The concept of alexithymia,a lack of emotional awareness and ability to describe feelings,was originally coined by Sifneos to describe a common characteristic of patients with psychosomatic illness. Accumulating previous research has shown that alexithymia is associated with pain in patients with a number of chronic pain conditions. Clinically,chronic pain patients who were resistant to ordinary biomedical approach and consulted to our department of psychosomatic medicine in Kyushu University Hospital have shown to be severely alexithymic.To elucidate the clinical role of alexithymia in chronic pain,we review the historical research on chronic pain and alexithymia.The identified articles studied alexithymia in a number of patient groups,including patients with pain at specific sites (e.g.,head,neck,shoulder,low back,extremity,head,chest,abdomen,and pelvis pain) as well as in patients with diagnoses associated with chronic pain (e.g.,fibromyalgia,temporomandibular disorder,cancer,chronic fatigue syndrome,lumbar spinal stenosis,and grossodynia). The most common measure of alexithymia in the research literature is the Toronto Alexithymia Scale (TAS-20),which assesses three distinct components of alexithymia: (1) difficulty identifying feelings,(2) difficulty describing feelings,and (3) externally-oriented thinking.Overall,the findings indicate a significant association between alexithymia and pain,and also that this association is moderated by a number of factors,such as heritability,family environment,negative emotion,sociodemographic variables (e.g.,age,gender,ethnicity,education,income),illness behavior,communication skills,coping responses,and social support.Moreover,neuroimaging research suggests that alexithymias association with pain may be associated with activity in a number of areas that are also a part of the pain matrix,such as the anterior cingulate cortex,insula cortex and medial frontal cortex.With these evidence,we sought to determine if the associations among measures of alexithymia,pain and functioning (pain interference,mental health,and vitality) replicate in samples of persons with chronic pain and neuromuscular disease in collaborating research with Department of Rehabilitation Medicine,University of Washington School of Medicine.One hundred and twenty-nine individuals with muscular dystrophy and chronic pain were administered measures of alexithymia (Toronto Alexithymia Scale,TAS-20),pain intensity (0-10 NRS),pain interference (Brief Pain Inventory Interference scale),mental health (SF-36Mental Health scale; as a proxy measure of negative affect) and vitality (SF-36 Vitality scale).Higher TAS scores were associated significantly with higher pain intensity and interference,and less vitality. Although the strengths of these associations were reduced when mental health was used as a control,the associations between the Difficulty Identifying Feelings scale and vitality,and the Externally Oriented Thinking and Total TAS scales and pain intensity remained statistically significant. The findings replicate and extend previous findings concerning the associations between alexithymia and important pain-related variables in a sample of persons with chronic pain and neuromuscular disease.Following the previous evidence,however,future research is needed to confirm these findings and determine the causal nature of these associations,and if modification of alexithymia has a beneficial impact on pain and its negative effects.