The chronic pain syndrome: a physical and psychologic challenge.

The chronic pain syndrome differs from chronic pain. The syndrome is a psychologic stress state that can produce physical-type illness, often with musculoskeletal manifestations. It tends to strike the "worried well," by nature hysterical, depressed, hypochondriacal, and dependent. Standard medical, surgical, and psychologic treatments do not alleviate the pain. The chronic pain syndrome progresses only with enablement by the physician or indiscriminate use of ancillary services. An early complete history and physical examination are the basis from which the physician draws logical conclusions about the patient to prevent progression. The long-range solution lies in a dynamically structured, progressive physical and mental reactivation program implemented by a highly trained interdisciplinary team of professionals using a holistic approach.