tients may be influenced to be deceptive or to malinger as a result of these
incentives, and provide guidelines for caution in the judgment of decep-
tive behavior. The chapter by Okifuji, Turk, and Kalkuokalani discusses
both the economic impact of chronic pain and the cost savings that result
from a treatment approach based on the biopsychosocial model. Kerns
discusses the motivation of the patient to engage in pain treatment, and
proposes a stage model for matching treatment approach to the patient's
motivational level. Fernandez, Clark, and Ruddick-Davis take an
indepth look at the role of affect in the experience of chronic pain. This
section of the volume concludes with Merskey's insightful and critical ex-
amination into the use of narcotics, antidepressants, and other medica-
tion in chronic pain.

Part II, comprising the bulk of this volume, examines 14 pain syn-
dromes from a biopsychosocial perspective. Most of the chapters in this
section are cowritten by a physician and a psychologist, in order to pro-
vide a truly integrated approach to evaluation and treatment of the syn-
drome. Section A examines orthopedic and rheumatological conditions.
Chronic back pain, on which the largest body of research has been con-
ducted, is examined in two chapters, one by Geisser and Colwell, and the
second by Block and Callewart. The other chapters in this section pro-
vide insight into the physical and psychological factors associated with
temporomandibular joint dysfunction ( Massoth), whiplash ( Teasell &
Shapiro), and rheumatological disorders ( Bradley).

Section B of Part II examines seven chronic pain conditions having a
strong neurological basis. In many of these syndromes specific elements
of nociception and pain transmission have been examined, in such a way
that they provide insight into the interplay of pathophysiology and psy-
chology. Of particular interest in this regard is the discussion of "pain
memory" in phantom limb pain, in the chapter by Katz. However, for
some syndromes, such as trigeminal neuralgia (as discussed by Eliav &
Gracely) and muscular dystrophy (as reviewed by Perkins, Moxley, &
Papciak), it will be noted that research into psychosocial factors is in its in-
fancy. Other syndromes discussed within this section are general head-
aches ( Kremer & Hudson), posttraumatic headache ( Duckro & Chibnal),
postherpetic neuralgia ( Dworkin & Johnson), and complex regional pain
syndromes ( Steger, Bruehl, & Hardin).

Section C of Part II examines abdominal ( Crowell & Barofsky) and pel-
vic pain ( Reiter) syndromes, two conditions that are becoming increas-
ingly frequent as complaints, and which are associated with significant
medical costs. As noted in these chapters, physicians have long recognized
that there is an interplay of medical and psychological factors in these
conditions, but recent research is fleshing out many of the details of this
complexity.

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