Functional Neurological Disorder With Chronic Pain and Fatigue: Care and Comorbidity

Author: Angela Bogdanova · Published: October 12, 2026 · Editorial Policy

Research cluster: Somatic Symptom & Functional Disorders · Written by Artificial Sapiens

Functional neurological disorder (FND) can occur alongside chronic pain and persistent fatigue. All three experiences can be disabling, fluctuate over time, interfere with sleep and activity, and require attention in a coordinated treatment plan. FND involves involuntary neurological symptoms; chronic pain and fatigue are symptom domains that deserve separate clinical evaluation. A diagnosis of FND neither implies that pain is imagined nor excludes another neurological, medical, or pain-related condition.

The strongest practical conclusion from current research is that successful treatment of functional neurological symptoms may leave chronic pain or fatigue substantially unchanged. A 2024 systematic review and meta-analysis of pain in FND identified frequent pain comorbidity and limited effects on pain in many FND intervention studies. A 2026 meta-analysis of rehabilitation trials found promising FND symptom outcomes but no statistically significant pooled benefit for fatigue in the available randomized comparisons. Integrated care therefore sets explicit, measurable goals for neurological function, pain, energy, sleep, and participation.

What does FND with chronic pain and fatigue mean?

Functional neurological disorder is diagnosed when a person's neurological presentation is supported by appropriate positive clinical findings, such as characteristic changes in movement control, tremor, sensation, or seizure-like episodes. It is sometimes called functional neurological symptom disorder. Symptoms are genuine and involuntary. Contemporary clinical guidance emphasizes that FND is established through clinical assessment, not merely the absence of disease on a scan.

Chronic pain generally refers to pain that persists or recurs for more than three months. Depending on the condition, pain may be nociceptive, neuropathic, nociplastic, or mixed. Some people have chronic primary pain, while others have chronic pain associated with another diagnosed disorder. Pain that appears alongside FND is not automatically part of the FND diagnosis. It may warrant its own examination, treatment, and follow-up according to the NICE chronic pain guideline.

Fatigue describes persistent or recurrent exhaustion, loss of energy, reduced capacity, or unusual effort intolerance. It can affect physical activity, concentration, and emotional regulation. Fatigue is a symptom shared by many conditions rather than an independent diagnosis on its own. Its clinical evaluation may involve sleep, medication effects, pain burden, anemia, endocrine conditions, infection, autonomic problems, depression, or a disorder characterized by post-exertional malaise.

The combination may take different forms. Someone might have functional leg weakness, migraine, and fatigue related to disrupted sleep. Another person might experience functional seizures, widespread chronic pain, and substantial delayed worsening after exertion. A third might have functional tremor along with an independently diagnosed autoimmune disorder. A credible clinical explanation identifies the evidence for each condition, distinguishes confirmed diagnoses from working hypotheses, and plans treatment around the individual's actual limitations.

How common are pain and fatigue in FND?

Pain prevalence and pain-related conditions

Steinruecke and colleagues' 2024 systematic review combined data from 30 cohorts involving 4,272 people with FND. The pooled estimate of participants reporting pain was 55%, with a 95% confidence interval of 46% to 64%. This represents a synthesis of selected clinical cohorts, with meaningful differences in sampling and measurement. It is not an individual's probability of experiencing pain and does not establish that every pain complaint is caused by FND.

The review reported co-occurring conditions such as fibromyalgia, irritable bowel syndrome, and complex regional pain syndrome in some cohorts. Pain-related disorders may require specialist assessment because diagnostic criteria and treatments differ. People with FND can simultaneously meet criteria for a separate pain disorder.

Importantly, several studies in the review found that FND treatment improved neurological measures while pain outcomes remained limited. This matters for planning: a program focused on walking, tremor, or seizure management should not be assumed to treat pain merely because the diagnoses coexist.

Fatigue, sleep, and quality of life

A 2023 review of FND comorbidities described fatigue estimates ranging from 47% to 93% across the included studies. The range is too wide to provide one reliable population prevalence, reflecting different clinical presentations and research methods. It does demonstrate that fatigue warrants routine discussion during FND assessment.

