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August 1988

Regional Pain Is Usually Hysterical

Author Affiliations

From the Department of Neurology, New York Medical College, Valhalla, and Phelps Memorial Hospital, North Tarrytown, NY.

Arch Neurol. 1988;45(8):914-915. doi:10.1001/archneur.1988.00520320116025

For every ill beneath the sun There is some remedy or none If there be one, resolve to find it; If not, submit, and never mind it.


Differentiating organic disease from hysterical conversion reactions (HCRs) is one of the most common and challenging problems facing the neurologist. Historically, the spectrum of involvement has ranged from blindness, paralysis, and convulsions, to the most common of all somatic symptoms, pain.1 Since pain is subjective and a personal experience (often hard to describe), the clinician is at a distinct disadvantage in assessing the severity and symbolism. This is a critical issue since aspects of diagnostic testing, therapy, and compensability loom in the background.

Many myths and confusion surround the entity of HCR and each physician seems to have his or her own definition. Since regional pain is usually hysterical in nature, precise definition and terminology is required if we are

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