Editor – We thank Dr Sawyer for his interest in our paper ‘The challenges of chronic pain and fatigue.’ It is, of course, implicit in much of what we say that pain and fatigue have a biopsychosocial dimension. We would not otherwise be advocating a multi-professional management strategy involving significant input from mental health professionals, the avoidance of over-investigation and medicalisation and, in our index case, referral to a dedicated pain-management service. The article contextualises the psychological factors implicated from a biological perspective. Several other manuscripts in the edition give the wider psychological framing.
Many conditions present with impairment of both physical and mental health. We feel strongly that in all cases it will be the evolution of a deeper understanding of the biology and pathophysiology of these illnesses, including myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) and fibromyalgia, that will in time lead to the evolution of more rationally-based and effective treatment strategies. Moreover, we feel that is it all too frequently the case that labelling a condition as ‘biopsychosocial’ or ‘psychological’ leads to negative perceptions among healthcare professionals, and may unfortunately result in physicians abrogating their clinical responsibilities to affected patients, as in our exemplar, Dr A.