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August 1988

The Nature of Regional Pain

Arch Neurol. 1988;45(8):918. doi:10.1001/archneur.1988.00520320120027

Pain is the most common symptom afflicting mankind. Eleven percent of the population suffers from chronic pain.1 Regional pain is experienced in areas remote from the presumed site of injury and does not conform to known patterns of spread. Weintraub argues that such pain is usually imagined or feigned, whereas Merskey maintains that most pain has a neurophysiologic basis. Merskey cautions against the diagnosis of psychiatric illness merely on the absence of signs of a physical disease. He reviews research suggesting that afferent neurons in the dorsal horn can change their receptive fields, that receptive fields themselves can extend and alter, and pain may change the perception of other stimuli. Merskey only accepts the diagnosis of hysteria if the following criteria, "stringently applied," are met: (1) occurrence of a symptom corresponding to an idea held by the patient; (2) the presence of strong positive (hysterical) signs; and (3)

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