Conversion Disorder, Functional Neurological Symptom Disorder, and Chronic Pain: Comorbidity, Assessment, and Treatment

Abstract

Conversion disorder is a significant problem that warrants further study, given that there are not many well-established guidelines. Accurate and timely assessment should help move treatment in a more fruitful direction and avoid unnecessary medical interventions. Advances in neuroimaging may also help further our understanding of conversion disorder. Creating a supportive environment and a collaborative treatment relationship and improving understanding of conversion symptoms appear to help individuals diagnosed with conversion disorder engage in appropriate treatments. Novel uses of earlier treatments, such as hypnosis and psychodynamic approaches, could potentially be beneficial and require a more vigorous and systematic study. There are treatments that produce significant improvements in functioning and reduction of physical symptoms from conversion disorder even for very severe cases. Hypnotherapy, cognitive behavioral therapy, and inpatient multidisciplinary treatment with intensive physiotherapy for severe cases have the most evidence to support reduction of symptoms. Components of treatment for conversion disorder overlap with treatments for chronic pain and can be used together to produce therapeutic effects for both conditions. Treatment needs to be tailored for each individual's specific symptoms.

Neuropsychiatric Factors Linked to Adherence and Short-Term Outcome in a U.S. Functional Neurological Disorders Clinic: A Retrospective Cohort Study

“…36 Associations between FND and chronic pain are also well established. [38][39][40][41][42][43][44][45] Our data suggest that chronic pain in motor FND may represent a particularly treatment-refractory subgroup worthy of additional prospective clinical research.…”

Inpatient Treatment of Functional Neurological Disorder: A Scoping Review

“…A scoping review was done to map the emerging research on inpatient functional treatment, reveal methodological gaps, and identify areas for future research. 12 This review included the following five key phases: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarizing, and reporting the results. 12 This framework was used to answer the following research questions:…”

Twisted in Pain: The Multidisciplinary Treatment Approach to Functional Dystonia

“…Hypnosis is a top-down regulation strategy that some children are able to use to help in managing physiological arousal, pain, and anxiety. [20][21][22][23] In Jai's case, the hypnotherapist quickly realized that Jai could readily enter a trance state. Hypnosis was therefore introduced into all of Jai's physical sessions-physiotherapy and occupational therapy-to manage his pain and dystonia during those interventions.…”

“…In research and the clinic, it is now understood that FND and chronic pain are best conceptualized as resulting from a complex, reciprocal interaction of biopsychosocial factors and that the treatment must be multidisciplinary and tailored to the individual patient. 20,44 Most likely, the total effect of such treatment programs has a greater effect than the just the additive effects of the separate treatment components alone. 45…”