A 2023 online survey of 527 adults with FND recorded retrospectively reported fatigue in 78.0% and pain in 78.1%, with sleep disturbance in 46.7%. Recruitment through patient advocacy networks and retrospective reporting limit the generalizability of these figures; they cannot be substituted for representative epidemiology.

A systematic review and meta-analysis of sleep in FND estimated that sleep disturbance was present in approximately 58% of pooled participants, while stressing heterogeneity and limitations of the available research. Sleep difficulties may worsen pain interference and exhaustion, but evidence that directly treating sleep disorders reliably corrects FND-specific neurological symptoms remains limited.

Why do FND, chronic pain, and fatigue overlap?

Interacting symptoms and daily-life demands

Pain can change movement patterns, interrupt sleep, and make rehabilitation difficult. Fatigue can reduce concentration, physical endurance, and the capacity to attend appointments. Functional neurological symptoms may introduce falls, uncertainty, activity restrictions, and additional effort in ordinary tasks. These influences can compound one another without establishing that a single mechanism produces all three.

A multidisciplinary assessment looks for treatable contributors: sleep disorders, migraine, medication adverse effects, deconditioning in some individuals, post-exertional malaise in others, mood symptoms where present, autonomic abnormalities, injuries, and independently diagnosed inflammatory or neurological conditions. The interpretation must fit the person's history and positive examination findings. A theoretical explanation should never displace a clinically appropriate investigation.

Attention, motor control, and pain processing

FND research studies interactions among attention, motor prediction, sense of agency, emotion processing, salience networks, and interoception. In some functional motor presentations, automatic movement differs from deliberate movement. Specific positive examination signs can help a neurologist establish the diagnosis; altered movement during distraction is a clinical phenomenon and says nothing about intention to deceive.

Research on chronic pain examines peripheral nociception, central pain modulation, sensory processing, and nociplastic mechanisms. A 2025 multimodal narrative review proposed possible overlap between neural processes involved in chronic pain and FND. These are developing research interpretations. Imaging differences across groups cannot currently diagnose the combined presentation in an individual, identify a universal cause, or justify choosing one therapy for everybody.

Is emotional trauma the underlying cause?

Trauma exposure, PTSD, dissociation, and stressful life events may be relevant to individual histories and clinical care. They are not universal prerequisites for FND and are not required for a positive FND diagnosis. The association between trauma and FND does not establish a specific causal pathway for any one person. Where PTSD or dissociative conditions are present, clinicians can offer appropriate assessment and treatment, respecting consent and the person's treatment goals. Treatment of motor symptoms or pain remains available regardless of trauma history.

Assessment: evaluate every symptom domain

Establish and explain the neurological diagnosis

A neurologist gathers a clinical history and examines the type and pattern of weakness, tremor, gait difficulties, sensory changes, speech problems, or episodic altered awareness. In suitable presentations, positive findings can include Hoover's sign, tremor entrainment, or distinctive variability across tasks. Their reliability depends on the context, clinician technique, and interpretation alongside other findings. Some symptoms require MRI, neurophysiology, or video-EEG when clinically justified.

Normal investigations alone do not establish FND. A patient can have FND and another neurological disease simultaneously, and evolving or new symptoms need reassessment. Our guide to FND diagnosis and positive signs explains the clinical approach in detail.

Take an independent pain history

Pain assessment documents where pain occurs, its quality, duration, severity and variability, and any associated sensory or inflammatory features. Clinicians examine relevant body regions, test neurological features when appropriate, and consider localized tissue injury, radiculopathy, neuropathy, migraine, fibromyalgia, inflammatory disease, complex regional pain syndrome, and other conditions based on findings.

Intensity alone is an incomplete outcome. The care team should also track pain-related interference with mobility, bathing, sleep, concentration, social life, and work. A person's pain experience deserves clinical attention even if their functional neurological symptoms are stable. NICE NG193 recommends shared assessment of the impact of pain and agreed individualized care.

