There may be times when the person in pain gives a picture verbally that is at odds with his or her physical or physiological signs. They may underplay the pain, claiming that it is not too bad, or even non-existent, and yet there may be obvious physical signs of damage, injury or disease, for example as described in the seminal paper by Beecher (1959). This may occur at times of great stress or motivation to overcome the pain, for a variety of reasons, such as helping someone else, or to satisfy some religious or cultural imperative. Women may belittle the pain of childbirth because of their desire to give birth, and yet at the same time acknowledge that it is a painful procedure. In relatively rare circumstances some individuals cannot feel pain, through conditions causing sensory paralysis, or even more rarely through being born without the ability to feel pain (Sternbach 1968)
In other situations someone may complain of being in pain and yet it may be difficult for the professionals to identify any cause for the pain. Some headaches are of this nature, and phantom pain, usually associated with amputation, is another example (Schoenen et al. 1994; Jensen et al. 1985). In other situations the patient may continue to complain of pain when to all intents and purposes the professionals feel that the original injury or disease has been healed or cured. This is particularly common with lower back pain, when there may be no clinical signs of damage or disease to warrant the complaint, or signs of deterioration in the condition. Some diseases of the nervous system can cause intense or long-lasting pain, and yet the clinical signs of disease or damage may be difficult to identify, for example with trigeminal neuralgia or post-herpetic shingles (e.g. Scadding 1994). Yet in all of these situations the experience of the pain is most real and intense to the sufferer. It can be described clearly and graphically, including its position and movement, its nature and bearability. It may be associated also with behavioural changes or restrictions in movement.
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