Painful and spotted, say (4)
I believe the answer is:
sore
'painful' is the definition.
(synonyms)
'spotted say' is the wordplay.
'spotted' becomes 'saw' (I've seen this in another clue).
'say' shows a homophone (sound like).
'saw' sounds like 'SORE'.
'and' is the link.
(Other definitions for sore that I've seen before include "Hard" , "Wound; painful" , "Causing or suffering pain" , "source of distress" , "Painful spot" .)