The field of Pain Medicine has evolved over the last 20 years to include an increasing array of sophisticated and technologically complex diagnostic and the- peutic procedures. Concurrent to this advancement has been the development of a battery of pharmacological options to treat pain, from extended-release formulations of analgesics to antidepressants and anticonvulsants designed to treat specific types of pain syndromes. Despite (and perhaps because of) this phenomenal growth, it is not uncommon for patients with persistent pain to find themselves having gone through a number of procedures and taking a growing list of medications without ever expe- encing true resolution of the condition or a return to a normal lifestyle and function. Inherent in this approach is the viewpoint that the clinician’s role is to do something to the patient that will reduce symptoms rather than to work in concert with the patient to either resolve the root causes or ameliorate the functional consequences of their pain condition. Although motivated by the desire to help, this model of pain management neglects individual choice and personal responsibility. This approach is of even greater concern in special populations such as the elderly.
