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Watson M, Kreuzman J, Zeribi K, Iskander JM, Hopper A, Simon L, Chesley G, Fobian A. The Current State of Pediatric Functional Neurological Disorder Treatment in the United States. Pediatr Neurol 2024; 158:144-155. [PMID: 39059300 DOI: 10.1016/j.pediatrneurol.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/15/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Pediatric functional neurological disorders (FNDs) are common but grossly under-researched. This survey study aims to define the current landscape of pediatric FND treatment in the United States, identifying treatment programs, care team composition, treatment approaches, and aftercare management. METHODS The Functional Neurological Disorder Society (FNDS) Pediatric Special Interest Group (SIG), a diverse set of clinician and caregiver stakeholders, collected information on available treatment programs in the United States via survey. Current programs were identified through the FNDS Pediatric SIG and FND Hope's provider registry. RESULTS Thirty-nine care team members from 24 health care centers yielded 31 unique FND treatment settings. Centers existed in 16 states, concentrated in the Midwest and Southern regions. Outpatient settings (62%) were more prevalent than inpatient. A psychologist (PhD/PsyD) was the most common clinician (52%) with dedicated time to treat FNDs. Most settings accepted ages six to 21 (55%) and treated all FND symptoms (77%). A spectrum of treatment approaches was endorsed with the most common being cognitive behavioral therapy (77%) and personalized approaches (58%). A biopsychosocial approach was evident, with most settings reporting active involvement with school (97%) and caregivers (94%). Most settings (74%) encouraged treatment re-engagement when needed with no strict time limits. All respondents provided aftercare recommendations or referrals. CONCLUSIONS Pediatric FND treatment is available across the United States, but there is high variability in care team membership, treatment approach, and aftercare management. Future research is necessary to develop effective and sustainable treatment to improve access for this population.
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Affiliation(s)
- Meagan Watson
- Department of Neurology, University of Colorado, Aurora, Colorado.
| | - Jason Kreuzman
- St Louis Children's Hospital, Allied Health/Therapy Services, St Louis, Missouri
| | - Karen Zeribi
- Shift-Results, Health Systems Improvement Consulting, Seattle, Washington
| | - Jeannette M Iskander
- Department of NeuroBehavioral Health, NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, Ohio
| | | | - Laura Simon
- Department of Pediatric Rehabilitation, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gayle Chesley
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aaron Fobian
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama
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Clarici A, Bulfon M, Radin Y, Panksepp J. Neuromodulation of safety and surprise in the early stages of infant development: affective homeostatic regulation in bodily and mental functions. Front Psychol 2024; 15:1395247. [PMID: 38903479 PMCID: PMC11187996 DOI: 10.3389/fpsyg.2024.1395247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Developing a sense of internal safety and security depends mainly on others: numerous neuromodulators play a significant role in the homeostatic process, regulating the importance of proximity to a caregiver and experiencing feelings that enable us to regulate our interdependence with our conspecifics since birth. This array of neurofunctional structures have been called the SEPARATION DISTRESS system (now more commonly known as the PANIC/ GRIEF system). This emotional system is mainly involved in the production of depressive symptoms. The disruption of this essential emotional balance leads to the onset of feelings of panic followed by depression. We will focus on the neuropeptides that play a crucial role in social approach behavior in mammals, which enhance prosocial behavior and facilitate the consolidation of social bonds. We propose that most prosocial behaviors are regulated through the specific neuromodulators acting on salient intersubjective stimuli, reflecting an increased sense of inner confidence (safety) in social relationships. This review considers the neurofunctional link between the feelings that may ultimately be at the base of a sense of inner safety and the central neuromodulatory systems. This link may shed light on the clinical implications for the development of early mother-infant bonding and the depressive clinical consequences when this bond is disrupted, such as in post-partum depression, depressive feelings connected to, addiction, neurofunctional disorders, and psychological trauma.
