Dilemmas in the treatment of chronic pain.

Chronic pain affects millions of people and results in activity limitations and psychologic and social problems. Even with the armamentarium of analgesics currently available, patients continue to receive inadequate relief of their painful conditions. One of the primary factors that limits appropriate utilization of analgesics is the spectrum of adverse effects that often results following acute and chronic use. In addition, legal and regulatory barriers, inability of physicians and other healthcare professionals to accurately assess pain, societal attitudes toward selected classes of pain medications, and other factors complicate pain management. Understanding how these barriers contribute to the undertreatment of pain and incorporating effective pharmacologic and nonpharmacologic measures into a treatment plan are required to manage patients with chronic pain.