References 313Despite the recalcitrance of the pain problems of the pa-
tients treated, they generally support the ef“cacy of MPRPs
on multiple outcome criteria including reductions in pain re-
duction, medication consumption, health care utilization, and
emotional distress, increases in activity and return to work,
and closure of disability claims (e.g., Turk & Okifuji, 1998a,
1998b). Moreover, examining the available outcome data, we
(Turk & Okifuji, 1998a, 1998b) concluded that the outcomes
for MRPs are more clinically effective, more cost effective,
and with fewer iatrogenic complications than alternatives
such as surgery, spinal cord stimulation, and conventional
medical care.
CONCLUDING COMMENTS
Pain is not a monolithic entity. Pain is, rather, a concept used
to focus and label a group of behaviors, thoughts, and emo-
tions. Pain has many dimensions, including sensory and af-
fective components, location, intensity, time course and the
memories, meaning, and anticipated consequences that it
elicits. It has become abundantly clear that no isomorphic
relationships exist among tissue damage, nociception, and
pain report. The more recent conceptualizations discussed
view pain as a perceptual process resulting from the nocicep-
tive input, which is modulated on a number of different levels
in the CNS. In this chapter, we presented conceptual models
to explain the subjective experience of pain.
As was noted, the current state of knowledge suggests that
pain must be viewed as a complex phenomenon that incorpo-
rates physical, psychosocial, and behavioral factors. Failure
to incorporate each of these factors will lead to an incomplete
understanding. It is wise to recall John Bonica•s comment in
the preface to the “rst edition (1953, 1990) of his volume,
The Management of Pain,and repeated in the second edition
some 36 years later:
The crucial role of psychological and environmental factors in
causing pain in a signi“cant number of patients only recently re-
ceived attention. As a consequence, there has emerged a sketch
plan of pain apparatus with its receptors, conducting “bers, and
its standard function that is to be applicable to all circumstances.
But... in so doing, medicine has overlooked the fact that the ac-
tivity of this apparatus is subject to a constantly changing in”u-
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