When is pain 'real'?

Physical symptoms may be a manifestation of a complex underlying pathology

When Ian O’Flanagan*, a man in his forties, walked into the ED of a local hospital on the Saturday morning of a public holiday weekend, he was clearly in severe pain and distress.

He appeared hardly able to walk, shuffling in with a stooped gait, clutching his hand to his right flank and groaning.

Between groans, Ian told the emergency doctors that severe cramping pains had started the previous evening in the right side of his abdomen, back and groin.

The pain occurred in waves but was never completely absent. He had been sweating, had vomited and was unable to get comfortable in any position.

Similar pains, though less strong, had come and gone over the past few weeks and he had noticed that sometimes his urine was red.

He hadn’t paid much attention as the pains had disappeared and the urine returned to its normal colour. This time, however, the pain had continued to

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