Management of acute and chronic pain has always presented the medical profession with special clinical and social challenges. The cause of chronic pain is often elusive and its diagnosis dependent largely upon the patient’s subjective description. The absence of fully effective means to assess and treat complaints of pain, combined with conflicted social attitudes about pain itself, has historically resulted in widespread under-treatment of the problem, particularly in the elderly and in those with chronic or critical conditions. Concern about the extent of under-treatment has, in recent years, led respected professional societies and international health organizations to urge the medical profession to be more thorough and aggressive in combating patient pain.
At the same time, however, key pharmaceutical tools essential to the alleviation of chronic pain—particularly opioid medications—are increasingly diverted and misused for non-medical purposes, creating an alarming social and public health problem of prescription medication abuse. Within the past four years, prescription medications (most prominently, the opioids Vicodin and OxyContin) have ranked second only to marijuana as drugs of abuse, especially among young adults and teenagers. Some estimates indicate that 10% of all teenagers have abused Vicodin and 5% have abused OxyContin. Not only do diversion and misuse of these drugs create major health and safety concerns in their own right, the prevalence of abuse and diversion serves to further stigmatize the legitimate pain patient and diminish the accessibility of needed medical care.