Abstract This chapter explores evidence suggesting an adaptive basis for chronic pain and the conceptual implications. A literature review included: human pain, animal pain across species, caregiving, cooperation, evolutionary theory, and signaling theory. Traditional models of chronic pain focus on proximal features rather than distal origins. Evolutionary perspectives emphasize pain’s late recuperative stage involving interactions between helpers and sufferers. Species vary in care-eliciting/caregiving behaviors, with some being biologically prepared to help, while others ignore injured conspecifics. Cooperation, the foundation of caregiving, evolved through diverse mechanisms. Research highlights communication and coping aspects of pain behavior, with signaling theory and cost-benefit perspectives adding new dimensions. If chronic pain evolved promoting care-elicitation to facilitate recuperation it may have been ancestrally adaptive. Understanding chronic pain in the social contexts of patients’ lives provides greater understanding than viewing patients as displaying abnormal pain behaviors.