Psychogenic and Somatic Pain: Understanding the Body-Mind Connection

Is psychogenic or somatic pain real pain?

Pain referred to as “psychogenic” or “somatic” is real pain, even when medical tests fail to identify a lesion that explains it. These two terms do not refer to a single diagnosis. Nociplastic pain involves a change in the nervous system’s processing of stimuli that threaten tissues; it is distinct from a functional neurological disorder—which primarily affects movement control or sensation—and from a disorder with somatic symptoms, which combines distressing symptoms with excessive health-related reactions.^{1, 2} Physical therapy may be part of the treatment, depending on the specific challenges and diagnosis.

You’re in pain. Yet, after tests, X-rays, or magnetic resonance imaging (MRI), you’re told that everything seems normal. An MRI produces images of the body’s internal structures. You may then wonder if your pain is being taken seriously. Normal test results don’t make your experience any less real.

It's normal to feel lost when tests don't find anything.

Treatment can help. The goal is to understand your situation, relieve pain when possible, and help you resume important activities. In functional motor disorders, movements are difficult to control despite the person’s best efforts. A randomized trial involving 355 adults compared specialized physical therapy with standard neurological physical therapy. More participants in the specialized group reported an improvement in motor symptoms. However, there was no clear difference between the groups in physical function as assessed by a questionnaire at 12 months.³ These findings regarding movement do not indicate a pain remission rate.

• Nociplastic pain describes a pain mechanism. It does not, on its own, constitute a psychiatric diagnosis.⁴
• Real pain can persist without any visible injury to explain it⁴
• Improvement is possible, but the extent and pace of that improvement vary depending on the situation
• For functional motor disorders, a group of specialists recommends education, movement practice, and strategies for daily life. These 2015 recommendations are based on the studies available at that time and the specialists’ experience.⁵ The more recent Physio4FMD trial supports certain benefits of specialized physical therapy, though it does not demonstrate superiority across all measures.³

This guide will help you understand what's happening in your body, why these pains occur, and how to regain control. For an overview of available treatment approaches, consult our complete guide to physiotherapy.

What is psychogenic or somatic pain?

The terms “psychogenic” and “somatic” refer, respectively, to a presumed psychological origin and to matters related to the body. They are not interchangeable. Pain that cannot be explained by imaging is not automatically psychological. A disorder with somatic symptoms is a distinct diagnosis, characterized by distressing symptoms and excessive health-related thoughts, emotions, or behaviors.² A physical illness may also be present. Your pain deserves care in all of these cases.

Several terms are used interchangeably in medical texts. The table distinguishes their meanings; it does not list four different names for the same disease.

• It is not made up or faked
• It is not "all in your head" in a derogatory way
• It does not mean you are crazy or weak
• It does not mean you are seeking attention

Pain can be severe and limit your daily activities, even without a clearly identified injury. Your suffering deserves a thorough evaluation. Our page on psychogenic or somatic pain provides information on these terms, the meanings of which should be clarified with your healthcare provider.

Evolution of the Medical Concept

Medicine has reevaluated several categories of physical symptoms. A psychological explanation cannot be inferred solely from the absence of findings on an examination. For functional neurological disorders, the diagnosis is based on characteristic signs observed during the evaluation.⁶

The DSM-5, the diagnostic manual for mental disorders published in 2013, introduced somatic symptom disorder. The diagnosis takes into account distressing symptoms and excessive reactions to those symptoms—for example, persistent preoccupation that takes up a disproportionate amount of one’s life. The presence or absence of a physical illness alone is not sufficient to confirm the diagnosis.²

Pain mechanisms and neurological diagnoses provide different types of information. The following section explains this distinction.

Which pain mechanisms should be distinguished from functional neurological disorders?

Nociceptive, neuropathic, and nociplastive pain describe three mechanisms of pain; functional neurological disorders constitute a separate diagnosis. Nociceptive pain results from actual or potential tissue damage; neuropathic pain results from a lesion or disease of the nerve pathways that process sensations. Nociplastive pain involves a change in this neural processing. Central sensitization, on the other hand, describes an increase in the reactivity of certain nerve cells in the brain and spinal cord. The spinal cord transmits messages between the brain and the body.¹ These concepts may coexist in the same person without being synonymous.

