Conclusions

Technological advancements, developments in medical science, and increasing expectations of communities as to what is available from healthcare providers continue to focus attention on the healthcare dilemma. Irrespective of funding levels, choices always have to be made as to where resources are allocated. In making such choices, decision-makers need to establish an explicit set of priorities while attitudes among professionals and societies need to be changed. The on-going development of evidence-based practice, the removal of interventions and services that provide no benefit, the recognition that resources are finite and choices have to be made, and an awareness of the need for fairness in resource allocation and service provision, are major steps along the road towards better health care, as well as addressing the issue of how much additional resources should be put into healthcare services. Although the evidence base on which to conduct economic analyses in the area of pain management is suboptimal and there are technical problems surrounding economic approaches to priority setting, these should not be allowed to detract from the fact that economic evaluation provides a rational framework within which other issues and approaches can be embraced and priorities established to move towards better health care.

Better health care does not necessarily require additional resources. Whole systems thinking, based on good quality relevant evidence rather than an aggregation of narrow, budgetary-focused organizations pursuing their own agendas without regard for the wider perspective, would have a major positive impact on the management of patients with chronic pain. More work is needed to develop a broader, strategic, whole systems agenda in pain management. High quality relevant evidence and health economics techniques and approaches are essential components of this particular agenda. Together they can provide the tools which decision-makers can utilize in the drive for reductions in pain and better health and health care for our respective communities and societies.

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