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What is Chronic Pain?

Persistent or Chronic Pain is a very common symptom in people with FND.  This website is not designed to discuss pain in a lot of detail. Nonetheless it is important to recognise that if you do have chronic pain as part of your illness, the two things are probably related.

We have learnt a lot about the mechanisms of chronic pain in the last 10-20 years. Chronic (longlasting) pain is different to the type of acute (sudden) pain that you get if you cut your finger. It has different mechanisms in the body.

Chronic pain is often due to an increase in the ‘volume knob’ in the pain pathways in the nervous system. The person suffering chronic pain cant just ‘turn the volume knob down’, the pain is ACTUALLY happening.

In this sense chronic pain can also be seen as a problem, like FND, to do with the functioning of the nervous system which is more to do with the ‘software’ of the nervous system, than the “hardware”.

Here are some videos which may help to explain.

Tame the Beast – from This is another great video from Lorimer Moseley – a pain researcher and clinician in Australia.
It aims to explain how chronic (long lasting) pain is different to acute (short lived) pain
Understanding chronic pain in 5 minutes
It was made by GP Access and the Hunter Integrated Pain Service, New South Wales, Australia

Locations of Pain

The commonest types of pain in people with functional neurological symptoms are:

  1. Back Pain – usually felt in the low back spreading to either side
  2. Neck Pain – often persistent and worse with movement
  3. Widespread muscle and joint pain – this is sometimes called ‘fibromyalgia’, especially when it presents in combination with fatigue and un-refreshing sleep.  
  4. Complex Regional Pain – This is when a limb becomes painful and difficult to use, usually after a minor injury. The limb may sometimes be swollen or change colour at times. Weakness is often seen in the affected limb which is not entirely due to pain and has identical clinical features to functional weakness. Likewise functional sensory symptoms and functional  movement disorders can be seen in complex regional pain.

Read more about this problem on this website.

There is useful information on most of  these types of pain from the Arthritis and Rheumatism Council. These links also explain exercises that can be useful for some kinds of pain.

The film below is a great short film about women with fibromyalgia from the BBC in the UK. My only gripes…it can be reversible and I don’t agree that it’s unexplained. We have learnt a lot about how fibromyalgia works in recent years.

 Fibromyalgia Information booklet:

Understanding vicious cycles of pain

Another thing that management of chronic pain has in common with the management of some functional symptoms is the way in which vicious cycles can develop making the problem worse. For example, if you fall down and hurt your back, you may find for a day or two that its difficult to move because your back is sore. After that time though, moving around slowly increasing your mobility may be the best thing to do. It will be sore, but the more you do it, the less sore it will be.

What sometimes goes wrong, especially after a minor injury, is that people worry that the pain they are experiencing in their back is a sign of something seriously damaged or ‘torn’. Understandably, with this in mind, they may be reluctant to move and may interpret pain as evidence that there is damage and that they should move as little as possible. Eventually however, this approach leads to more and more immobility and more and more pain. The figure opposite illustrates this.

Where to get help for Pain

If your main problem is pain you may get further help from a Pain Clinic or a Pain Management Programme which can spend much longer helping you understand your pain better and learn to adapt to it better.

The “Pain Toolkit”

You may like to have a look at ‘The Pain Toolkit’, a booklet by Pete Moore, who has persistent pain himself and Dr Frances Cole, a GP and Pain Rehabilitation Specialist in Yorkshire UK.

The booklet and website describes 12 “tools” important in learning to manage and overcome chronic pain.

Internet Resources for Patients with Pain

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