Theoretical Medicine

, Volume 12, Issue 3, pp 213–225 | Cite as

What is chronic pain?

  • John D. Loeser


Chronic pain leads to individual suffering and to major costs for all developed countries. Previous studies suggest that both the incidence of disabling chronic pain and the amount of health care consumption due to chronic pain are rapidly increasing. Western medicine is not only often ineffective but may be one of the causes of this epidemic. This article will address the issue of chronic pain of unknown etiology and has the goals of: (1) identifying the factors which have led to our confusion about this topic, and (2) proposing alternative ways of conceptualizing chronic pain and its ensuing behaviors and social consequences. It is concluded that it is essential to discriminate between tissue damage, pain, suffering, pain behaviors, health care consumption, impairment and disability if one is to develop a meaningful conceptualization of the medical, social, economic and political problems of chronic pain. Successful treatment must be defined in behavioral terms such as restoration of normal activities. Disabling chronic pain is often a sign of overwhelming stress engendered by the individual's failure to cope with the demands of industrialized society.

Key words

behavior epidemiology concepts of pain disability health care consumption impairment nociception pain suffering 


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  1. 1.
    Bonica JJ. History of pain concepts and theories. In: Bonica JJ, ed. The Management of Pain. 2nd ed. Philadelphia and London: Lea and Febiger, 1990:2–7.Google Scholar
  2. 2.
    Loeser JD, Cousins MJ. Contemporary pain management. Med J Aust 1990;53:208–16.Google Scholar
  3. 3.
    Nachemson AL, Bigos SJ. The low back. In: Cruess J, Rennie WJR, eds. Adult Orthopedics. Vol 2. New York: Churchill Livingstone, 1984:843–937.Google Scholar
  4. 4.
    Lewis T. Pain. New York: Macmillan, 1942.Google Scholar
  5. 5.
    International Association for the Study of Pain. Pain terms: a list with definitions and notes on usage. Pain 1979;6:249–52.Google Scholar
  6. 6.
    Loeser JD. Concepts of pain. In: Stanton-Hicks M, Boas R, eds. Chronic Low Back Pain. New York: Raven Press 1982: 145–8.Google Scholar
  7. 7.
    Turk DC, Meichenbaum D, Genest M. Pain and Behavioral Medicine: A Cognitive-Behavioral Perspective. New York: Guilford Press, 1983.Google Scholar
  8. 8.
    Cassell EJ. The nature of suffering and the goals of medicine. N Engl J Med 1982;306:639–45.Google Scholar
  9. 9.
    Digvi AB. Oncologist-induced vomiting: the igvid syndrome. [Letter]. N Engl J Med 1989;320:190.Google Scholar
  10. 10.
    Magora A. Investigation of the relation between low back pain and occupation. Scan J Rehabil Med 1973;5:191–6.Google Scholar
  11. 11.
    Volinn EP, Lai D, McKinney S, Loeser JD. When back pain becomes disabling: a regional analysis. Pain 1988;33:33–9.Google Scholar
  12. 12.
    World Health Organization. International Classification of Impairments, Disabilities, and Handicaps. Geneva: WHO, 1980.Google Scholar
  13. 13.
    Loeser JD, Seres JL, Newman RI. Interdisciplinary, multimodal management of chronic pain. In: Bonica JJ, ed. The Management of Pain. 2nd ed. Philadelphia and London: Lea and Febiger, 1990:2107–20.Google Scholar
  14. 14.
    Foley KM. Pain syndromes in patients with cancer. Med Clin North Am 1987;71:169–84.Google Scholar
  15. 15.
    Long DM, Filtzer DL, BenDebba M, Nelson HH. Clinical features of the failed-back syndrome. J Neurosurg 1988;69:61–71.Google Scholar
  16. 16.
    Loeser JD, Bigos SJ, Fordyce WE, Volinn EP. Low back pain. In: Bonica JJ, ed. The Management of Pain. 2nd ed. Philadelphia and London: Lea and Febiger, 1990:1448–85.Google Scholar
  17. 17.
    Volinn EP, Mayer J, Diehr P, van Kovering D, Connell FA, Loeser JD. Small area analysis of surgery for low back pain. Spine (in press)Google Scholar
  18. 18.
    Volinn EP, Turczyn KM, Loeser JD. Surgical and nonsurgical hospitalizations for low back pain in the United States of America. Pain 1990;(Suppl 5):S388.Google Scholar

Copyright information

© Kluwer Academic Publishers 1991

Authors and Affiliations

  • John D. Loeser
    • 1
  1. 1.Department of Neurological Surgery Multidisciplinary Pain CenterUniversity of Washington School of MedicineSeattleUSA

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