Nociplastic pain

In 2016, researchers proposed a third term to describe certain pain mechanisms.⁴ The current definition of nociplastive pain describes altered nociception. The pain is not clearly explained by actual or potential tissue damage that activates sensory nerve endings, nor by a lesion or disease of the part of the nervous system that processes sensations.¹ This part of the nervous system processes, in particular, touch, temperature, and information from the tissues.

Nociplastic pain is not synonymous with imaginary pain or a psychiatric disorder. The metaphor of “turned up volume” can help explain increased sensitivity, but it does not establish a diagnosis. A nociplastic component can coexist with pain caused by an injury or inflammation.¹

• Fibromyalgia, which is characterized by widespread pain and increased sensitivity, among other symptoms
• Complex regional pain syndrome, a condition characterized by persistent pain in a specific area—often a limb—along with changes in sensation, temperature, or swelling
• Some persistent chronic pain conditions
• Irritable bowel syndrome, with abdominal pain and changes in the frequency or appearance of stools
• Increased sensitivity associated with certain inflammatory pain conditions, though it does not replace an assessment of inflammation

Functional Neurological Disorders (FND)

Functional neurological disorders affect movement or sensation. The symptoms are involuntary. The doctor looks for characteristic signs, such as a movement that changes in a specific way depending on the task. The diagnosis is not based solely on a normal imaging result.⁶

The Functional Neurological Disorders Clinic at the University of Montreal Hospital Center (CHUM) brings together doctors, physical therapists, and occupational therapists. The occupational therapist helps patients perform their daily activities. This team develops a plan tailored to the needs of adults with a confirmed diagnosis.⁷

• Muscle weakness whose physical examination findings are consistent with a functional disorder
• Tremors
• Walking difficulties
• Functional seizures that resemble epileptic seizures but do not share the same mechanism; the two diagnoses can coexist
• Numbness or tingling

Functional neurological disorders lie at the intersection of neurology and psychiatry. Both physical and psychological factors may play a role, but an identifiable stressor is not required. A neurological disorder may also coexist.⁶Functional pain must be evaluated on its own merits; not all pain constitutes a functional neurological disorder.

Central sensitization

Central sensitization is an increase in the responsiveness of nerve cells that process pain-related stimuli in the brain and spinal cord. It can contribute to increased sensitivity to touch, pressure, or movement. Its severity varies depending on the individual and their health conditions.⁸

Imagine an alarm that reacts more easily. This image can help explain why even mild stimulation becomes painful. It is just a comparison, not a medical test. Central sensitization can also contribute to certain types of neural pain—that is, pain related to the nervous system.

Understanding these mechanisms is the first step. Now, let's see how to recognize the specific symptoms.

What symptoms might accompany persistent pain?

Persistent pain may be accompanied by fatigue, sleep disturbances, or difficulty concentrating. Certain functional neurological disorders can also cause weakness, tremors, or changes in sensation. These symptoms require evaluation; their presence together does not confirm a single diagnosis.^{6, 9}

• Diffuse or localized pain (frequently in the back, head, jaw, and face, abdomen)
• Intense and persistent fatigue
• Sensory disturbances (numbness, tingling, abnormal sensations)
• Motor disturbances (weakness, tremors, coordination difficulties)
• Difficulty concentrating or remembering things, sometimes called “brain fog”

• Symptoms can fluctuate depending on the emotional context
• Possible improvement during distracting activities
• Distribution of symptoms that does not follow the usual course of a nerve
• Day-to-day variability

• Sleep Disorders
• Anxiety can accompany pain or functional symptoms; it also warrants treatment
• Depression and persistent pain are often associated, although this association does not establish a cause-and-effect relationship in any specific direction¹⁰.

Anxiety or depression does not make pain any less real. These conditions can coexist and require coordinated care. A link between pain and depression does not prove that one is the sole cause of the other.¹⁰

This understanding leads us to a fundamental question: why is this pain always real?

Why does pain remain real even when there is no visible injury?

