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August 1988

Regional Pain Is Rarely Hysterical

Author Affiliations

From the University of Western Ontario and London Psychiatric Hospital, London, Ontario, Canada.

Arch Neurol. 1988;45(8):915-918. doi:10.1001/archneur.1988.00520320117026

The idea of hysteria is influential in determining how we evaluate reports of pain. We usually expect pain to be located at the site of an injury or to correspond to the patterns of distribution of dermatomes or nerves. When pain spreads to a contiguous area or radiates within the territory of a nerve pathway, the extension may be explained by the known idiosyncrasies of the nervous system. The same applies in the case of occasional remote pain or tenderness, as with shoulder pain from gallbladder disease. Pain that affects a region but lacks these characteristics is often held to be "nonanatomical." Increased or decreased sensitivity to light touch or pinprick likewise may be said to be "nonanatomical." It has been believed that such patterns do not correspond to what we know about the physical mechanisms of sensation. Instead, they fit quite well with the notion that a patient

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