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Moreover, studies suggest that in the majority of cases the emotional distress observed in these patients occurs in response to persistence of pain and not as a causal agent (eg, Okifuji, Turk, & Sherman, 2000; Rudy, Kerns, & Turk, 1988) and may resolve once pain is adequately treated (Wallis, Lord, & Bogduk, 1997) Not surprisingly, insightoriented therapy has not been shown to be effective in reducing symptoms for the majority of patients with chronic pain There are, however, some patients for whom such insight is essential before they are able to engage successfully in rehabilitation (Grzesiak et al, 1996) Secondary-Gain Model of Chronic Pain The secondary-gain model is an alternative to the psychogenic model.

Zehr (1990) convincingly argued that many crimes rupture human relationships and that it is these relationships that need to be repaired Currently, crime is viewed as contrary to the state, and the state punishes an offender (who is made into a criminal, who often attempts to avoid responsibility by offering a defense) and largely ignores the victim Zehr suggested that, as an alternative, the state ask the victim if he or she would like to meet the offender and see what the offender could do to restore the human relationship between them Studies of trial programs of such restorative justice have found that about 50% of victims want to meet the person who wronged them, that it is usually possible to negotiate a way to restore the human relationship, and that in such cases there is much less recidivism Justice has been attained nonviolently, by restoration rather than retribution.

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Peace Through Justice There are times when repressive forces are so strong that a completely unjust peace may exist for years However, situations inevitably change, and when opportunities arise, rebellion and revolution occur, often killing some who opposed the injustice that existed Yet the path of peace through justice is much more than an attempt to stave off violent revolution..

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From this perspective, reports of pain in the absence of or in excess of physical pathology are attributed to the desire of the patient to obtain some bene t such as attention, time off from undesirable activities, or nancial compensation secondary gains In contrast to the psychogenic model, in the secondary-gain view, the assumption is that the patient is consciously attempting to acquire a desirable outcome Simply put, the report of pain in the absence of a pathological process is regarded as fraudulent (Bayer, 1984) Assessment of patients from the secondary-gain model focuses on identifying discrepancies between what patients say they are capable of doing and what they actually can do or from facial expressions that deviate from norm-based expectations (Craig, Hyde, & Patrick, 1991).

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A high degree of discrepancy between what patients say about their pain and physical capacity and performance on more objective assessment of physical functioning and facial expressions are.

Rule-of-thumb methods (such as that a restaurant should price its menu items at 2.5 times food cost to achieve a 40% cost of sales) may have had validity at one time but should not be relied on in today s highly competitive environment because they pay no attention to the marketplace (competition, value for money, and so forth).

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