Pain as a Model of Somatic Symptom Formation

  • R. Alec Ramsay


The proverb “all that glitters is not gold” is one of the traditional gentle injunctions used by parents and educators to urge their young charges to look beyond first impressions in evaluating the world around them. In an attempt to communicate some understanding of the complexities involved in the formation of pain as a symptom, one could perhaps begin with a gentle reminder to all of us raised on the Western medical model that “all that hurts is not somatic”. This has a double meaning, which is intended. On the one hand it refers to the long historical record (Merskey and Spear, 1967), expressed in literature, etymology, religion and philosophy of “pain”, “hurt”, and related words being used as much to refer to emotional events as to physical ones. A second meaning is that pain in the clinical situation does not always have an identifiable somatic basis or so-called “peripheral input”. Particularly in the case of patients with chronic pain, keeping these two basic concepts in mind will contribute greatly to their understanding and to more effective clinical management.


Chronic Pain Somatization Disorder Peripheral Input Multidisciplinary Pain Factitious Disorder 
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  1. 1.
    Aronoff, G.M., Evans,W.O. and Enders, P.L. A review of follow-up studies of multidisciplinary pain units. Pain 16: 1–11, 1983.PubMedCrossRefGoogle Scholar
  2. 2.
    Barsky,A.J. and Klerman,G.L. Overview: Hypochondriasis, bodily complaints and somatic styles. Am.J.Psychiatry 140: 273–283, 1983.PubMedGoogle Scholar
  3. 3.
    Black,R.G. Evaluation of the pain patient. In:The Treatment of Pain. (Eds) Wain, H.J. and Devaris, D.P. Jason Aronson, New York, 1982. pp. 11–25.Google Scholar
  4. 4.
    Block, A.R., Kremer, E. and Gaylor, M. Behavioral treatment of chronic pain: variables affecting treatment efficacy. Pain 8: 367–375, 1980.PubMedCrossRefGoogle Scholar
  5. 5.
    Bond, M.R. Pain. Its Nature, Analysis and Treatment. Churchill Livingstone, Edinburgh, 1979.Google Scholar
  6. 6.
    Bonica, J.J. The nature of pain of parturition. Clin. Obstet. Gynec. 2: 499–516, 1975.Google Scholar
  7. 7.
    Cannon, J.T., Liebeskind, J.C. and Frenk, H. Neural and neurochemical mechanisms of pain inhibition. In: The Psychology of Pain. (Ed) Sternbach, R.A. Raven Press, New York, 1978, pp. 27–47.Google Scholar
  8. 8.
    Carlsson, A.M. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 16: 87–101, 1983.PubMedCrossRefGoogle Scholar
  9. 9.
    Catchlove, R.F.H. and Cohen, K. Effects of a directive return to work approach in the treatment of workman’s compensation patients with chronic pain. Pain 14: 181–191, 1982.PubMedCrossRefGoogle Scholar
  10. 10.
    Chertok, L. ‘Hysteria’ versus ’Briquet’s Syndrome’. Am.J.Psychiatry 132: 1087, 1975.PubMedGoogle Scholar
  11. 11.
    Diagnostic and statistical manual of mental disorders. Third Edition. American Psychiatric Association, Washington, 1980.Google Scholar
  12. 12.
    Friedmann, C.T.H. Munchausen’s Syndrome. In: Contemporary Models in Liaison Psychiatry. (Ed) Faguet, R.A., Spectrum, New York, 1978, pp. 79–86.Google Scholar
  13. 13.
    Hardy, J.D., Wolff, H.G. and Goodell, H. Studies on pain: A new method for measuring pain threshold: observations on spatial summation of pain. J.Clin. Invest. 19: 649–657, 1940.PubMedCrossRefGoogle Scholar
  14. 14.
    Large, R.G. and Mullins, P.R. Illness behaviour profiles in chronic pain: the Auckland experience. Pain 10: 231–239, 1981.PubMedCrossRefGoogle Scholar
  15. 15.
    Melzack, R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1: 277–299, 1975.PubMedCrossRefGoogle Scholar
  16. 16.
    Melzack, R. and Dennis, S.G. Neurophysiological foundations of pain. In: The Psychology of Pain. (Ed) Sternbach, R.A. Raven Press, New York, 1978, pp. 1–26.Google Scholar
  17. 17.
    Merskey, H. An investigation of pain in psychological illness; thesis, Oxford, 1964.Google Scholar
  18. 18.
    Merskey, H. Hysterical mechanisms and pain. In Hysteria. (Ed) Roy, A. John Wiley & Sons, London, 1982, pp. 247–260.Google Scholar
  19. 19.
    Merskey, H., and Spear, F.G. Pain: Psychological and Psychiatric Aspects. Ballière, Tindall Cassel, London, 1967.Google Scholar
  20. 20.
    Modai, I., Bleich, A. and Cygielman, G. Masked depression–an ambiguous entity. Psychother. Psychosom. 37: 235–240, 1982.PubMedCrossRefGoogle Scholar
  21. 21.
    Mountcastle, V.B. Pain and temperature sensibilities. In: Medical Physiology, 13th Ed. (Ed) Mountcastle, V.B. Mosby, St.Louis, 1974.Google Scholar
  22. 22.
    Pilowski, I. and Spence, N.D.Pain and illness behavior: a comparative study. J. Psychosom. Res. 20: 121–134, 1976.Google Scholar
  23. 23.
    Richards, J.S., Nepomuceno, C., Riles, M. and Suer, Z. Assessing pain behavior: The UAB Pain Behavior Scale. Pain 14: 393–398, 1982.PubMedCrossRefGoogle Scholar
  24. 24.
    Smith, G.M., Egbert, L.D., Markowitz, R.A., Mosteller, F. and Beecher, H.K. An experimental pain method sensitive to morphine in man: the submaximum effort tourniquet technique. J. Pharmac. Exp. Ther. 154: 324–332, 1966.Google Scholar
  25. 25.
    Streltzer, J. and Wade, T.C. The influence of cultural group on the undertreatment of post-operative pain. Psychosom. Med. 43: 397–403, 1981.PubMedGoogle Scholar
  26. 26.
    Szasz, T.S. Pain as career and as strategy. In: The Treatment of Pain. (Eds) Wain, H.J. and Devaris, D.P., Jason Aronson, New York, 1982, pp. 27–38.Google Scholar
  27. 27.
    Szasz, T.S. Pain and pleasure: a study of bodily feelings. Tavistock, London, 1957.Google Scholar
  28. 28.
    von Knorring, L., Perris, G., Eiseman, M., Ericksson, V. and Perris, H. Pain as a symptom in depressive disorders, I. Relationship to diagnostic subgroups and depressive symptomatology. Pain 15: 19–26, 1983.CrossRefGoogle Scholar
  29. 29.
    Wall, P.D. On the relation of injury to pain. Pain 6: 253–264, 1979.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1985

Authors and Affiliations

  • R. Alec Ramsay
    • 1
  1. 1.Department of PsychiatryAllan Memorial Institute(Royal Victoria Hospital) and McGill UniversityMontrealCanada

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