The article by Cohen and colleagues ⇓ challenges the concept of persistent pain as a disease and raises some interesting points for discussion. As one of the authors of the article to which they refer ⇓, I appreciate the opportunity to make a reply. There are many points raised in their article and it is not possible to address them all in an article of this length. I will largely confine myself to the central issue of persistent pain as a disease. As Cohen and colleagues correctly assert, the central question is one of definition. In fact, there are two questions that are fundamental to this debate: What is a disease? And, does pain meet the criteria for that definition? In our original article, we gave a definition from the Oxford dictionary, but the definition put forward by Cohen and colleagues is equally valid. Although space is limited, it is worth restating because it is central to the whole issue. Their definition of a disease is as follows; “a disease is any deviation from or interruption …