How not to miss a somatic needle in the haystack of chronic pain

Interviews with 18 male patients with predominantly psychogenic pain (DSM-III and DSM-III-R) and with 18 male patients with pain of mainly physical origin, consecutively admitted to a medical department, were rated by blinded and independent raters with respect to ''symptom description,'' ''manner of speech,'' ''personality characteristics,'' ''interviewer reactions,'' ''interpersonal relationships,'' and ''relationships at work.'' Patients with predominantly organic pain significantly more often described a clear localization of the pain symptom, used more sensory words for the description of pain quality; more often described discrete changes of pain intensity and periodicity; more often showed pain intensifying factors dependent on movement and pain-decreasing factors; more often believed pain to be a symptom versus as a disease itself, and tended to have fewer difficulties in their interpersonal relationships than those with predominantly psychogenic pain (p<0.05 for all factors, two-tailed Fisher's Exact test). (C) 1997 Elsevier Science Inc.