Pain in Functional Motor Disorders: Clinical Correlates From the Italian Registry 2026 Nisticò et al

[Andy]

ABSTRACT

Background

Pain is a frequent and disabling symptom in patients with Functional Motor Disorders (FMD), yet its clinical correlates and impact have not been characterized in large, representative cohorts. The aims of this study were to identify clinical predictors and correlates of pain intensity and interference among FMD patients.

Methods

We conducted a cross-sectional analysis within the Italian Registry of Functional Motor Disorders, including 466 adults with FMD recruited from 25 movement disorders centers. Pain was assessed using the Brief Pain Inventory (BPI), which captures pain experienced during the 24 h prior to assessment, alongside sociodemographic, clinical, and psychometric data on depression, anxiety, alexithymia, fatigue, and quality of life.

Results

Pain was reported by 78.8% of participants. Fibromyalgia strongly predicted pain, whereas comorbid epilepsy was linked to reduced risk. The presence of pain was associated with a poorer self-reported sense of physical health. Among patients with pain, higher intensity and interference were associated with younger age, Restless Legs Syndrome, Irritable Bowel Syndrome, physical trauma as a precipitating factor for FMD, anxiety, and poorer physical and mental health. Painkillers were prescribed to 41.6% of patients, yet 39.27% reported pain despite medications, and 39.48% had pain while not receiving analgesics.

Conclusions

Pain is highly prevalent in FMD when assessed over the previous 24 h and is frequently reported in patients who are either not receiving analgesics or continue to experience pain despite treatment. Multiple factors influence its intensity and interference in daily life. Longitudinal studies are needed to clarify causal relationships and to inform pain management strategies.

Open access

 

[Andy]

"Among the associated symptoms, pain is frequently reported by patients with FMD [6]. Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or resembling such experience [7]. In fact, the debate is ongoing regarding whether pain should be included in the diagnostic criteria for FND, either as a distinct functional sensory symptom (so-called “nociplastic pain”, which arises from altered nociception despite the absence of tissue damage [8]) or as a diagnostic specifier [9]. A recent systematic review with meta-analysis estimated that 55% of patients with FND report either pain symptoms or chronic pain, which may be accompanied by other chronic pain comorbidities such as complex regional pain syndrome, irritable bowel syndrome (IBS), and fibromyalgia [6]."

 

[Sean]

Change that to absence of known tissue damage, and unrecognised/misinterpreted and/or untreated pain, which is a more realistic and honest characterisation of the situation, and you get a potentially very different picture.