As part of our “Pain And…” series, Samantha Levy covers the relationship between pain and the occurrence of symptoms without a readily identifiable cause.
In medicine, a symptom or group of symptoms is described as “functional” when no anatomical, pathological, or physiological cause can be identified. Although no medical evidence exists to explain the condition, the symptoms are genuinely experienced by the individual and are not fabricated. Functional Neurological Disorder (FND) occurs when the body exhibits signs resembling a neurological condition despite no identifiable medical explanation. For instance, a person might experience what appears to be a seizure, but an EEG evaluation reveals no epileptic activity in the brain. Other typical FND symptoms include temporary immobility of one or more body parts, sudden collapses (losing consciousness and falling), and abrupt, short-term blindness. These symptoms feel entirely real—and they are—despite lacking a definitive medical origin.
While chronic pain is not an FND, these two syndromes often co-occur or appear at different times in a person’s life. Those with a history of medical ailments such as pain are more susceptible to developing an FND. Like patients with pain disorders, many people with FNDs also have comorbid anxiety, OCD, and/or depression.
Why do chronic pain and FNDs co-occur? Both chronic pain and FND symptoms can be a result of emotions that are not expressed, trauma that has not been processed, stressors without the skills to handle them, mental health issues, or ongoing negative situations that they do not know how to escape–the body can express what is going on through pain or FND symptoms. FND and chronic pain both require patients to learn to and be allowed to express their feelings of sadness or anger without repercussions. For pain disorders, pent-up feelings contribute to the central nervous symptoms firing signals that a part of the body is hurt even when there is nothing wrong with that part of the body. In FND, these feelings find their way out through neurological symptoms that are psychogenic in their underlying cause.
With both FND and chronic pain, medical causes for your child’s symptoms must first be ruled out. Both diagnoses require understanding the whole person from a biopsychosocial perspective. For both struggles, the whole family must be involved in the healing process, and the function of the behavior (FND) or the pain must be considered. For example, does the disorder bring attention to the child, help them escape stressful situations, or avoid negative emotions?
In both situations, calming, creative activities are helpful. Healing from either of these takes time and a team of practitioners with experience in this area.