Investigate fatigue and distinguish types of exertion intolerance

Ask whether the main problem is sleepiness, muscular tiredness, cognitive exhaustion, unrefreshing sleep, lightheadedness, or a delayed symptom worsening after effort. Review its duration, onset, relationship to infection, activity, standing, medication changes, pain flares, and sleep quality. Depending on the clinical presentation, appropriate testing may address hematologic, endocrine, cardiac, pulmonary, nutritional, inflammatory, autonomic, or sleep-related factors.

Post-exertional malaise (PEM) deserves particular attention: it involves a delayed or prolonged worsening of symptoms following physical, cognitive, emotional, or social activity that would previously have been tolerated. Suspected ME/CFS requires assessment under relevant criteria rather than simple attribution to deconditioning. The NICE ME/CFS guideline advises energy management within the person's limits and specifically rejects fixed-increment graded exercise therapy for ME/CFS. Treatment intensity needs modification when such features are present.

Consider sleep disorders, medication effects, and other illnesses

Review insomnia, snoring and breathing pauses, restless legs symptoms, irregular sleep, daytime sedation, and adverse effects of drugs prescribed for pain, seizures, mood, sleep, or other disorders. Medications can also interact to worsen dizziness or cognitive slowing. Any adjustment requires a prescriber's supervision; a person should not stop anti-seizure or other prescribed medicine on the assumption that every episode is functional.

Assess depression, anxiety, PTSD, psychological distress, substance use, and social barriers as clinically relevant. The purpose is to identify problems worth treating, support safety, and improve access to care. Neither the presence nor the absence of psychiatric symptoms determines whether pain or fatigue is real.

Use questionnaires appropriately

Symptom measures and functioning scales may help track pain interference, fatigue severity, sleep, quality of life, and rehabilitation goals. The meaning of a screening score depends on clinical context, the instrument's validity, and change over time. No questionnaire alone can confirm FND, prove fibromyalgia, establish ME/CFS, or show that pain is psychological.

Differential diagnosis and coexistence

Fibromyalgia and widespread chronic pain

Fibromyalgia can involve widespread pain, fatigue, sleep disturbance, and cognitive complaints. It is evaluated through its own clinical framework; FND does not establish or rule it out. Coexisting fibromyalgia can change the rehabilitation plan, especially when pain sensitivity and post-activity recovery limit practice. Its treatment belongs to a pain-focused pathway while functional neurological symptoms receive their own management.

ME/CFS and post-exertional malaise

Severe prolonged fatigue associated with PEM, unrefreshing sleep, and other characteristic features warrants assessment for ME/CFS. FND and ME/CFS refer to different clinical entities and may require different activity recommendations. Progressively increasing activity without regard to delayed relapse can be counterproductive for people with ME/CFS. A clinician should consider both diagnostic and functional implications.

POTS and orthostatic intolerance

Palpitations on standing, dizziness, presyncope, fatigue, and exercise intolerance may justify orthostatic heart rate and blood pressure assessment and review of other causes. Postural orthostatic tachycardia syndrome (POTS) cannot be established from fatigue or an FND label alone. A physiological diagnosis, when present, should have an appropriate management plan.

Migraine, neuropathy, and other neurological conditions

Migraine can include headaches, sensory disturbances, dizziness, cognitive changes, and profound exhaustion. Neuropathic pain can result from peripheral nerve or spinal disorders. Some inflammatory or structural conditions fluctuate. New neurological deficits, objective progression, or clinically distinctive pain warrant appropriate assessment even if the person already has positive signs of FND.

Somatic symptom disorder, depression, and anxiety

Somatic symptom disorder (SSD) is a separate DSM-5-TR diagnosis defined by distressing bodily symptoms and excessive symptom-related thoughts, feelings, or behavior in a specific clinical context. Pain, fatigue, or FND alone never establishes SSD. SSD may coexist with diagnosed medical conditions, and its diagnostic features must be assessed rather than inferred from the number or intensity of symptoms. Depression, anxiety, and insomnia may similarly coexist and require separate evidence-based care when indicated.

Functional seizures and epilepsy

Seizure-like episodes can be functional, epileptic, or involve both types in one person. An epilepsy-informed assessment and sometimes video-EEG of typical events are needed to distinguish presentations. The American Academy of Neurology practice guideline published online in 2025 and in Neurology in January 2026 addresses diagnostic communication, comorbidity, and treatment of functional seizures. Decisions about anti-seizure medicines belong with the clinician who knows the seizure diagnoses and safety considerations.

