Abstract
Secondary gain is claimed to be important to the generation and maintenance of disease or illness behavior. This concept is of major interest to the clinician dealing with the chronic pain patient, as these clinicians often encounter patients with whom secondary gain factors are suspected or inferred, or both. The author begins a critical examination of the concept of secondary gain. Primary, secondary, and tertiary gains and secondary losses are defined and described. Difficulties with and abuses of the secondary gain concept in chronic pain treatment are presented.
