Looking back: development in our understanding of the occurrence, aetiology and prognosis of chronic pain 1954-2004

This article summarizes the work of the Arthritis Research Campaign Epidemiology Unit in the field of pain and soft tissue rheumatism during the 50 years 1954-2004. It reviews the information gathered on the occurrence of symptoms and its causes, which began with Kellgren and Lawrence's pioneering work during the 1950s in the coalfields and general population of Leigh, Greater Manchester. They studied the roles of posture, mechanical load and the physical environment (dampness) on back pain. This was followed by the Calderdate study in the 1980s examining the prevalence of disability and its causes in the population, which demonstrated the important rote of regional pain in causing disability. More recent studies in the 1990s and at the beginning of the 21st century have allowed us to define the relative roles of mechanical (load) factors, individual (psychological) factors and the social environment, and the biological mechanisms by which they may result in symptoms. The further challenge over the coming decade is to use our knowledge of the aetiology and influences on outcome to design management strategies which demonstrate improved outcomes for patients.