Response to the article: "stigmatization of patients with chronic pain: the extension of empathy." Cohen ML, Quintner JL, Buchanan DA, Nielsen M, Guy L. Pain Med 2011;12:1637-43.

The first inference to be drawn from the article by Cohen et al. is that patients become (or are likely to become) stigmatized where a doctor fails or declines to authenticate a clinical presentation using the template provided by “the scientific revelations of neuroplasticity that provide plausible neurobiological explanations for complex sensory and motor phenomena which would have once been dismissed as residing in the mental domain” [1]. The second is that doctors who do not toe the party line i.e., who fail to endorse this explanatory model themselves run, the risk of being stigmatized. One cannot help but be reminded of the Australian repetition strain injury (RSI) epidemic of the 1980s and 1990s in which the high priests of RSI demonized as “incompetent” those doctors with the temerity not to diagnose RSI in those presenting with unexplained, upper limb pain occurring in an occupational setting [2]. Now in Australia, RSI is a historical footnote.