Doctors are being urged to take patients' complaints of pain seriously.
It's the number one reason Kiwis visit their GP, with one in five New Zealanders suffering chronic and/or persistent pain - but there's a big problem.
"It's so hard to tell if it is real," Dr Nicola Swain told The AM Show on Friday.
"Everyone turns up at the doctor and suggests their pain is real, but you can't see it, you can't scan it, you can't get a blood test. There's no way of really telling how much pain a person is feeling."
Dr Swain co-authored an editorial in the latest issue of the New Zealand Medical Journal, calling on doctors to believe patients when they say they're in pain.
"If you look at a scan of the damaged shoulder, some people will find it extremely painful and for other people, there can be no pain at all…There's no way of knowing how much pain a person is going to feel."
The article claims doctors' pain education is poor, and there needs to be a rethink into how pain detection and treatment is being taught.
Dr Swain says there needs to be more than just prescribing "drugs or surgery", particularly when the cause of the pain cannot be identified.
"People also need help in psychological ways, educating people about what causes pain, and also social aspects of treatment."
Surgery is often ineffective, the article states, and comes at high cost and with a high risk of complications.
"It is more appropriate to manage persistent musculoskeletal pain as a long-term health condition... To reduce the growing burden of persistent pain on people, the healthcare system and society, we need to focus on providing these high-value management approaches in favour of high cost but ultimately low-value interventions."
Pain is becoming a bigger problem as the population ages, and for working people, is the number one cause of lost productivity.
Dr Swain also told The AM Show there's no truth to the myth than women handle pain better than men.
"Women experience more pain, they experience it more often and they complain more. There's lots of conditions that women have a lot more than men, like fibromyalgia and migraines. In general, women are not tougher than men."
On the flipside, the article says healthcare providers are more likely to believe women are exaggerating the extent of their pain.
"Women are more likely to be offered psychological support and men more likely to be offered analgesics."
Culture and ethnicity can also play a part, with Maori and Pacific Islanders reporting pain at higher rates, but not accessing persistent pain services.