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Editor's Correspondence
August 9/23, 1999

More Thoughts on Somatization

Arch Intern Med. 1999;159(15):1811-1817. doi:

In reply

We agree with Dr Zwillich that understanding the patient's experience of pain, rather than radiographic findings, should guide therapy directed at symptomatic relief. We object to the term "amplifying" for 3 reasons. First, it may be inaccurate. Two patients with similar joint disease who report different levels of pain may have a different primary subjective experience of pain, or may have the same primary experience but express it differently. The first hypothesis is supported by the poor correlation between reported symptoms and diagnostic test results for a variety of conditions, including myocardial infarction, peptic ulcer disease, and rheumatoid arthritis. The second hypothesis is supported by observations that different cultures express symptoms differently. Second, it is an unfortunate reality that "amplification," to many practitioners, imputes volition, and with it, blame.1 We do not believe that these issues are different for primary care practitioners as compared with rheumatologists. Third, we believe that the term is unnecessary. We would prefer to say to a patient, "You are experiencing a lot of pain" rather than "You are amplifying your pain." The medical chart note would emphasize the need for symptom control in addition to therapy to control the course of the disease.