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Affiliation(s)
- Andrea Clarici
- Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Matteo Bulfon
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Yvonne Radin
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Jaak Panksepp
- College of Veterinary Medicine, Washington State University, Pullman, WA, United States
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3
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Popkirov S. [Functional movement disorders: overcoming belle indifférence]. DER NERVENARZT 2024; 95:497-498. [PMID: 38874600 DOI: 10.1007/s00115-024-01646-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Stoyan Popkirov
- Klinik für Neurologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
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4
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Farenga E, Bulfon M, Dalla Zonca C, Tersar C, Ricci G, Di Lorenzo G, Clarici A. A Psychological Point of View on Endometriosis and Quality of Life: A Narrative Review. J Pers Med 2024; 14:466. [PMID: 38793048 PMCID: PMC11121802 DOI: 10.3390/jpm14050466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Endometriosis is a chronic gynecological disorder with a multifactorial etiology that has not yet been fully elucidated. What is known, however, are the pathological tissue dynamics that lead to the complex symptoms that women suffer from. The known symptoms are mainly fertility problems and pain. Both dimensions have an impact that varies from case to case, but that is certainly decisive concerning a woman's health, specifically by affecting the overall quality of life (QoL). In this publication, we will deal with the descriptive aspects of endometriosis's pathology and then present a review of the aspects impacting QoL and their psycho-social consequences. Finally, the experience of pain in the context of the mind-brain-body relationship will be discussed, describing the complexity of this dimension and emphasizing the importance of a multi-professional approach that considers the relevance of the contribution that a psychotherapy intervention based on up-to-date neurobiological models can make for women with endometriosis. A review of the literature and current knowledge on the neural and psychological aspects of pain lead to the conclusion that it is of the utmost importance to provide informed psychological support, alongside medical treatments and sexual counseling, to patients with endometriosis.
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Affiliation(s)
- Elisa Farenga
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Matteo Bulfon
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Cristiana Dalla Zonca
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Costanza Tersar
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Giuseppe Ricci
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste (UniTS), Cattinara Hospital, Strada di Fiume, 447, 34149 Trieste, Italy;
| | - Giovanni Di Lorenzo
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Andrea Clarici
- Department of Medical, Surgical and Health Sciences, University of Trieste (UniTS), Cattinara Hospital, Strada di Fiume, 447, 34149 Trieste, Italy;
- Centro Formazione e Ricerca in Psicoterapia a Orientamento Psicoanalitico, Via Antonio Canova, 2, 34129 Trieste, Italy
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Kapur N, Kemp S. Words Matter: "Functional Neurologic Disorder" or "Functional Symptom Disorder"? Neurol Clin Pract 2024; 14:e200238. [PMID: 38250138 PMCID: PMC10795004 DOI: 10.1212/cpj.0000000000200238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Narinder Kapur
- University College London (NK); Leeds Beckett University (SK)
| | - Steven Kemp
- University College London (NK); Leeds Beckett University (SK)
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Watson M, Woodward J, Strom LA. The Financial Burden of Functional Neurological Disorders. Curr Neurol Neurosci Rep 2023; 23:637-643. [PMID: 37695443 DOI: 10.1007/s11910-023-01298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE OF REVIEW Functional neurological disorder (FND) is a common and severely debilitating condition lacking clinical ownership, existing between neurology and psychiatry. This article reports the findings of recent research investigating the economic costs of FND diagnosis and management. We define what the costs are, why they exist, and suggest actionable steps to reduce them. RECENT FINDINGS The financial burden of FND exists across the globe characterized by high healthcare utilization resulting in exorbitant direct and indirect costs for the patient, healthcare system, and society. Inadequate medical education and stigmatization of the disorder prolong the time to diagnosis, during which cyclical utilization of inpatient and emergency department services drive up costs. Despite being cost-effective, lack of accessible treatment compounds the issue, leaving patients without a reliable exit. Recent findings support an increased awareness and the need for a cultural shift to overcome the financial burden associated with this underserved population.
