P-A-I-N: a four-cluster MMPI typology for chronic pain

Raymond M. Costello, Timothy L. Hulsey, Lawrence S. Schoenfeld, Somayaji Ramamurthy

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


A 4-cluster empirically derived MMPI typology for chronic pain sufferers has been demonstrated by combining the results of 10 investigative teams. These MMPI 'types' have been labeled P-A-I-N and appear to have important clinical and demographic correlates. Type P is the most 'psychopathological' looking as nearly all scales are usually elevated. Type P patients are extreme in their claims of physical illness, psychological distress and social maladaptation. Demographic correlates include poor education, high rates of unemployment, and limited household income. Type A is defined by a 'conversion V' on the 'neurotic' triad scales. It has no unique correlates. Type I has elevations on all of the neurotic triad scales and on no others. Type I patients appear to be the most physically infirm with multiple surgeries and hospitalizations. They may not improve physical status with treatment, but appear to benefit psychologically. Type N profiles are 'normal' in that no scale, except perhaps scale K, is often elevated. Type N patients are moderate in their claims of ill health, often are better educated and employed, and appear to respond well to treatment. Classification rules have been proposed to allow patient-typing without a computer. Use of these rules should allow programmatic research into treatment/ type interactions even in the ordinary clinical setting. The typology appears well enough established to allow for prospective studies to test theoretical hypotheses drawn from the literature base.

Original languageEnglish (US)
Pages (from-to)199-209
Number of pages11
Issue number2
StatePublished - Aug 1987


  • Chronic pain
  • MMPI typology

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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