Primary, secondary, and tertiary losses in chronic pain patients

Treating individuals with chronic illness and disability requires attention to physical, psychological, and social factors. These unique challenges are optimally addressed by utilizing a biopsychosocial approach, while considering the potential array of both gains and losses that chronic pain patients experience. The benefits a patient receives from remaining ill are often referred to as secondary gain. In medicolegal settings, a common example of a secondary gain issue is the effort to obtain financial compensation. While secondary gain can be one factor that contributes to perpetuating illness and disability, there are often more powerful losses that lead to such perpetuation. The losses associated with pain and disability are not frequently discussed. The overall purpose of this paper is to identify primary, secondary, and tertiary loss issues in chronic pain patients, and address issues related to how these factors are important within a medicolegal/forensic context.