Chronic Pain and Functional Neurological Disorder: Understanding the Overlap
Living with chronic pain or Functional Neurological Disorder (FND) can be an overwhelming experience. At Philadelphia Integrative Psychiatry, Dr. Danish and his team are committed to offering compassionate, evidence-based care for patients navigating these complex conditions. Chronic pain is a frequent and significant comorbidity in individuals with FND, yet it often goes underrecognized and untreated.
Recent research, including a comprehensive systematic review published in 2024, sheds light on the intricate relationship between chronic pain and FND. This blog explores the prevalence, challenges, and potential treatment approaches for managing chronic pain in FND patients, offering insights into how integrative care can improve outcomes.
Efficacy of Treatments for Chronic Pain in FND
Chronic pain is highly prevalent among individuals with FND, affecting an estimated 55% of patients. Studies have shown that conditions such as Complex Regional Pain Syndrome (CRPS), irritable bowel syndrome (IBS), and fibromyalgia frequently co-occur with FND, with prevalence rates of 22%, 16%, and 10%, respectively[1][2]. Unfortunately, traditional interventions for FND—such as psychotherapy or physiotherapy—often fail to alleviate pain symptoms even when other neurological symptoms improve[2][3].
Emerging evidence suggests that interdisciplinary pain management programs may offer more effective solutions. These programs combine medication management, psychotherapy, physical therapy, and patient education to address both the physical and emotional aspects of chronic pain. For instance, one study reported significant reductions in pain-related disability following a 3–4 week outpatient program that integrated these modalities[3].
Recommended Dosing and Timing for Pain Management
Effective pharmacological management of chronic pain in FND often involves a combination of medications tailored to the patient's specific needs. Common options include:
Opioids: Used cautiously due to risks of dependency and side effects. Time-scheduled dosing is preferred over pain-contingent dosing to maintain stable blood levels and reduce reinforcement of pain behaviors[8][12].
Antidepressants (e.g., SSRIs or SNRIs): These are often prescribed for their dual benefits in managing chronic pain and associated mood disorders. However, clinicians must monitor for potential interactions with opioids, which can increase the risk of serotonin syndrome[6][10].
Adjuvant Medications: Drugs like gabapentin or pregabalin may be used to target neuropathic components of chronic pain.
Dosing schedules should be carefully individualized. For example:
Long-acting opioids may be dosed every 12–24 hours for baseline control.
Short-acting opioids can be reserved for breakthrough pain at doses equivalent to 10% of the total daily opioid dose[4][12].
Potential Side Effects
Patients should be aware of common side effects associated with chronic pain medications:
Opioids: Sedation, constipation, nausea, dependency risks.
Antidepressants: Weight gain, sexual dysfunction, or gastrointestinal upset.
Adjuvant Medications: Dizziness or fatigue.
Managing side effects involves close collaboration with healthcare providers. For instance:
Opioid-induced constipation can often be mitigated with stool softeners or laxatives.
Antidepressant side effects may require dose adjustments or switching medications[6][12].
Interactions with Other Medications
Drug interactions are a critical consideration in managing chronic pain in FND patients:
Combining opioids with benzodiazepines can lead to additive sedative effects and respiratory depression[10].
SSRIs or SNRIs used alongside opioids such as methadone or fentanyl increase the risk of serotonin syndrome[6].
Medications like fluoxetine or amitriptyline may elevate plasma levels of methadone, necessitating dose adjustments[6].
Patients should always inform their healthcare providers about all medications they are taking to avoid harmful interactions.
Getting in Touch with Dr. Danish and His Team
At Philadelphia Integrative Psychiatry, we pride ourselves on staying at the forefront of psychiatric care by integrating evidence-based treatments for conditions like FND and chronic pain. Our holistic approach ensures that we address all aspects of your well-being to create personalized treatment plans that work for you.
If you’re seeking support for chronic pain or Functional Neurological Disorder—or want to learn more about your options—call us today at 610-999-6414.
For More on This Topic and Related Subjects, Check Out These Blogs by Dr. Danish:
https://phillyintegrative.com/blog/treating-complex-regional-pain-syndrome
Sources
Steinruecke M et al., "Pain and functional neurological disorder: a systematic review and meta-analysis," PubMed (2024). Available at: https://pubmed.ncbi.nlm.nih.gov/38383157/
"Functional neurological disorder is common in patients attending chronic pain clinics," PubMed (2023). Available at: https://pubmed.ncbi.nlm.nih.gov/37227931/
Jimenez XF et al., "Functional neurological disorder responds favorably to interdisciplinary rehabilitation models," Psychosomatics (2019). Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8666110/
Principles of Pain Management - PMC (2003). Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC1069064/
Monitoring Pharmacological Treatment in Patients With Chronic Pain - PMC (2021). Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8666110/
