Dear Editor, We read with great interest the article by Cohen and coworkers [1], who critically discussed the view that chronic pain may be considered as a disease on its own because the pathophysiological grounds of chronic pain conditions are still uncertain and there are big difficulties in separating eudynia (good pain) from maldynia (bad pain) [2]. In addition to the pathogenic and taxonomic issues [1], the concept of chronic pain as a disease may carry the risk of a delay in the diagnosis of the pathology underlying pain and inappropriate treatment, as demonstrated by the following cases. ### Case 1 A 15-year-old boy reported a 2-year history of severe low back pain (LBP) with a numeric rating scale (NRS) of 8–9/10, right lower-limb irradiation, and that worsened during walking. Four months after the onset of LBP, he underwent a lumbar magnetic resonance imaging (MRI; Figure ⇓A), which was performed without gadolinium (Gd), and was reported as unremarkable. Different treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, gabapentin, and physical therapies were only slightly effective on LBP (NRS reduced to 6–7/10). Chronic LBP with reactive depression and psychogenic LBP were suspected in two different pain centers, and psychotherapy was started with no consistent change in …