Pain remains real even without visible injury because it is a lived experience, not the result of a medical image. The International Association for the Study of Pain distinguishes this experience from mere nerve activity. Your description must be taken seriously.¹

The Neuroscience of Pain

Research distinguishes between nerve signals and the personal experience of pain:

The nervous system plays a role in the experience of pain. A cut activates the sensory nerve endings in the finger. Signals travel through the nerves, the spinal cord, and the brain. This neural processing and the pain felt are two related but distinct phenomena. Pain can be felt in the finger even though its experience involves the nervous system.¹

The brain interprets information from the body by taking into account context and past experience. Some models describe this process as a prediction. It is not a conscious decision to produce pain. These models help in the study of symptoms, though they do not, on their own, explain every case.¹¹

Pain is not simply a fixed measure of physical damage. The brain modulates it significantly based on what a person thinks and feels. This is one of the reasons why stress, fear, or constant focus on pain can intensify it.¹²

Central sensitization: pain's volume turned up

Repeated stimulation can increase the responsiveness of certain nerve pathways. Stimulation that was previously tolerated may then become painful. This phenomenon does not occur in the same way in all cases of persistent pain.

Central sensitization can prolong or amplify a pain response. Laboratory research has shown that stimulation can trigger increased sensitivity and measurable changes in nerve activity. These observations help us understand pain, but they are not sufficient to diagnose a person based on their symptoms.¹³

The image of increased volume illustrates heightened sensitivity: a light touch or movement can cause more pain. Such sensitivity may accompany persistent nociceptive pain. It does not mean that every movement is dangerous.

It's NOT 'in your head'

In experiments with volunteers, central sensitization is accompanied by changes in brain activity as measured by imaging or electrical recording techniques.¹³ These results do not mean that brain imaging is a test that validates or invalidates your pain. Improvement is still possible, though there is no guarantee that symptoms will disappear completely.

Your pain is real. It is not made up, faked, or imaginary. It deserves to be taken seriously and treated with respect and expertise.

Knowing that your pain is real and can be treated, let's see how physiotherapy can help you.

How does physical therapy help manage this pain?

Physical therapy helps you regain movement and resume activities through education, tailored exercises, and a progression plan that is reassessed with you. For primary chronic pain—which persists for more than three months without being adequately explained by another medical condition—the British NICE guidelines recommend that people aged 16 and older engage in supervised exercises tailored to their abilities and preferences.¹⁴ For functional motor disorders, exercises are primarily aimed at regaining control over movement.⁵

Combine treatments to suit your needs

The plan may combine physical, psychological, and medical care. Each intervention addresses an identified need:

• Physical Therapy: Exercises and Movement Training to Resume Daily Activities and Help Manage Pain
• Psychotherapy: Psychological support and, if needed, cognitive-behavioral therapy, which addresses thoughts and behaviors related to difficulties
• Pharmacology: Medication if necessary (not always required)

Treatment needs vary depending on the diagnosis. For a disorder with somatic symptoms, regular follow-up and psychotherapy can help manage symptoms and distress.² For a functional motor disorder, physical therapy focuses on movement, working with other professionals as needed.⁵ The report from the Order of Psychologists notes that somatization is a term with multiple meanings.¹⁵

Therapeutic Education on Pain

Therapeutic education involves explaining your condition, your treatment options, and ways to resume your activities. Understanding the plan can help you participate in it and discuss any difficulties.

• Understanding that pain without injury does not mean "fake" pain
• Reducing the fear of movement (kinesiophobia)
• Changing negative beliefs about pain
• Providing a sense of control

A review of eight studies involving 401 people with persistent muscle or joint pain reports potential benefits of education regarding pain, activities, and movement.¹⁶ The programs and study participants differed, making it impossible to pool the numerical results. These findings do not directly measure the effect of this education when used alone for a functional neurological disorder.¹⁶

Graded Movement and Progressive Exposure

Movement rehabilitation begins at a level appropriate for your abilities. The physical therapist adjusts the intensity and tasks based on your response. For certain functional motor disorders, the therapist specifically aims for movements that are more automatic and require less conscious control. This approach aligns with movement rehabilitation.⁵

• Start small, increase gradually
• Don't try to cause pain in order to make progress
• Observe their response and gradually try tasks that are appropriate for them
• Celebrate small victories

Specific Techniques Used

The CHUM’s outpatient rehabilitation program for functional neurological disorders currently lasts 8 to 12 weeks. Rehabilitation helps patients regain their abilities and perform activities of daily living. A medical evaluation is conducted before the program begins; a follow-up visit typically takes place three to six months after the program ends.⁷ This timeline describes a specific service, not a recovery timeframe applicable to all types of pain.

