Pain represents a major clinical, social, and economic problem and one which has challenged generations of healthcare professionals across many continents as they attempt to provide relief to reduce the suffering caused by pain. The advent of modern anesthetics and analgesics has meant that the effects of pain can be ameliorated, but even in hospital settings in recent years, nearly nine out of every ten patients have experienced pain levels considered to be excessive.1,2 This proportion is clearly unacceptable and represents a challenge to those involved in the commissioning and provision of services. It has been argued that "pain relief should not be seen as someone else's responsibility or simply dismissed because in the end the pain and the patient go away. Freedom from pain is important to patients. In 1846 the first anesthetic provided pain free surgery. One hundred and fifty years later, patients should not have to endure unrelieved pain anywhere in the hospital.''3 However, for many patients pain is more or less a permanent feature of their lives and extends well beyond the acute phase. Pain has a profound impact on their quality of life, and for them, it is the management of their pain that is important, so that suffering is minimized for as much of the time as possible. It has been recognized that chronic pain is one of the most widespread and difficult problems the medical community has to face,4 with other symptoms, such as depression, anxiety, physical dysfunction, and social isolation, often presenting alongside.5
The epidemiology of chronic pain has been addressed in Chapter 5, Epidemiology of chronic pain: classical to molecular approaches to understanding the epidemiology of pain. While many attempts have been made to estimate the prevalence of chronic pain,6'7'8'9'10'11'12'13'14'15, 16'17 the range of estimates bears testimony to the difficulties involved in defining the condition and the difference in approaches and methodologies employed to determine the extent of chronic pain across different population groups. Moreover, the impact of chronic pain is expected to increase dramatically as the effects of population ageing are manifest, while changes in lifestyle factors are also predicted to further increase the burden, as increased obesity and lack of physical activity resulting from the "increased urbanization and motorization of the developing world'' will increase the prevalence of conditions associated with chronic pain.16
The prevalence and impact of chronic pain have also led to calls for it to be regarded as a disease entity in its own right,18'19 with a consensus emerging that failure to secure appropriate management strategies for pain is unethical and may be susceptible to legal and professional action.18
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Do You Suffer From Chronic Pain? Do You Feel Like You Might Be Addicted to Pain Killers For Life? Are You Trapped on a Merry-Go-Round of Escalating Pain Tolerance That Might Eventually Mean That No Pain Killer Treats Your Condition Anymore? Have you been prescribed pain killers with dangerous side effects?