The burden of suffering pain imposes on individuals and the enormous costs, which society has to bear as a result, demonstrate that policy-makers, commissioners, and healthcare decision-makers should adopt a broad, strategic, and coherent perspective in determining issues relating to service provision and resource allocation. Fragmented, budgetary-based interventions and programs based on at best inadequate evidence do little to alleviate the problems associated with chronic pain and deprive patients of those services that would have a positive impact. Differentials between the demands placed on health services for treatments for pain relief, and other aspects of health care and the resources available to meet such needs, continue to be major headaches for those involved in policy-making, decision-making, commissioning services, and the provision and delivery of healthcare services. It has therefore been advocated that decisions relating to patient management are made with regard to "the three Es'' -effectiveness, efficiency, and equity.55
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