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From earlier work on the effects of instructional sets, it was hypothesized that subcultural differences in attitudes toward pain should be reflected in psycho‐physiological correlates. Yankee, Irish. Jewish, and Italian housewives participated in threshold and magnitude estimation studies of electric shock, and their skin potential responses to repetitive electrical stimulation were recorded. Significant differences in upper thresholds and in the adaptation of diphasic palmar skin potentials are consonant with attitudinal differences, and such differences support earlier findings on the influence of sets on psychophysiological functioning.

SYNOPSIS The results of the study support the findings that vascular headache patients obtain lower MMPI scores than do muscle contraction and mixed headache patients. We suggest that this may be due to more frequent and longer pain‐free intervals. We also note a tendency for male muscle contraction headache patients to be somewhat more morally self‐righteous than the other categories, but this finding requires confirmation. Comparisons between these headache patients (all categories) and 50,000 general medical patients showed the former to obtain scores markedly greater than the latter on most scales; this also may reflect greater duration and severity of subjective distress.

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A national survey of pain in the United States has been conducted, using a sample of 1254 persons 18 years of age or more, statistically constructed so as to permit projections to be made to the entire adult population of 174 million with a predicted accuracy of +/- 2-3%. Pain prevalence and severity, and its impact on work and other activities were obtained and correlated with demographic variables. This paper reports the portion of the study examining the association of pain with stress, daily hassles, measures of health locus of control, and various health habits. There was a very strong association between stress and pain and hassles and pain. The greater the stress and hassles, the greater the incidence, frequency and severity of all pains reported. Those with high internal health locus of control are more likely to have healthy behavior, are less likely to have all kinds of pain, and have less severe pain. Stress was voluntarily mentioned by respondents as a major cause of pain in headaches, backaches, stomach pains, and menstrual pains, but not for muscle, joint or dental pains.

Common criticisms of behavioral treatment programs for chronic pain are summarized. Some criticisms are based on conceptual misunderstandings; therefore, basic concepts and goals of behavioral programs are presented. Other criticisms question the effectiveness of these programs; therefore, the role of social reinforcers in maintaining or reducing pain behaviors is reviewed. The failure to isolate specific treatment variables is alleged; this is acknowledged, along with the practical and ethical questions making this virtually impossible. Finally we describe the need to change the thinking about 'pain' from the pathological or disease model, appropriate to acute pain, to a learning model when discussing the excess disability and suffering of chronic pain patients.

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