In practical terms, what does a consultation with a physical therapist for these symptoms look like?

What to Expect During Your First Consultation?

The initial consultation explores your symptoms, their impact on your daily activities, and the physical, psychological, and social factors relevant to your care. The physical therapist also assesses your range of motion and functional abilities. The duration of the appointment depends on the service and your needs; the clinic can provide you with an estimated time when you make your appointment.

1. Your complete history

• Onset and evolution of symptoms
• Life context at the time of onset
• Previous treatments
• Impact on your daily life

2. Factors related to the body, thoughts, and living environment

• Biological factors (sleep, physical activity)
• Psychological factors (stress, anxiety, beliefs about pain)
• Social factors (work, relationships, support)

3. Physical assessment

• Tests of sensation, strength, and automatic responses known as reflexes
• Movement observation
• Identifying characteristic signs that support a diagnosis, and signs that require further evaluation

• Active and empathetic listening
• Validation of your experience
• Non-judgmental approach
• Clear explanation of diagnosis and treatment plan

• Focused on your activities, such as walking to a store
• Progressive and achievable
• Measurable (to track progress)

Your sleep, your mood, and your work can influence your symptoms or make treatment more difficult. Talking about these things helps adjust the treatment plan; these questions do not mean that the pain is automatically attributed to a psychological cause.

Let's now look in more detail at the therapeutic approaches that will be used.

What therapeutic approaches are used?

Treatment may combine exercises, activities, pain education, psychological support, and medications appropriate for the diagnosis. Treatment options are discussed with you and reassessed based on the results.¹⁴

Physical Therapy

The main goal is to help you regain control of your body. Physical therapy for functional motor disorders combines explanations, movement exercises, and strategies for daily life⁵.

• Exercises tailored to your specific challenges
• Individualized progression
• Working on movements you fear
• Integration into daily activities

This approach may include muscle-strengthening and endurance exercises tailored to your specific challenges.

Working on Thoughts and Behaviors Related to Pain

Through their work on movement and activities, physical therapists can help you:

• Recognize the thoughts that always predict the worst, such as “I’ll never be able to walk again”
• Recognize avoidance behaviors
• Gradually change habits that prevent you from trying appropriate activities

Psychotherapy may be offered by a qualified professional when psychological difficulties warrant it. It complements your care based on your needs.²

Stress and anxiety management

Chronic stress and pain can influence each other. A narrative review suggests that threat learning contributes to the maintenance and amplification of certain types of pain, but presents this mechanism as a hypothesis to be tested¹¹. Simple techniques can help:

• Slow, comfortable breathing
• Progressive Muscle Relaxation
• Focus on the present moment, also known as mindfulness

Physical activity as medicine

Exercise can temporarily reduce sensitivity to pain induced in a laboratory setting. In a study of 58 healthy young adults, a drug that blocks the action of opioids—a class of substances that can reduce pain—did not eliminate this effect. Levels of certain molecules produced by the body, known as endocannabinoids, increased after exercise. The authors suggest that these molecules may play a role in the observed effect.¹⁷ A review of studies finds immediate benefits from certain exercises in healthy individuals, but inconclusive results in those with persistent pain.¹⁸ This does not summarize the benefits of an exercise program on activity levels or quality of life.

Exercises for the stabilizing muscles, which help control the joints, can be selected based on a specific level of difficulty.The McKenzie approach, in particular, explores the response to repetitive movements for certain back or neck problems. These approaches are not a substitute for specific treatment of a functional motor disorder.

Recovery time varies depending on several factors, which we will explore.

How long do treatment and recovery take?

Treatment and recovery can take several weeks or several months; some people require longer follow-up care. For functional motor disorders, the ideal number of sessions and their intensity have not been established for everyone.⁵ As a concrete guideline, the CHUM outpatient program lasts 8 to 12 weeks, followed by tailored follow-up care.⁷ The end of a program does not always mean that symptoms have disappeared.

