The pain puzzle: a visual and conceptual metaphor for understanding and treating pain in pediatric rheumatic disease.

Chronic pain is a primary clinical manifestation of pediatric rheumatic diseases that for some children persists into adulthood and is associated with increased disability. The "pain puzzle" is presented as a visual and conceptual metaphor for understanding and treating pediatric rheumatic disease related pain. This metaphor is consistent with a biobehavioral model of pain that focuses on the unique and interactive components of nociceptive activity, emotions, cognitions, and behavior in the experience of pain. We describe the parts of the pain puzzle and review the implications for treating pediatric rheumatic disease related pain.