REVIEW Changing Face of Pain: Evolution of Pain Research in Psychosomatic Medicine FRANCIS J. KEEFE,PHD, MARK A. LUMLEY,PHD, ANGELA L. H. BUFFINGTON, MA, JAMES W. CARSON, MA, JAMIE L. STUDTS, MA, CHRISTOPHER L. EDWARDS,PHD, DEBRA J. MACKLEM, BA, ANN K. ASPNES, BA, LAURIE FOX, BA, AND DANIELLE STEFFEY, BA Objective: This article provides an overview of how psychosomatic research on pain has evolved over the past 60 years as exemplified by studies published in Psychosomatic Medicine. Methods: Each issue of Psychosomatic Medicine from 1939 to 1999 was reviewed to identify papers that dealt with pain, painful medical conditions, or pain management. A total of 150 papers were identified and grouped into seven categories: 1) case studies; 2) studies of personality traits and other individual differences; 3) psychophysiological studies of pain; 4) studies using pain induction techniques; 5) studies examining the relation of relation of race, ethnicity, and culture to pain; 6) studies of pain unique to women; and 7) studies examining treatments for pain. Results: A substantial number of studies on pain and painful conditions were published in the Journal in the 1940s and 1950s, and that number has almost doubled in the most recent full decade of the Journal. Within the pain area, however, the topics of interest to psychosomatic researchers have been, and continue to be, quite diverse. Although publications on certain methods or topics (eg, psychodynamic case studies, physiological correlates of pain) have decreased over time, publications on other topics (eg, personality traits and individual differences) have remained relatively constant, and publications on still other topics (eg, studies using pain induction techniques; studies of race, ethnicity, and culture; women’s pain; and treatment studies) have flourished recently. Conclusions: Considered overall, the results of our review suggest that the face of pain research published in PM has changed considerably in the past 60 years. Given the ongoing commitment of psychosomatic researchers to this area, we expect this evolution to continue in the years to come. Key words: pain, pain assessment, pain management, chronic pain. ACTH = adrenocorticotropic hormone; CBT = cogni- tive-behavioral therapy; EEG = electroencephalogra- phy; EMG = electromyography; MDQ = Menstrual Distress Questionnaire; MMPI = Minnesota Multipha- sic Personality Inventory; PM = Psychosomatic Medi- cine; PMSS = premenstrual symptoms and syn- dromes; RCT = randomized, controlled trial; TMD = temporomandibular disorder. INTRODUCTION Severe or persistent pain is one of the most chal- lenging experiences that a person can face. During the past 20 years, research on pain and pain management has burgeoned (1). Pain researchers have formed inter- disciplinary scientific organizations and created spe- cialized journals devoted to advancing the under- standing and treatment of pain. Although pain as a unique research topic has only recently become pop- ular, psychosomatic practitioners and researchers have long been intrigued with the phenomenon of pain and the people who suffer it. More than 60 years ago, some of the earliest psychosomatic clinicians (2) wrote about their experiences in treating patients who had chronically painful diseases; shortly after, psychoso- matic researchers began to systematically study pa- tients suffering from painful disorders. Psychosomatic researchers were among the first to recognize the com- plexity of pain; to highlight the important role played by emotional, cognitive, and social factors in the de- velopment and maintenance of pain; and to demon- strate that people vary substantially in their responses a painful condition. The purpose of this article is to review of how psychosomatic research on pain has evolved over the past 60 years. We sought to evaluate how the topics studied by psychosomatic researchers interested in pain have changed, how the research methods used have evolved, and how the conceptualization of the causes and consequences of pain have developed. An overarching goal was to determine how these topics, methods, and conceptualizations have influenced con- From Duke University Medical Center (F.J.K., C.L.E., D.S.) and Duke University (F.J.K., A.L.H.B., A.K.A.,), Durham, North Carolina; Wayne State University (M.A.L., D.J.M.), Detroit, Michigan; Univer- sity of North Carolina (J.W.C.), Chapel Hill, North Carolina ; Univer- sity of Lousiville School of Medicine (J.L.S.), Louisville, Kentucky; and Ohio University (L.F.), Athens, Ohio. Address reprint requests to: Francis J. Keefe, PhD, Duke Univer- sity Medical Center, Box 3159, Durham, NC 27710. Email: keefe003@mc.duke.edu Received for publication April 5, 2001; revision received January 3, 2002. DOI: 10.1097/01.PSY.0000038934.67401.BA 921 Psychosomatic Medicine 64:921–938 (2002) 0033-3174/02/6406-0921 Copyright © 2002 by the American Psychosomatic Society