Scott M. Fishman, MD, editorial in the International Anesthesia Research Society, July 2007, argues that pain management is neither an absolute science nor risk free. At one extreme is the clinician who avoids pain treatment completely, which has brought criminal charges of abuse for under-treating a patient.

The opposite extreme are federal regulations that blur the line between substantial use of controlled substances for pain control and criminal activity. Although there is wide support by U.S. physicians for pain control there are pressures that lead doctors to under-treat pain. Much of the pressure comes from the Federal government in their efforts to stem the abuse of prescription drugs.

Despite chronic pain being the number one reason patients seek medical care the National Institutes of Health (NIH) does not have an institute that focuses primarily on pain. The funding for pain research is also inadequate. Even with the enormous number of patients seeking relief from chronic pain, specialists to treat them is a scarce resource.