Pain Patients and Their Partners; The Role of Collusion in Chronic Pain

The mystery of pain which is refractory to repeated medical and surgical intervention often becomes understandable upon examination of the chronic pain patient's family dynamics. Analogous to recent descriptions of dyadic patterns in depression, the chronic pain patient typically has a partner who performs a caretaking function. The caretaking role, while superficially appearing “helpful”, is in many cases extreme and contributory to the maintenance of the chronic pain role. The concept of collusion is used here to explain the formation and persistence of patient‐caretaker dyads. Case material is presented to show how an examination of the chronic pain patient and his partner can alert the clinician to the presence of psychological factors in chronic pain.