Factors That Can Support Recovery

• Early diagnosis: Early referral is recommended for functional motor disorders; however, it does not guarantee a specific outcome
• Accepting the Diagnosis: Understanding the Proposed Diagnosis and Being Able to Discuss Any Unresolved Questions
• Commitment to treatment: Participation in a manageable program, adjusted as needed if difficulties arise
• Social support: A supportive and encouraging environment.

A study of 253 workers with lower back pain found that expectations regarding recovery and perceptions of their health helped predict a return to work. These associations pertain to a specific population and a specific outcome. They do not prove that mindset causes recovery.¹⁹

Challenges to Consider During Follow-Up

• Prolonged duration of symptoms before treatment
• Stress related to work, a claim for compensation, or a legal dispute
• Untreated depression
• Persistent concerns or conflicting explanations that complicate the plan

How Does Recovery Work?

A clear explanation and exercises that demonstrate existing abilities can help build confidence in the plan. For functional motor disorders, the physical therapist can use a task or rhythm that facilitates movement requiring less conscious control.⁵

Improvements may involve walking, a household task, or social participation before the pain changes. A review of pain associated with functional neurological disorders highlights that improved movement is not always accompanied by a reduction in pain.⁹ These outcomes should therefore be monitored separately, and pain management should be adjusted accordingly.

A more recent study examined 100 people who had completed four weeks of inpatient rehabilitation for a functional neurological disorder. The group for whom persistent pain was the primary symptom reported improvements in pain, health, and symptoms of anxiety and depression. The program involved a multidisciplinary team. Since there was no control group that did not receive this program, the study alone does not allow us to attribute the changes to the treatment or to physical therapy alone.²⁰

Realistic Expectations

It is important to understand that:

• Healing is generally not instantaneous
• Progress may be interspersed with more difficult days
• The goal may be to perform your daily activities more effectively, even if the pain does not go away completely
• Relapses are possible and are part of the process

However, some signs require prompt medical attention. If you experience sudden acute pain with alarming symptoms, seek immediate consultation.

When to consult and who can help?

A doctor can reevaluate new or worsening pain, and a physical therapist can help patients resume their activities; however, some symptoms require urgent attention. A previous diagnosis of persistent pain or a functional disorder does not preclude the need to evaluate a new symptom.

Signs That Require Prompt Evaluation

Call 911 if you suddenly experience weakness in your face or on one side of your body, or if you suddenly have trouble speaking. These signs may indicate a stroke, a problem with blood flow to the brain. Even if they go away, immediate evaluation is necessary.²¹

Go to the emergency room immediately if you experience new difficulty urinating, loss of bladder or bowel control, or loss of sensation around the genitals or anus, in the perineal region. These changes may indicate significant nerve damage. The NHS, the UK’s public health service, describes these symptoms as including back pain; it also classifies pain, tingling, numbness, or weakness in both legs associated with back pain as urgent.²²

Worsening weakness also requires prompt medical evaluation. For individuals with current or past cancer, new neurological symptoms—such as weakness, difficulty walking, or bladder problems—constitute a medical emergency.²³

Seek medical advice promptly if the pain is accompanied by a fever, chills, or general malaise, or if it rapidly becomes more severe. Severe nighttime pain, unexplained weight loss, or a history of cancer should also be reported to a doctor. If you have a current or past history of cancer, severe and persistent back pain—whether it is progressive or interferes with sleep—warrants a medical evaluation within 24 hours.^{22, 23} Do not assume that these symptoms are caused by a previously diagnosed functional disorder.

The multidisciplinary team

Your care may involve several professionals, depending on your needs:

Resources in Quebec

• CHUM TNF Clinic: Specialized interdisciplinary program
• Chronic Pain Clinics: Available in several hospitals
• Physioactif Persistent Pain Program: Integrated approach in a private setting

For those suffering from associated joint or muscle pain, our services can also be adapted.

Physioactif stands out for its unique approach to this type of pain.

Why choose Physioactif for this type of pain?

Physioactif offers an assessment of your abilities and a plan to help you resume the activities that matter to you. The explanations, exercises, and collaboration with other professionals are tailored to your situation.

