REFERENCE · RECOVERY TECHNIQUE

Desensitization for Painful Touch and Hypersensitivity

Most likely fit: Clothing, washing or another normally non-painful contact hurts or overwhelms the person after relevant causes have been assessed. [Clinical consensus; direct evidence for an isolated FND desensitization protocol is limited]

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For the Person With FND

What this approach is for

Desensitization means exploring a manageable amount of ordinary contact with control over stopping. The aim might be washing a hand more comfortably. It is not a test of how much pain you can endure.

Begin with something already tolerable. If every option is painful, first ask for pain and skin assessment. New swelling or changes in skin colour and temperature may need a different treatment plan.

Terms in everyday language

Allodynia means pain from something that is not normally painful, such as a sleeve. Hyperalgesia means an increased response to a normally painful stimulus. Neither proves FND. Skin inflammation, nerve conditions and complex regional pain syndrome can also cause sensitivity.

A practical example and flare adaptations

For example, a person who finds rubbing difficult might prefer simply laying a soft cloth on the hand and lifting it away. Another person may prefer their own palm. Choose the contact rather than assuming soft is always easiest.

Keep the first trial brief. Review how the area feels afterwards and later in the day before deciding whether to repeat. Progress toward an actual need, such as drying the hand, rather than collecting increasingly uncomfortable textures. During a flare, return to an easier contact or suspend practice. No surprise rubbing, scratching or painful pressure is required.

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)

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For Family, Friends, and Other Supporters

Agree on a stop signal before helping. The person should not have to justify using it. Prepare a tolerable version of washing or dressing and accept adaptations when contact remains difficult.

Do not take away comfortable clothing to make practice unavoidable. Help describe delayed pain to the therapist; the later response matters as well as what happened during the session.

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

Selection and assessment

Assess allodynia distribution, oedema, perfusion, skin disease, neuropathic features, joint limitations and possible complex regional pain syndrome. Separate a tolerability intervention from diagnostic sensory testing. Consent must specify area, material, pressure and who applies contact.

Explicit procedure

Define the activity prevented by sensitivity and examine the involved tissue.
Identify an input the person already tolerates; if none exists, address pain and access first.
Allow self-application, or show the agreed contact before delivering it.
Trial static contact before movement if rubbing is less tolerable, without making this a universal hierarchy.
End the trial before cumulative escalation; document immediate and delayed effects.
Adjust one feature and connect improved tolerance, if present, to the chosen activity.

Review, progression and stopping

Progress when contact supports the chosen activity without unacceptable after-effects. Do not require a zero pain score, and do not interpret increased pain as evidence of useful retraining. New injury, persistent swelling or vascular change calls for clinical review. Sensitivity that does not improve still warrants comfortable care and equipment.

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

For the Person With FND
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Research and Sources

OT and physiotherapy consensus describe graded contact within functional rehabilitation. These recommendations do not establish an optimal texture, frequency or dose for functional sensory symptoms.

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, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. JNNP. 2015;86:1113–1119. FND-CIT-0028. 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 —