The causes of this calamity are clear. In patients, the fear of addiction, or of being seen as an addict, is common. Their families also typically fear addiction, even in terminal cancer and AIDs cases. Further, patients tend to conceal pain, fearing that increased pain reveals increased illness, something every "good" patient is reluctant to admit or impose upon their family and physician. Among Health Care Professionals, poor pain assessment and communication with patients, fear of patient addiction, fear of medication side-effects, fear of regulatory authorities and inadequate knowledge and pain management skills, are constant barriers to proper pain care.

Regarding the Health Care System, the principle causes of inadequate pain care are insufficient availability and access to pain treatment, inadequate third party reimbursement, low priority for cancer and non-malignant pain, and restrictive and punitive regulation of pain medication and physicians.

The situation is particularly ironic as highly effective new technology has rapidly emerged, which offers great success in the management of pain. New drugs and techniques are available which provide more effective relief with fewer side effects, at lower cost. Unfortunately, the most common alternatives to pain medication, the NSAIDs (non-steroidal anti-inflammatory drugs), are pharmacologically many times more dangerous, and routinely present as gastric injuries in emergency rooms. In 1996, 76,000 hospitalizations, averaging $20,000 each, were caused by these drugs.

Far more seriously, the cost to the nation of inadequate pain treatment is monumental. With contemporary medical management the morbidity of intractable pain can be very substantially reduced. Annually, 1,308 million work days are lost to back pain and 638 million days are lost to headaches. These numbers represent only a portion of the human cost, from acute pain, which is universally under treated.

The costs of chronic pain are probably greater. Intractable pain patients are inevitably disabled; most often completely. With adequate help many could recover significantly. Adequately treated non-malignant pain patients become tax-payers, assert leaders in the pain management specialties. Further, chronic pain inevitably proceeds to depression, and frequently involves alcoholism and illicit drug use, and substantially contributes to the demand for illegal narcotics such as heroin. As also noted by W.H.Stein, M.D., of the UCLA Medical Center, patients in unrelieved pain suffer increased psychiatric illness, more suicides, deteriorations in immune functions and increased metastatic cancer growth. Families are daily destroyed by the fall out of untreated pain. The status of the treatment of chronic pain is abysmal. Stein noted that in one recent study 81% of physicians and nurses felt that the most common form of narcotic abuse in the care of the dying is the under treatment of pain.

Lastly, the professional costs of treating pain are staggering. According to DEA testimony, In 1995 and 1996, 900 physicians were prosecuted and lost their narcotics licenses for attempting to treat chronic pain with appropriate narcotics. This represents an incidence of almost 1 per every 300 U.S. physicians. In November of 1997, at a meeting in Phoenix, Arizona, of 125 attending pain management specialists, including orthopedic surgeons, neurologists, anesthesiologists, physiatrists, family practitioners and psychiatrists, 20 had been the object of prosecution. In at least 30 states in the union, despite overwhelming contemporary scientific acceptance of the on-going treatment of chronic, non-malignant pain, chronic use of narcotic pain medications is not permitted and is prosecuted. Despite repeated clinical studies which show that less than 1% of all chronic non-malignant pain patients ever demonstrate any symptoms of addiction, the myth of addiction, plus tabloid sensationalism about a "drug-free America", continue to drive "opiophobia".

Regarding state-level values, the Pain Research Study Group at the University of Wisconsin surveyed all the Medical Boards in the nation on their attitudes and policies regarding pain control. While 75% of the respondents approved of the use of narcotic pain medications for cancer pain patients, fully 25% of the respondents still believed that pain medications should not be regularly prescribed for cancer pain. Further, regarding the treatment of intractable pain from non-malignant causes, only 14% approved of the use of narcotic pain medications for non-malignant pain patients, and stated that they would prosecute physicians doing so! Antiquated values and attitudes, and misinformation, still dominate the state level of regulation.