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Despite its importance for chronic pain diseases, pain-related disability is a poorly defined concept with theoretical deficits. The distinction between impairment, disability, and handicap proposed by the WHO is an important contribution to clarification of the disability construct. With reference to four criteria (underlying disability construct, degree of behaviour generalization, assessment mode, scope) different assessment procedures of pain-related disability are presented and the advantages and disadvantages of each are discussed. A multidimensional approach to pain-related disability is advocated. Diagnostic information yielded by different assessment procedures should be viewed as complementary rather than as exclusive data sources. A German version of a self-report instrument (Pain Disability Index) that assesses disability in chronic pain patients is presented. The results from four data sets concerning different aspects of reliability and validity confirm the good psychometric properties of the instrument. The instrument can be used in chronic pain research as well as in clinical contexts. It is recommended that subjective disability data be complemented by behavioral observation and additional data sources (e.g. assessment of disability by the spouse/partner).

A multidisciplinary approach, acknowledged as being the best treatment strategy for a wide range of chronic pain patients, requires cooperation at least between trained professionals in the medical and the psychological disciplines. Psychological criteria are formulated to bridge persisting gaps in the interdisciplinary implementation of pain treatment strategies.

Psychosocial factors play a decisive part in the development of chronic pain. They have an effect on the success of treatment, even when signs of a physical disease are present. There are, however, no common personality features or any characteristic forms of psychic disorders that could be demonstrated in these patients. Hypothetical explanations for the correlations between psychic factors and chronic pain, and various psychological modes of treatment are presented. Indications for the detection of risk patients are given.