [2] [Guideline-based practice]
During a familiar flare: adjust the load, use the agreed relief plan and keep necessary support available. New injury, new neurological loss or substantially changed pain needs reassessment; an established pain diagnosis should not block it. [2]
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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For Family, Friends, and Other Supporters
Help make the chosen activity possible—perhaps by carrying something or providing a seat. Do not turn help, mobility aids or pain relief into rewards for progress. A day with more participation can still involve considerable pain.
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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For Clinicians and the Care Team
Formulate nociceptive, neuropathic and nociplastic contributions rather than inferring mechanism from normal imaging. Keep pain and FND outcomes separate. NG193 recommendations concern chronic primary pain; apply condition-specific guidance to secondary pain and review existing medicines collaboratively rather than abruptly withdrawing them. [1][2][3]
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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Research and Sources
Evidence reviewed: September 23, 2026. The FND pain review establishes substantial burden and limited treatment evidence. Chronic primary pain interventions are adjacent evidence, not proof of benefit for every FND-associated pain presentation.
Technique labels describe the evidence for the named condition. A treatment working does not confirm an FND diagnosis or prove a shared mechanism.
| No. | Source and stable record | What it supports and limits | Figure |
|---|---|---|---|
| 1 | International Association for the Study of Pain. Terminology: nociplastic pain. Definitions. Accessed September 23, 2026. FND-CIT-0203 | Terminology and pain-mechanism distinctions; not a diagnostic test or intervention study. | — |
| 2 | National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NG193. Recommendations. Accessed September 23, 2026. FND-CIT-0204 | Chronic primary pain guideline; recommendations must not be generalized to every pain cause or to FND efficacy. | — |
| 3 | Steinruecke M, Mason I, Keen M, McWhirter L, Carson AJ, Stone J, Hoeritzauer I. Pain and functional neurological disorder: a systematic review and meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry. 2024;95(9):874–885. https://doi.org/10.1136/jnnp-2023-332810 FND-CIT-0015 | FND pain systematic review; co-occurrence and treatment burden, not proof of common causation. | — |
| 4 | Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. Journal of Neurology, Neurosurgery & Psychiatry. 2020;91(10):1037–1045. https://doi.org/10.1136/jnnp-2019-322281 FND-CIT-0011 | Occupational therapy consensus for FND; practical adaptation, not proof of a specific component effect. | — |
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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