A behavioural perspective on chronic pain.

This review outlines a behavioural view of chronic pain, in which pain behaviours are considered as operants. This view is supported by experiments in which pain behaviour is shown to be under the influence of environmental factors. The number of exercises performed by pain patients working to tolerance tend to be in multiples of five, rather than following a chance distribution. The exercise deficit seen in pain patients under conditions where exercises are counted does not occur when feedback is removed, and under these circumstances pain patients do not differ from normals. Other studies show that tolerance can be increased by verbal reinforcement, and that pain ratings are influenced by the presence or absence of a patient's spouse. Implications of these findings for the maintenance or reduction of chronic pain are discussed.