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Affiliation(s)
- Meagan Watson
- Department of Neurology, University of Colorado, Aurora, CO, USA.
| | - Jared Woodward
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Laura A Strom
- Department of Neurology, University of Colorado, Aurora, CO, USA
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Gilmour GS, Lidstone SC. Moving Beyond Movement: Diagnosing Functional Movement Disorder. Semin Neurol 2023; 43:106-122. [PMID: 36893796 DOI: 10.1055/s-0043-1763505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Functional movement disorder (FMD) is a complex neuropsychiatric syndrome, encompassing abnormal movements and weakness, and is a common cause of potentially disabling neurological symptoms. It is vital to recognize that FMD is a syndrome, with nonmotor manifestations negatively affecting a patient's quality of life. This review highlights a diagnostic algorithm, where a history suggestive of FMD is combined with the presence of positive signs on examination and appropriate investigations to make the diagnosis. Positive signs indicate internal inconsistency such as variability and distractibility, and clinical findings that are incongruent with other known neurological disease. Importantly, the clinical assessment acts as the first opportunity to allow patients to understand FMD as the cause for their symptoms. Accurate and early diagnosis of FMD is necessary given that it is a treatable and potentially reversible cause of disability, with significant risk of iatrogenic harm associated with misdiagnosis.
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Affiliation(s)
- Gabriela S Gilmour
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Ontario, Canada
| | - Sarah C Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Ontario, Canada.,Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Edwards MJ, Yogarajah M, Stone J. Why functional neurological disorder is not feigning or malingering. Nat Rev Neurol 2023; 19:246-256. [PMID: 36797425 DOI: 10.1038/s41582-022-00765-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 02/18/2023]
Abstract
Functional neurological disorder (FND) is one of the commonest reasons that people seek help from a neurologist and is for many people a lifelong cause of disability and impaired quality of life. Although the evidence base regarding FND pathophysiology, treatment and service development has grown substantially in recent years, a persistent ambivalence remains amongst health professionals and others as to the veracity of symptom reporting in those with FND and whether the symptoms are not, in the end, just the same as feigned symptoms or malingering. Here, we provide our perspective on the range of evidence available, which in our view provides a clear separation between FND and feigning and malingering. We hope this will provide a further important step forward in the clinical and academic approach to people with FND, leading to improved attitudes, knowledge, treatments, care pathways and outcomes.
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Affiliation(s)
- Mark J Edwards
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK.
| | - Mahinda Yogarajah
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK.,Epilepsy Society, London, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Aybek S, Chan A. The borderland of multiple sclerosis and functional neurological disorder: A call for clinical research and vigilance. Eur J Neurol 2023; 30:3-8. [PMID: 36135345 DOI: 10.1111/ene.15568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Functional neurological disorders (FNDs) have attracted much attention from the neurological medical community over the last decades as new developments in neurosciences have reduced stigma around these by showing brain network dysfunctions. An overlap with other neurological conditions such as multiple sclerosis (MS) is well known by clinicians but there is a lack of clinical and fundamental research in this field to better define diagnosis and therapeutic decisions, as well as a lack of deep understanding of the underlying pathophysiology. AIM We aimed to provide a critical commentary on the state of knowledge about the borderland between FNDs and MS. METHODS We based our commentary on a joint point of view between an FND specialist and an MS expert. RESULTS A brief review of the previous literature and relevant new studies covering the overlap between FNDs and MS is presented, along with suggestions for future research directions. CONCLUSION There are clear diagnostic criteria for both FNDs and MS and a strict application of these will help better diagnosis and prevent unnecessary treatment escalation in MS or absence of referral to multimodal therapy in FND. Better teaching of younger neurologists is needed as well as prospective research focusing on pathophysiology.
