How do doctors decide if a pain is real or imaginary if there's no proof, like a broken bone, or something?

Pain is a very individual experience and while some people are able to cope with intense pain, others have difficulty coping with what some may consider to be mild pain. Add to this that pain is not always caused by a specific thing, such as a broken bone, a cut in the skin, or a mass in the body and you will see that pain is very complex.

If a patient sees a doctor for pain that can't be tracked down to an obvious cause, the doctor must investigate further to see if an illness may be the problem. Some illnesses, such as fibromyalgia, cause pain but it can't be pinpointed such as a broken bone.

Imaginary pain is not necessarily not real. If a person is experiencing emotional pain that is coming out as physical pain, their experience must still be acknowledged and dealt with, although treatment may not be with pain relievers.

Reference: 

Harold Merskey. Somatization: or another God that failed. In Pain. September 2009. Vol. 145. Nos. 1 to 2. Pp. 4 to 5.

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