background Neuromodulation may influence abnormal brain activation patterns in medically unexplained symptoms (MUS).
aim To assess the importance and direction of future studies on patients with MUS.
method We describe the results of the first studies on patients with functional neurological symptom disorder (fNSD) and chronic pain.
results Clinically relevant improvements in the health condition of a substantial number of patients with fnsd have been reported. Randomised clinical trials (RCTs) show significant improvements in patients who have received neuromodulation for chronic pain.
conclusion In our view it is important to perform placebo-controlled RCTs in order to test the therapeutic effect of neuromodulation on patients with MUS. We need to find out more about the involuntary mechanisms and the possible role of the brain in MUS and chronic pain. Neuroimaging would be helpful in this respect.