At the crossroads: Pain in the 21st century

This paper, written from the perspective of a psychologist working in a tertiary care chronic pain program, presents an overview of chronic pain with suggestions as to what may be important directions for research and treatment in the future. It is suggested that the monumental problem of chronic pain needs to be better appreciated, that both biological and psychosocial factors contributing to presentation need to be better understood, and that the most fruitful avenue of research may be an exploration of the interface between psychosocial and biological components, i.e., the neurobiological substrate mediating psychological effects or the nature of brain-behavior relationships involved in chronic pain. A method to assist in the differentiation of central from peripheral and organic from psychosocial components, and the outline of a novel neuropsychobiological model are described.