Expertise in Pain Science

The assessment and explanations may cover:

• The Mechanisms of Chronic Pain
• Central sensitization
• Therapeutic pain education
• Research-validated approaches

We do not stigmatize. We understand that your pain is real, and we have the tools to help you.

Comprehensive Care

A biopsychosocial approach takes into account the body, thoughts, and emotions, as well as the living environment:

• Comprehensive assessment of biological, psychological, and social factors
• Collaboration with other professionals as needed
• Continuity of care throughout your journey

We also offer telerehabilitation services for certain follow-ups.

Proximity and accessibility

Our clinics in the Greater Montreal area offer follow-up options that we can discuss with you:

• Please check with your chosen clinic for hours and availability
• Teleconsultation available for certain follow-ups
• Welcoming and attentive team

If you're living with pain that has no clear explanation, don't give up. There are solutions. Visit our page on treating muscle tension, stiffness, and loss of mobility to learn more.

What are the most frequently asked questions?

Frequently asked questions focus on the reality of pain, diagnosis, the chances of improvement, medications, the role of stress, and support from family and friends. They also address the role of physical therapy, the number of sessions, and exercises to do at home.

Does psychogenic pain mean I'm faking it?

No. Real pain does not become feigned simply because a test result is normal or because a psychological factor is involved. The term “psychogenic” is not proof of feigning. Ask your healthcare provider what this term means in your situation.^{1, 2}

Can I be completely cured?

Significant or complete improvement is possible, but it is not guaranteed. Some people continue to experience symptoms but still gain greater independence. Follow-up visits assess pain, activities, and quality of life to adjust the treatment plan.¹⁴

Do medications help?

Certain medications may help, depending on the diagnosis. For primary chronic pain in adults, NICE recommends considering certain antidepressants—even in the absence of depression—by weighing their benefits against their risks.¹⁴ For a somatic symptom disorder, medications can be used to treat associated anxiety or depression.² The decision on their use is made in consultation with the prescriber; they should not be stopped abruptly without medical advice.

My doctor can't find anything, what should I do?

Ask what the tests assessed, what diagnosis is being considered, and what signs would warrant further evaluation. Normal test results alone do not confirm a functional disorder. Treatment can begin for the identified difficulties while medical follow-up continues.^{6, 14}

Can stress really cause physical pain?

Chronic stress and pain can influence each other. A narrative review suggests that threat learning and changes in the neural networks that modulate the stress response may contribute to the persistence of certain types of pain¹¹. This explanation remains a hypothesis to be tested and does not imply that the pain is imaginary.

How can I explain my symptoms to the people around me?

You can say: “My pain is real. The tests don’t explain everything yet. My healthcare team is helping me understand my symptoms and get back to my normal activities.” If a specific diagnosis is confirmed, use the terms explained by your healthcare professional. You don’t have to claim that all other conditions have been ruled out in order to ask for support.

Is physiotherapy alone enough?

Physical therapy can play an important role, especially when it comes to mobility issues. Some people also need medical care, occupational therapy, or psychological support. The choice depends on the diagnosis, pain, and other challenges; it is reassessed with you.^{5, 14}

How many sessions are usually needed?

The number of sessions is determined based on your goals, your response to treatment, and the available resources. There is no average that applies to all situations falling under this category. A specific program can serve as a guideline: at the CHUM, outpatient rehabilitation for functional neurological disorders lasts 8 to 12 weeks.⁷

Are there exercises I can do at home?

Yes. The physical therapist can teach you exercises and strategies to practice between sessions. The program should be manageable and can be adjusted if new symptoms appear or existing ones worsen. Practicing these exercises helps you work toward the agreed-upon goals, though it does not guarantee a faster recovery. See also our exercise videos section for additional resources.

How do I know if my pain is psychogenic or organic?