Integrated care: who treats what?

Care works best when clinicians share an explanation of the neurological findings and coordinate rather than leaving the patient to reconcile contradictory advice. Depending on the situation, a care team may include primary care, an FND-informed neurologist, a rehabilitation physician, physiotherapist, occupational therapist, psychologist, pain specialist, sleep specialist, and other clinicians. Every specialist does not have to attend every visit; the essential feature is a shared plan and clear responsibility for follow-up.

The 2025 Australian multidisciplinary FND recommendations and 2025 practical management review emphasize understandable explanations, tailored rehabilitation, treatment of comorbidities, and collaboration. The best plan makes space for both symptom improvement and meaningful participation in daily life.

Explain the diagnoses and prioritize patient-valued outcomes

The clinical explanation should identify the positive signs supporting FND, any confirmed pain diagnosis, what is known about fatigue, and which medical questions remain open. Patients should be able to ask why one treatment targets gait or tremor while another targets sleep or pain.

Agree on goals that can be monitored separately: safer walking, fewer falls, less pain interference, better sleep, steadier energy, preparing meals, attending school, returning to work, or taking part in relationships. A neurological improvement that leaves severe fatigue unresolved is valuable but incomplete; the care plan should recognize both outcomes.

FND-informed physiotherapy

Specialist physiotherapy may use education about positive functional motor signs, attention redirection, movement retraining, automatic movement strategies, task practice, and gradual re-engagement with safe meaningful activities. The international physiotherapy consensus supports individualized approaches that avoid suggesting involuntary symptoms are under deliberate control.

The 2024 Physio4FMD randomized controlled trial compared specialist physiotherapy with treatment as usual for functional motor disorder. There was no statistically significant advantage on the primary physical-functioning outcome at 12 months, although some secondary outcomes favored specialist treatment. This finding supports offering appropriate rehabilitation with realistic expectations rather than assuming a specialized program cures every symptom.

A 2026 systematic review and meta-analysis of FND rehabilitation trials reported encouraging results for some FND symptoms. However, heterogeneity and the lack of a statistically significant fatigue effect in randomized comparisons underscore the need for explicit comorbidity care. Details on FND-specific physical and psychological interventions appear in FND Treatment: Rehabilitation and Psychological Care.

Occupational therapy and sustainable activity

Occupational therapy can focus on self-care, meal preparation, childcare, writing, transport, school participation, and work tasks. Therapists help adapt task demands, identify useful rest periods, reduce falls, and assess accessibility and assistive technology when appropriate. A good plan respects the patient's goals and fluctuating capacity.

Pacing is often used to distribute energy and activity across the day. Its application differs by clinical condition. For a patient with PEM, the emphasis may be on staying within an energy limit and preventing crashes. For a patient without PEM whose main problem is avoidance or loss of conditioning, carefully monitored capacity-building may be reasonable. Clinicians should ask about delayed worsening before prescribing repetitive increases in exercise.

Pain treatment deserves a separate pathway

Pain management depends on the diagnosis. Treatments for neuropathic pain, migraine, inflammatory pain, and chronic primary pain follow different guidelines. Options may include targeted medication, movement or physical rehabilitation within tolerance, pain education, sleep support, psychological interventions for pain-related distress, and support for valued daily activities. A generic pain plan should not replace condition-specific medical treatment.

For adults with chronic primary pain, NICE NG193 includes recommendations to consider supervised group exercise and acceptance and commitment therapy (ACT) or cognitive behavioral therapy (CBT) for pain. The guideline's prescribing recommendations are specific to chronic primary pain; they do not automatically apply to neuropathy, migraine, or every person with FND. Medication reviews should consider sedation, dependence, interactions, and other adverse effects, especially when fatigue is prominent.

Pain-focused psychological care can address fear of activity, distress, sleep disruption, coping, and disability. Such treatment acknowledges the reality of pain and does not imply deception or that pain is exclusively emotional. Meaningful outcomes may include less interference and improved function even where pain intensity persists.

Treat fatigue and sleep according to the findings

A useful fatigue plan identifies and treats relevant contributors: a diagnosed sleep disorder, medication-related sedation, endocrine or hematologic illness, uncontrolled pain, orthostatic intolerance, mood symptoms, or another medically identified condition. Energy budgeting, rest, routines, and adjustments to therapy intensity may help with daily management. There is currently insufficient high-certainty evidence to prescribe one universal treatment specifically for fatigue in FND.

Track recovery after each physical and cognitive activity, including symptoms that develop the following day. Delayed worsening may be more important than symptoms during the session. A program should be modified when it repeatedly produces major deterioration. The person should know whom to contact when the plan is not tolerable.

Psychological and psychiatric treatment where indicated

Psychological therapy can help manage functional symptoms in selected presentations, anxiety, depression, pain interference, sleep problems, health concerns, or adjustment to disability. Evidence varies by FND subtype and psychotherapy model. The 2025 umbrella review of FND treatments describes promising approaches while reporting substantial methodological heterogeneity and variable certainty.

A psychological intervention should have a stated purpose and follow informed, collaborative decision-making. Access to FND rehabilitation should not require a patient to accept a trauma narrative. Coexisting PTSD, major depression, or another psychiatric disorder can be treated according to its own clinical indications.

Coordinating medicines and specialist appointments

A single clinician should ideally maintain a current medication list and review duplication, side effects, withdrawal risks, and interaction with rehabilitation. Some drugs for pain, insomnia, and mood symptoms can contribute to daytime exhaustion. Treating a coexisting medical disease may also change neurological functioning and fatigue. The medication plan should be reviewed when symptoms change, rather than assigning every new complaint to FND.

What does current rehabilitation evidence tell us?

The evidence for FND treatment is expanding, but FND includes distinct neurological presentations. Studies of functional seizures, functional movement disorder, and other subtypes should not automatically be combined into one claim about recovery. Outcome measures, intervention intensity, settings, and follow-up periods differ.

A 2025 umbrella review assessed existing reviews of therapeutic approaches and found developing evidence of benefit with important certainty limitations. A 2026 meta-analysis found improvement on certain overall FND outcomes while specific outcomes such as fatigue were inconclusive. These findings support offering rehabilitation with symptom-by-symptom monitoring and transparent expectations.

Research on physical activity in FND is particularly constrained. A 2024 review concluded that exercise guidance often draws partly on evidence from coexisting disorders because FND-specific studies remain limited. Advice needs modification for severe pain, cardiovascular risk, orthostatic disorders, falls, and PEM. Treatment should not escalate according to a fixed template in the face of sustained harm.

Prognosis and long-term management

Prognosis varies with subtype, duration, comorbidities, baseline disability, social circumstances, and access to appropriate care. Some people recover substantially, others achieve meaningful functional improvement with ongoing symptoms, and others live with long-term disability. A 2025 meta-analysis examining symptom chronicity found that longer duration was associated with smaller improvement in certain motor and quality-of-life outcomes, but did not eliminate the possibility of treatment benefit.

Different symptoms may move on different timelines. Functional tremor may improve before fatigue; sleep can stabilize before pain intensity; occupational participation may improve while neurological episodes persist. An accurate progress review asks what changed in each domain and whether the person's own goals are being met.

Symptom flares may follow illness, poor sleep, pain increases, treatment overload, medication changes, or other life circumstances. Review any clinically relevant change, especially new objective neurological abnormalities. A previous FND diagnosis does not remove the need for ordinary ongoing health care.

Children, adolescents, and school participation

Children and adolescents may experience functional neurological symptoms with headaches, pain, fatigue, sleep difficulties, reduced attendance, and social withdrawal. Pediatric clinical care must be developmentally appropriate and include assessment for medical conditions. Families need clear explanations, educational support, and coordinated communication rather than blame.

The Canadian Paediatric Society's 2024 clinical guidance recommends validating symptoms, thorough assessment, interdisciplinary planning, and attention to participation and family context. School accommodations may include flexible schedules, rest opportunities, reduced task load, accessible mobility support, and periodic review. If symptoms suggest PEM, attendance and activity planning must respect recovery requirements.

A child's treatment goals may include sleeping regularly, attending selected classes, seeing friends, or reducing falls before returning to full athletic demands. Family members and clinicians can support independence while recognizing that recovery pathways vary.

Red flags and the need for reassessment

An FND diagnosis should never be used to dismiss signs of stroke, epilepsy, infection, spinal cord compression, cardiac disease, or other urgent conditions. Seek emergency assessment for sudden facial droop, new one-sided weakness or speech difficulty, a first or prolonged seizure-like episode, repeated episodes without recovery, severe chest pain, major breathing difficulty, acute severe headache with neurological changes, or new bladder and bowel dysfunction with spinal symptoms.

Prompt nonemergency review is appropriate for unexplained weight loss, ongoing fever, progressive neurological abnormalities, a markedly changed headache or pain pattern, persistent deterioration in fatigue, a new fainting pattern, or medication-related complications. Testing should be clinically directed by the new features rather than repeated automatically without purpose.

Practical questions for an appointment

A patient and clinician can start with these questions: Which positive findings support my FND diagnosis? What separate explanations have been considered for pain? Has my fatigue been evaluated for sleep, medication, autonomic, and medical contributors? Do I experience delayed post-exertional worsening? Who coordinates my care? What outcome measures will show whether each intervention is helping?

A written care plan can record the patient's most important activities, safety instructions, treatment responsibilities, follow-up intervals, and reasons to seek reassessment. People should be able to describe what happens when they exceed their usual capacity without being assumed to be unmotivated or intentionally producing symptoms.

What is established and what remains uncertain?

Established evidence supports FND as a clinical disorder requiring positive neurological assessment, the high frequency of co-occurring pain and fatigue in studied clinical cohorts, and the potential usefulness of carefully selected rehabilitation for some functional neurological symptoms. Evidence-based care also includes appropriate investigation and treatment of separate medical conditions.

Evidence remains limited for a unified biological mechanism explaining all FND-associated pain and fatigue, the precise population prevalence of individual comorbidities, the best sequencing of treatments, and reliably predicting which patients will improve in every symptom domain. Shared brain-network hypotheses remain preliminary. Review estimates vary with population and definitions, and individual treatment outcomes cannot be guaranteed.

Integrated care is therefore an evidence-informed clinical strategy: explain the confirmed findings, address pain and fatigue independently, monitor participation and adverse effects, and change the plan when evidence or patient circumstances change.

Frequently asked questions

Does FND cause chronic pain?

Chronic pain is frequent among people with FND and may interact with functional neurological symptoms. Coexistence does not establish a single cause. Pain may result from another diagnosable condition or from mixed mechanisms and should receive appropriate assessment.

Can FND cause extreme fatigue?

Fatigue is common in studied FND groups but has many potential contributors. Sleep disorders, pain, medications, ME/CFS, autonomic problems, and other diseases may be involved. Persistent or changing exhaustion deserves evaluation on its own merits.

Is chronic pain with FND the same as fibromyalgia?

No. Fibromyalgia has a distinct clinical assessment. It can coexist with FND, but neither diagnosis follows automatically from the other. Both may require specific treatment goals.

Is FND the same as ME/CFS?

No. ME/CFS evaluation centers on a specific clinical pattern that includes post-exertional malaise; FND diagnosis requires appropriate positive evidence for functional neurological symptoms. Both conditions should be assessed independently when suggested by the history.

Can physiotherapy make fatigue worse?

Some programs can exceed an individual's tolerable capacity, particularly when marked PEM, severe pain, or orthostatic symptoms are present. Tell the therapist about delayed crashes and prolonged flares. The plan should be adapted and clinical contributors reassessed.

Will pain disappear if FND treatment improves my movement?

Not necessarily. The 2024 pain review found that some FND treatments improved neurological outcomes while pain benefits were limited. Pain-focused care may remain necessary after successful neurological rehabilitation.

Can CBT help physical symptoms?

CBT can be used for selected functional symptoms, chronic pain coping, insomnia, anxiety, or depression according to clinical indications. It does not imply that physical symptoms are imagined, and its evidence differs among FND presentations.

Is trauma required for FND?

No. Trauma and dissociation may be relevant to some histories and deserve respectful assessment when indicated, but trauma is neither a universal cause nor a diagnostic requirement.

Can someone have both FND and a neurological disease?

Yes. FND can coexist with migraine, epilepsy, peripheral nerve disorders, and other illnesses. Clinicians reassess new or changing symptoms and diagnose the conditions supported by evidence.

Is exercise always recommended for fatigue?

Activity recommendations depend on the cause and symptom pattern. A person with ME/CFS and PEM requires an approach consistent with energy management; a person without PEM may have other rehabilitation goals. Fixed-increment exercise is not an appropriate universal prescription.

Is it possible to return to work or school?

Participation may improve with individualized rehabilitation and accommodations, including flexible scheduling, accessible transport, rest periods, phased returns, or modified tasks. Medical conditions and exertional limits should inform the plan.

When is another medical assessment needed?

A new focal neurological symptom, progressive change, concerning pain, serious systemic symptoms, new seizure-like episodes, or sustained deterioration warrants reassessment. Emergency signs require urgent evaluation regardless of an existing FND label.

Related Articles

Read the FND diagnosis, symptoms, and treatment overview for the parent condition. The FND diagnosis and positive signs guide covers diagnostic evidence and neurological testing. The FND rehabilitation and psychological care guide develops symptom-specific rehabilitation methods. The somatic symptom and functional disorders atlas explains related clinical classifications and diagnostic distinctions. For closely related questions, consult FND and trauma research, FND and dissociation, and living with FND at work and school.

References

American Academy of Neurology. (2026). Management of functional seizures practice guideline executive summary. Neurology. PubMed.

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision: Somatic Symptom and Related Disorders. DOI.

Aybek, S., & Perez, D. L. (2022). Diagnosis and management of functional neurological disorder. BMJ, 376, o64. Journal.

Boylan, K. A., et al. (2024). Functional neurological disorder, physical activity and exercise: What we know and what we can learn from comorbid disorders. Epilepsy & Behavior Reports, 27, 100682. DOI.

Canadian Paediatric Society. (2024). Somatic symptom and related disorders: Guidance on assessment and management. Guideline.

Dworetzky, B. A., & Baslet, G. (2025). Functional neurological disorder: Practical management. Neurotherapeutics, 22(4), e00612. DOI.

Kannan, S., Dutta, A., & Das, A. (2025). Sleep disorders in functional neurological disorder: A systematic review and meta-analysis. Neurological Sciences. DOI.

Kannan, S., et al. (2025). Shared neural signatures in functional neurological disorder and chronic pain: A multimodal narrative review. BMJ Neurology Open. DOI.

Keatley, E. S., et al. (2026). Rehabilitation therapies for functional neurological disorder: A systematic review and meta-analysis of clinical trials. The Journal of Neuropsychiatry and Clinical Neurosciences. DOI.

Lehn, A., et al. (2025). Managing functional neurological disorder: Treatment recommendations for health professionals in Australia. BMJ Neurology Open. DOI.

Mavroudis, I., et al. (2025). Treatment of functional neurological disorder: An umbrella review of systematic reviews and meta-analyses. Journal of Neurology. DOI.

National Institute for Health and Care Excellence. (2021). Chronic pain (primary and secondary) in over 16s: Assessment of all chronic pain and management of chronic primary pain (NG193). Guideline.

National Institute for Health and Care Excellence. (2021). Myalgic encephalomyelitis/chronic fatigue syndrome: Diagnosis and management (NG206). Guideline.

Nielsen, G., et al. (2015). Physiotherapy for functional motor disorders: A consensus recommendation. Journal of Neurology, Neurosurgery & Psychiatry. PubMed.

Nielsen, G., et al. (2024). Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): A randomized controlled trial. The Lancet Neurology. PubMed.

Steinruecke, M., et al. (2024). Pain and functional neurological disorder: A systematic review and meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry. DOI.

Thomas, S. T., et al. (2025). Treatment outcomes in functional neurological disorder: A systematic review and meta-analysis exploring symptom chronicity. BMJ Neurology Open. DOI.