2
|
Steinruecke M, Mason I, Keen M, McWhirter L, Carson AJ, Stone J, Hoeritzauer I. Pain and functional neurological disorder: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332810. [PMID: 38383157 DOI: 10.1136/jnnp-2023-332810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Functional neurological disorder (FND) is characterised by neurological symptoms, such as seizures and abnormal movements. Despite its significance to patients, the clinical features of chronic pain in people with FND, and of FND in people with chronic pain, have not been comprehensively studied. METHODS We systematically reviewed PubMed, Embase and PsycINFO for studies of chronic pain in adults with FND and FND in patients with chronic pain. We described the proportions of patients reporting pain, pain rating and timing, pain-related diagnoses and responsiveness to treatment. We performed random effects meta-analyses of the proportions of patients with FND who reported pain or were diagnosed with pain-related disorders. RESULTS Seven hundred and fifteen articles were screened and 64 were included in the analysis. Eight case-control studies of 3476 patients described pain symptoms in a higher proportion of patients with FND than controls with other neurological disorders. A random effects model of 30 cohorts found that an estimated 55% (95% CI 46% to 64%) of 4272 patients with FND reported pain. Random effects models estimated diagnoses of complex regional pain syndrome in 22% (95% CI 6% to 39%) of patients, irritable bowel syndrome in 16% (95% CI 9% to 24%) and fibromyalgia in 10% (95% CI 8% to 13%). Five studies of FND diagnoses among 361 patients with chronic pain were identified. Most interventions for FND did not ameliorate pain, even when other symptoms improved. CONCLUSIONS Pain symptoms and pain-related diagnoses are common in FND. Classification systems and treatments should routinely consider pain as a comorbidity in patients with FND.
Collapse
Affiliation(s)
| | - Isabel Mason
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Mairi Keen
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
3
|
McLoughlin C, Hoeritzauer I, Cabreira V, Aybek S, Adams C, Alty J, Ball HA, Baker J, Bullock K, Burness C, Dworetzky BA, Finkelstein S, Garcin B, Gelauff J, Goldstein LH, Jordbru A, Huys ACM, Laffan A, Lidstone SC, Linden SC, Ludwig L, Maggio J, Morgante F, Mallam E, Nicholson C, O'Neal M, O'Sullivan S, Pareés I, Petrochilos P, Pick S, Phillips W, Roelofs K, Newby R, Stanton B, Gray C, Joyce EM, Tijssen MA, Chalder T, McCormick M, Gardiner P, Bègue I, Tuttle MC, Williams I, McRae S, Voon V, McWhirter L. Functional neurological disorder is a feminist issue. J Neurol Neurosurg Psychiatry 2023; 94:855-862. [PMID: 36977553 PMCID: PMC10511956 DOI: 10.1136/jnnp-2022-330192] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/26/2023] [Indexed: 03/30/2023]
Abstract
Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people with FND continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. There is abundant evidence that disorders perceived as primarily affecting women are neglected in healthcare and medical research, and the course of FND mirrors this neglect. We outline the reasons why FND is a feminist issue, incorporating historical and contemporary clinical, research and social perspectives. We call for parity for FND in medical education, research and clinical service development so that people affected by FND can receive the care they need.
