#7207 Changes in referral patterns to an inpatient FND service: implications for clinical management of pain
Year: 2025
Type: conference-paper
Study design: Observational Study
Abstract: Objectives Inpatient treatment programmes can be an important option for the treatment of FND, particularly in severe or disabling cases. However, there are few inpatient facilities for FND in the UK. Our well-established inpatient FND programme in the Neuropsychiatry Department at the National Hospital for Neurology and Neurosurgery, London, constitutes a 4-week multidisciplinary approach. Aside from psychiatric and neurological assessments, patients receive regular therapy input from mental health nurses, physiotherapy, occupational therapy, CBT and speech and language therapy. The programme can be physically demanding and intensive. Referrals to our inpatient FND service have increased over time, and patients present with a wide range of functional symptoms, including pain. Patients with chronic or complex pain tend to be managed in pain management services, but it is increasingly recognised that pain can be a prominent symptom of FND. Methods We report an evaluation of our inpatient FND service using a retrospective review of patients admitted to the inpatient programme. We compared data from two time periods, 2012 to 2015 and 2021 to 2023. We were interested in examining whether there have been changes to the pattern of referrals over time, the clinical characteristics of FND, particularly presentations with pain, and the relationship to clinical outcome. Results Preliminary analysis indicated that over time, there has been an increase in the number of patients referred and admitted to the FND inpatient program presenting with comorbid pain. In addition, more patients were prescribed opiate analgesia prior to admission, and these medications were not withdrawn during admission. Pain can be a limiting factor for participation in physically demanding treatment. Therefore, our current programme may not be suitable for patients with pain as the prominent symptom of their FND. Detailed analysis of the data will be discussed. Conclusion Our results suggest that it is increasingly recognised that pain is a common symptom in FND which needs to be addressed. Many of these patients had previous contact with local pain management services. Current MDT inpatient programmes for FND like ours may not be fully equipped to address pain or opiate medications/withdrawal. A cohesive approach with input from a pain management service or incorporating pain management into an FND multidisciplinary team may improve clinical outcomes.
Authors: A Baginski, J Lee, G Price, P Petrochilos, J Foong
Institution: National Hospital for Neurology and Neurosurgery
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4407111377