This Article examines the problem of enigmatic chronic pain. The principal contention is that psychosomatic explanations of chronic pain are flawed, despite their inordinate popularity with social critics, expert witnesses, and a growing number of judges. There is little empirical evidence to support the view that chronic pain is principally a symptom of psychic conflict and distress, and much evidence to rebut it. Most compelling is the emerging biological evidence demonstrating that much chronic pain results from pathology in the central nervous system, rather than discrete injury or illness like that which produces acute pain.

The problem of chronic pain is examined by focusing on the most prevalent chronic pain syndrome found in litigation today, fibromyalgia. Fibromyalgia is nothing less than the widespread pain of rheumatism that has distressed humanity throughout recorded history. This pain syndrome has been described as one of the "most controversial conditions in the history of medicine," and it is at the center of the debate about the nature of chronic pain. Part II begins by examining how chronic pain often straddles competing diagnoses in medicine and psychiatry, thus lending credibility to both organic and psychogenic concepts of pain. Part III then examines how the concept of psychosomatic pain or "somatization" has attained prominence in cultural history and critical medical literature. Although the concept of somatization does not intrinsically disparage chronic pain, it has acquired a distinct secondary meaning - that pain symptoms are exaggerated or feigned and, ultimately, within the control of the sufferer. Segments of the insurance and health care industries have now appropriated the theme of somatization to minimize the chronic pain experience and control health care costs.

Part IV next assesses empirical research concerning the role of psychological distress in the generation of chronic pain. As demonstrated, there is widespread acceptance that psychological factors play a role in the pain process. But research does not support the much broader claim that chronic pain syndromes are largely the consequence of psychological distress. The neo-Freudian concept of somatization has been greatly oversold and is driven more by theory than scientific evidence.

Finally, Part V examines the developing biological model of chronic pain. A compelling body of evidence now demonstrates that the acute-pain model still dominant in medical practice and the law is incomplete. There is growing recognition that the central nervous system is far more plastic than previously imagined. In an appreciable segment of the population the central mechanisms governing pain can be fundamentally altered, resulting in the persistent production of pain with no discernible relationship to bodily injury or illness. These central mechanisms, rather than mental disturbances, dispel the enigma of much chronic pain.

Part VI concludes that, somewhat remarkably, while a fundamental reassessment of chronic pain has occurred in the scientific literature, this reassessment has gone unnoticed in the law. Until courts rethink the prevailing model of pain and its mechanisms, chronic pain will remain a stubborn mystery, and its sufferers will remain under suspicion as latter-day hysterics and malingerers.

This Article considers the constitutional status of state punitive damage judgments and the particular obligation that sister-states have to enforce them. Part I considers the legality of measures recently enacted by the tobacco companies' home states to delay enforcement of the judgment in Engle. This discussion will show that, contrary to the public protestations of many legal scholars, those states properly exercised their authority under the Full Faith and Credit Clause of the Constitution when they acted to defer enforcement of the Engle judgment while it is appealed through the Florida courts.

Part II of this Article considers whether there is any obligation under the Full Faith and Credit Clause to enforce sister-state judgments for punitive damages. According to Supreme Court precedent dating back to the nineteenth century, "penal" judgments are not entitled to full faith and credit. While the penal judgment rule has not seen great service in recent decades, its reexamination is timely. First, there is widespread agreement that modern punitive damages awards no longer serve the compensatory purposes they served at the time the Full Faith and Credit Clause was ratified: Punitive damages now serve the quasi-criminal purposes of deterrence and punishment, and are therefore penal in nature. Second, an increasing number of states have reaffirmed the penal role of punitive damages by appropriating a share of the plaintiff's punitive award. Such shared recovery laws emphasize that punitive awards now vindicate "public wrongs," and so fulfill the historical purpose of penal laws.

This Article contends, however, that the penal judgment rule should not be extended to permit the denial of full faith and credit to judgments for punitive damages. Notwithstanding the linguistic similarity in the epithets penal judgments and punitive damages, the concepts address quite different concerns. Further, application of the penal judgment rule to punitive damages awards would serve no state or litigant interest not already addressed by other constitutional provisions - particularly the Due Process Clause. For these reasons, courts should not revivify the penal judgment rule to address contemporary problems posed by punitive damages awards.

This Article concludes that the Constitution offers defendants who suffer the imposition of catastrophic verdicts like that in Engle a measure of protection. States may, and after Engle should, eliminate appellate bond requirements for punitive awards when there is no reason to suspect that the judgment debtor will intentionally dissipate its assets. This approach will leave intact appellate bond requirements for compensatory damages, and thus secure the judgment creditor's right to be made whole for his losses. At the same time, judgment debtors need not face the prospect of bankruptcy, or exorbitant settlement, simply because they cannot post security for an aberrant, punitive verdict like that in Engle. The Supreme Court has emphasized the critical role of appellate courts in policing unconstitutionally excessive punitive verdicts, and that role can only be fulfilled if the appellate process is affordable.

Realistic appellate bond requirements, however, are only part of the solution. Engle sounds a grave warning. The current system of tort law increasingly "commits the fate of an entire industry or, indeed, the fate of a class of millions, to a single jury."The constellation of interests affected by mass tort litigation--injured persons, consumers, states, national industries, and local economies - exceeds the competence of a single jury or single state court to resolve. A national solution is needed, and by default the task of devising that solution falls on Congress.