Collapse
Affiliation(s)
- Caoimhe McLoughlin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Neurology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Selma Aybek
- Department of Clinical Neuroscience, Hopitaux Universitaires de Geneve, Geneva, Switzerland
- Department of Clinical Neuroscience, Inselspital Universitatsspital Bern Universitatsklinik fur Neurologie, Bern, Switzerland
| | - Caitlin Adams
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jane Alty
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Harriet A Ball
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
- Neurology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Janet Baker
- Randwick Specialist Centre, Private Practice, Randwick, New South Wales, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California, USA
| | | | - Barbara A Dworetzky
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Finkelstein
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jeannette Gelauff
- Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anika Jordbru
- Faculty of Humanities, Sport and Educational Science, University of South-Eastern Norway, Kongsberg, Norway
| | - Anne-Catherine Ml Huys
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Aoife Laffan
- Neurology, St. James's Hospital, Dublin, Ireland
| | - Sarah C Lidstone
- University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Stefanie Caroline Linden
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Lea Ludwig
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Julie Maggio
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Physical Therapy and Functional Neurological Disorder Unit and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
| | - Elizabeth Mallam
- The Rosa Burden Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Clare Nicholson
- Therapy Services, National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary O'Neal
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Isabel Pareés
- Movement Disorders Program, Neurology Deparment Hospital Ruber Internacional, Madrid, Spain
- Movement Disorders Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain
| | | | - Susannah Pick
- Section of Cognitive Neuropsychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Wendy Phillips
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Karin Roelofs
- Donders Institute for Brain Cognition and Behaviour: Donders Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Rachel Newby
- Neurology, Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Cordelia Gray
- Neurology Psychotherapy Service, Sheffield Teaching Hospital, Academic Neurology Unit, The University of Sheffield, Sheffield, UK
| | - Eileen M Joyce
- Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Marina Aj Tijssen
- Expertise Center Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Maxanne McCormick
- Physician assistant/patient with FND, FNDRecovery.com, -, Monument CO, USA
| | - Paula Gardiner
- Psychological Therapy in Primary Care, University of Dundee, Dundee, UK
- enhance-cbt.com therapist, NeuroSpecialist Physiotherapist, Stirling, UK
| | - Indrit Bègue
- Department of Psychiatry, Geneva University Hospitals, Geneve, Switzerland
| | - Margaret C Tuttle
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Functional Neurological Disorder Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isobel Williams
- Neuropsychology, Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Sarah McRae
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Valerie Voon
- Psychiatry, University of Cambridge, Cambridge, UK
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
4
|
Geroin C, Stone J, Camozzi S, Demartini B, Gandolfi M, Tinazzi M. Triggers in functional motor disorder: a clinical feature distinct from precipitating factors. J Neurol 2022; 269:3892-3898. [PMID: 35441888 PMCID: PMC9217842 DOI: 10.1007/s00415-022-11102-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 12/05/2022]
Abstract
Background and objective People with functional motor disorder (FMD) report triggers—sensory or motor-induced stimuli that exacerbate or initiate paroxysmal occurrences of their movement disorder. These are a distinct phenomenon from precipitating factors occurring at the initial onset of the disorder. We aimed to assess triggers in FMD and understand their relevance to paroxysmal variability often seen in FMD. Methods We enrolled consecutive outpatients with a definite diagnosis of FMD. Each patient underwent a detailed clinical evaluation also including the presence of trigger factors and video-recordings both during neurological examination and physiotherapy treatment. Patients were classified as having “triggers” (T-FMD) or “not having triggers” (NoT-FMD) as well as “paroxysmal” compared to “persistent with paroxysmal variability”. Results The study sample was 100 patients (82% female) with FMD; the mean age at onset was 41 years. Triggers were observed in 88% of patients and in 65 of these the FMD was pure paroxysmal. The most common triggers were movement or physical exercise, followed by emotional, visual, touch, and auditory stimuli; 39 (44%) were isolated and 49 (56%) were combined triggers. Among the T-FMD patients, FMD were paroxysmal in 74% (n = 65) and persistent with paroxysmal variability in 26% (n = 23). The T-FMD patients were younger (p = 0.016) and had a gait disorder (p = 0.035) more frequently than the NoT-FMD patients. Discussion Triggers are frequent in FMD and may have diverse overlapping clinical presentations. In this sample, FMD was most often paroxysmal, suggesting the value of noting triggers as clinical clues in the diagnosis and rehabilitation of FMD. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11102-1.
Collapse
Affiliation(s)
- Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy. P.le Scuro 10, 37134, Verona, Italy.
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Serena Camozzi
- Physiotherapy Bachelor, University of Milan, Milan, Italy
| | | | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy. P.le Scuro 10, 37134, Verona, Italy.
| |
Collapse
|