On pain,illness and disability

Abstract

The biomedical perspective on management of pain, illness, and disability is analyzed and discussed. Pain and pain behavior are delineated. The distinction between acute and chronic pain, and the potential impact of social and environmental factors on pain behavior are reviewed. Distinctions between pain and suffering and between specific and non-specific pain are drawn and implications for the diagnostic process are considered. The importance of viewing clinical pain in biopsychosocial terms is emphasized and implications of that conceptual shift are reviewed. Attending to the social/environmental context in which patients function leads to an analysis of the social contract between individual and society. Implications of the concept of ‘effort-related’ on clinician as well as patient is considered. Clinician potential for stifling patient effort is reviewed. Finally implications of a biopsychosocial perspective on facilitation of return to work is considered.