A medical evaluation examines symptoms, physical findings, and relevant tests. Physical mechanisms and psychological factors can coexist in any pain condition. A disorder with somatic symptoms and a functional neurological disorder each have their own diagnostic criteria; a normal test result alone does not resolve this issue.^{2, 6}

References

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2. What Is Somatic Symptom Disorder? (Back to sections: 1, 2, 3, 4, 5, 6, 7, 8)
3. Nielsen G, Stone J, Lee TC, Goldstein LH, Marston L, Hunter RM, et al. Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicenter, phase 3 randomized controlled trial. Lancet Neurol. 2024;23(7):675-686. (Back to sections: 1, 2)
4. Kosek E, Cohen M, Baron R, Gebhart GF, Mico JA, Rice ASC, et al. Do we need a third mechanistic descriptor for chronic pain states? Pain. 2016;157(7):1382-1386. (Back to sections: 1, 2, 3, 4, 5)
5. Nielsen G, Stone J, Matthews A, Brown M, Sparkes C, Farmer R, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry. 2015;86(10):1113-9. (Back to sections: 1, 2, 3, 4, 5, 6, 7, 8)
6. Bennett K, Diamond C, Hoeritzauer I, Gardiner P, McWhirter L, Carson A, et al. A practical review of functional neurological disorder (FND) for the general practitioner. Clin Med (Lond). 2021;21(1):28-36. (Back to sections: 1, 2, 3, 4, 5, 6)
7. Services Offered at the TNF Clinic. (Back to sections: 1, 2, 3, 4)
8. Nijs J, George SZ, Clauw DJ, Fernández-de-Las-Peñas C, Kosek E, Ickmans K, et al. Central sensitization in chronic pain conditions: latest discoveries and their potential for precision medicine. Lancet Rheumatol. 2021;3(5):e383-e392. (Back to section: 1)
9. Steinruecke M, Mason I, Keen M, McWhirter L, Carson AJ, Stone J, et al. Pain and functional neurological disorder: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2024;95(9):874-885. (Back to sections: 1, 2)
10. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433-45. (Back to sections: 1, 2)
11. Timmers I, Quaedflieg CWEM, Hsu C, Heathcote LC, Rovnaghi CR, Simons LE. The interaction between stress and chronic pain through the lens of threat learning. Neurosci Biobehav Rev. 2019;107:641-655. (Back to sections: 1, 2, 3)
12. McCarberg B, Peppin J. Pain Pathways and Nervous System Plasticity: Learning and Memory in Pain. Pain Med. 2019;20(12):2421-2437. (Back to section: 1)
13. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15. (Back to sections: 1, 2)
14. NICE. Recommendations | Chronic pain (primary and secondary) in people over 16: assessment of all chronic pain and management of chronic primary pain | Guidance | NICE. (Back to sections: 1, 2, 3, 4, 5, 6)
15. Ordre des psychologues du Québec. Introduction to the topic: Somatization—the physical manifestation of suffering—Ordre des psychologues du Québec—OPQ. (Back to section: 1)
16. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011;92(12):2041-56. (Back to sections: 1, 2)
17. Koltyn KF, Brellenthin AG, Cook DB, Sehgal N, Hillard C. Mechanisms of exercise-induced hypoalgesia. J Pain. 2014;15(12):1294-1304. (Back to section: 1)
18. Wewege MA, Jones MD. Exercise-Induced Hypoalgesia in Healthy Individuals and People With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. J Pain. 2021;22(1):21-31. (Back to section: 1)
19. Schultz IZ, Crook J, Meloche GR, Berkowitz J, Milner R, Zuberbier OA, et al. Psychosocial factors predictive of occupational low back disability: toward the development of a return-to-work model. Pain. 2004;107(1-2):77-85. (Back to section: 1)
20. Foong J, Price G, Baginski A, Lee-Davey J, Petrochilos P. Chronic Pain in Functional Neurological Disorders: Clinical Outcomes from an Inpatient Rehabilitation Program. Pain Manag. 2026;16(2):107-112. (Back to section: 1)
21. nhs.uk. Symptoms of a stroke. 2024. (Back to section: 1)
22. nhs.uk. Back pain. 2017. (Back to sections: 1, 2)
23. NICE. Recommendations | Spinal Metastases and Metastatic Spinal Cord Compression | Guidance | NICE. (Back to sections: 1, 2)
24. Radio-Canada. Functional Neurological Disorder: Reprogramming the Brain When It Goes Off the Rails | Radio-Canada. 2024.
25. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.