Psychosocial Factors in Pain: Clinical Perspectives

From our regular book review column.

Pain accounts for over 80% of physician visits. The importance of psychological factors has been demonstrated by the observations of Henry Beecher at the Battle of Anzio, experience with multidisciplinary treatment by John Bonica and Wilbert Fordyce, and formulation of the Gate Control Theory by Ronald Melzack and Patrick Wall. This book places particular emphasis on chronic musculoskeletal pain such as low back pain, the most expensive benign medical condition in industrialized countries. In response to this problem, hundreds of pain clinics have been opened in the United States. Mainstream medical practitioners have been reluctant to refer patients to pain clinics, perhaps owing to overstated treatment results, skepticism about behavioral science, and barriers from managed care organizations and workers’ compensation underwriters.