"A Painful Case" is a short story by Irish author James Joyce published in his 1914 collection Dubliners.

The two draw closer together, and one night Mrs. Sinico impulsively takes his hand and presses it to her cheek, but Duffy is not pleased at the development and ends their meetings.

He reacts at first with revulsion, concluding that some inherent weakness led to her drinking and the accident, but he slowly comes to believe that it was his rejection that condemned her to solitude and death.

The story ends with Duffy listening to the silence of the surrounding night atop a hill overlooking Dublin where he and Sinico used to sit down and talk, where he realizes just how lonely he really is.

Stanislaus Joyce believed that "A Painful Case" was based on an entry in his diary describing two encounters with a young woman when he was eighteen—his brother, writing the story in Trieste, having given her a Triestine name—and that James Duffy was "intended to be a portrait of what my brother imagined I should become in middle age".