The differentiation of organic and psychogenic pain

The differentiation between the organic and psychogenic origin of pain is often difficult to establish. One helpful characteristic for the detection of the organicity of a pain syndrome is its consistent change in intensity and/or quality as a function of the motoric behavior of the patient, which can be assessed while taking the history. This observation is illustrated by means of four clinical vignettes. The theoretical background is in accordance with Freud's statement about the real versus the intrapsychic origin of a perception: A perception (in our case, a pain) is real (of organic origin) if it can be made to disappear (to change in intensity and/or quality) by means of a motoric action of the subject (i.e. of the patient).