FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Coexisting Pain, Migraine and Medical Review

Most likely fit: Burning, pain, spreading numbness or sensory overload may have more than one contributor, or a changed pattern needs reassessment. [Clinical assessment and coordinated-care consensus; treatment follows the condition identified]

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For the Person With FND

What this approach is for

A person can have functional sensory symptoms and another condition at the same time. Treating migraine, a skin problem or nerve compression may improve comfort and access to rehabilitation even if some functional symptoms continue.

The purpose of review is a useful explanation and plan. Neither assuming everything is FND nor repeating every test indefinitely is an adequate substitute for a focused assessment.

Terms in everyday language

A peripheral nerve carries information between the body and spinal cord. Neuropathy means a disorder of these nerves. A nerve root is where nerves connect with the spinal cord. Migraine aura can include sensory symptoms, but a new sudden neurological change should not be self-labelled as aura.

A practical example and flare adaptations

Bring a short description of where the sensation occurs, when it started, what changed and what activity it prevents. Mention rash, injury, colour change, new medicines and symptoms that accompany it. A simple written note may be easier than a detailed diary.

Ask who is responsible for each part of treatment and when the plan will be reviewed. Medication changes belong with the prescriber. During a familiar flare, use the agreed plan; new or markedly different symptoms need a fresh decision.

These are choices to discuss with your care team, not a required exercise schedule. Helpful activity, comfort and access matter even when sensation remains altered. The evidence and its limits are explained below. (Sources: 1, 2)

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Family, Friends, and Other Supporters

Help prepare the brief history if wanted, including what is new compared with the established pattern. Avoid speaking over the person or attributing every problem to stress.

Support access to examination and follow-up. If an urgent change occurs, communicate both the existing FND diagnosis and the new features; one does not cancel the other.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Clinicians and the Care Team

Selection and assessment

Map sensory modality and distribution and assess the relevant neurological, dermatological, musculoskeletal and vascular findings. Positive functional evidence must be interpreted within the whole examination; traditional sensory splitting signs have limitations. Consider overlapping migraine, neuropathy, radiculopathy and pain syndromes according to the findings.

Explicit procedure

  1. Establish the previous assessed pattern and the exact new or unresolved feature.
  2. Triage urgent neurological, spinal, vascular or infectious possibilities before rehabilitation.
  3. Perform a focused examination and select investigations or referral from the clinical findings.
  4. Explain which findings support FND, which remain uncertain and which belong to a coexisting condition.
  5. Coordinate condition-specific treatment with OT or physiotherapy and review medication burden when relevant.
  6. Provide written follow-up and escalation instructions with a named care contact where possible.

Review, progression and stopping

Seek emergency help for sudden one-sided numbness or weakness with facial or speech change, or another possible stroke presentation. New saddle numbness with bladder or bowel dysfunction, a suddenly cold or discoloured limb, or rapidly worsening neurological symptoms also need urgent assessment. A familiar label must not delay care for these changes.

The procedures are educational implementation examples requiring clinical adaptation, not validated standalone protocols. (Sources: 1, 2)

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

Research and Sources

OT consensus supports care for overlapping problems. The 2026 sensory-sign case-control study addresses diagnostic limitations; it does not evaluate this care pathway or prove that an individual symptom has a functional cause.

Citation Full citation
[1] Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. JNNP. 2020;91:1037–1045. FND-CIT-0011. Source
[2] Nielsen G, Higgins R, Stone J, Coebergh J, Edwards MJ. Functional sensory symptoms and signs: a case-control study of 102 patients. Brain Communications. 2026;8(1):fcag031. FND-CIT-0023. Source

Source check: September 15, 2026 · Occupational-therapy, physiotherapy, neurology, pain, equipment, lived-experience, supporter and accessibility review pending.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —