Sintomas Neurológicos Funcionais e Dissociativos: um guia para pacientes

Hemi

Pain

Pain is a very common symptom in patients with functional neurological symptoms. 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 (and have something like functional weakness for example), the two things may not be unrelated.

Most people with chronic pain do not have anything to see on an MRI scan that is causing their symptoms

Chronic pain can also be seen as a problem to do with the functioning of the nervous system which is complex and takes time to understand

Types 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 unrefreshing 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. For a good scientific discussion of complex regional pain by a leading pain neurologist working in London click here (http://pn.bmj.com/cgi/reprint/7/3/145)

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

Neck - http://www.arc.org.uk/arthinfo/patpubs/6024/6024.asp

Back - http://www.arc.org.uk/arthinfo/patpubs/6002/6002.asp

Fibromyalgia - http://www.arc.org.uk/arthinfo/patpubs/6013/6013.asp or
http://www.fibromyalgia-associationuk.org/

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 Pain

BackCare  www.backcare.org.uk
British Pain Society   www.britishpainsociety.org
Pain Association Scotland  www.painassociation.com
Pain Concern  www.painconcern.org.uk
Pain Relief Foundation   www.painrelieffoundation.org.uk
Pelvic Pain Support Network   www.pelvicpain.org.uk