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Affiliation(s)
- Selma Aybek
- Psychosomatic Medicine Unit, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Lim N, Wood N, Prasad A, Waters K, Singh-Grewal D, Dale RC, Elkadi J, Scher S, Kozlowska K. COVID-19 Vaccination in Young People with Functional Neurological Disorder: A Case-Control Study. Vaccines (Basel) 2022; 10:2031. [PMID: 36560442 PMCID: PMC9782633 DOI: 10.3390/vaccines10122031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The emergence of acute-onset functional neurological symptoms, the focus of this study, is one of three stress responses related to immunisation. This case-control study documents the experience of 61 young people with past or current functional neurological disorder (FND) in relation to the COVID-19 vaccination program in Australia. METHODS Information about the young person's/parent's choice and response pertaining to COVID-19 vaccination was collected as part of routine clinical care or FND research program follow-up. RESULTS 61 young people treated for FND (47 females, mean age = 16.22 years) and 46 healthy controls (34 females, mean age = 16.37 years) were included in the study. Vaccination rates were high: 58/61 (95.1%) in the FND group and 45/46 (97.8%) in the control group. In the FND group, 2 young people (2/61, 3.3%) presented with new-onset FND following COVID-19 vaccination; two young people with resolved FND reported an FND relapse (2/36, 5.56%); and two young people with unresolved FND (2/20, 10.0%) reported an FND exacerbation. In the control group no FND symptoms were reported. CONCLUSIONS Acute-onset FND symptoms following COVID-19 vaccination are uncommon in the general population. In young people prone to FND, COVID-19 vaccination can sometimes trigger new-onset FND, FND relapse, or FND exacerbation.
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Affiliation(s)
- Natalie Lim
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Archana Prasad
- Department of General Medicine, The Children’s Hospital at Westmead Clinical School, Westmead, NSW 2145, Australia
| | - Karen Waters
- Sleep Medicine, The Children’s Hospital at Westmead, Westmead Clinical School, Westmead, NSW 2145, Australia
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Davinder Singh-Grewal
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Department of Rheumatology, Sydney Children’s Hospital Network, Westmead, NSW 2145, Australia
- School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW 2031, Australia
| | - Russell C. Dale
- Kids Neuroscience Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- The Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
| | - Joseph Elkadi
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Stephen Scher
- McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- Speciality of Psychiatry, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Brain Dynamics Centre at Westmead Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
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Ballantyne JC, Sullivan MD. Is Chronic Pain a Disease? THE JOURNAL OF PAIN 2022; 23:1651-1665. [PMID: 35577236 DOI: 10.1016/j.jpain.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/24/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022]
Abstract
It was not until the twentieth century that pain was considered a disease. Before that it was managed medically as a symptom. The motivations for declaring chronic pain a disease, whether of the body or of the brain, include increasing its legitimacy as clinical problem and research focus worthy of attention from healthcare and research organizations alike. But 1 problem with disease concepts is that having a disease favors medical solutions and tends to reduce patient participation. We argue that chronic pain, particularly chronic primary pain (recently designated a first tier pain diagnosis in International Diagnostic Codes 11), is a learned state that is not intransigent even if it has biological correlates. Chronic pain is sometimes a symptom, and may sometimes be its own disease. But here we question the value of a disease focus for much of chronic pain for which patient involvement is essential, and which may need a much broader societal approach than is suggested by the disease designation. PERSPECTIVE: This article examines whether designating chronic pain a disease of the body or brain is helpful or harmful to patients. Can the disease designation help advance treatment, and is it needed to achieve future therapeutic breakthrough? Or does it make patients over-reliant on medical intervention and reduce their engagement in the process of recovery?
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Affiliation(s)
- Jane C Ballantyne
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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12
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Kanaan RA. Functional neurological disorder and other unexplained syndromes. Lancet Neurol 2022; 21:499-500. [DOI: 10.1016/s1474-4422(22)00095-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
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