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This is the first part of a two-part extended review on the interdependency between chronic pain and families. This paper will address the role of the family in the etiology and maintenance of chronic pain and will describe the reciprocal impact of chronic pain on families. Different conceptualizations of the role of the family and the available empirical evidence related to 3 central questions, namely, ‘do families play an etiological role in chronic pain?,’ ‘does the family maintain the chronic pain problem?,’ and ‘is there a negative impact of chronic pain on the family?’ will be critically examined. The second, companion paper will address the issue of the inclusion of family members in the assessment and treatment of chronic pain. Finally, recommendations for future research will be made.