The Conundrum of Pain

The year 2000 was an important year in the world of pain and its management. Pain was officially designated as the “5th vital sign” by the Veteran’s Health Administration and Congress, and the year was designated as the beginning of the Decade of Pain Control and Research. The impetus behind these actions was to recognize that pain was a significant medical condition in the United States and that patients had a right to expect that it would be appropriately assessed and treated. Expectations were that research would identify outstanding questions and they would be answered. Unfortunately, what followed was what I now refer to as “the conundrum of pain.” Instead of consensus formation, passionate debates and finger-pointing ensued not only about whether or not designating pain as the 5th vital sign was actually a marketing strategy developed by pharmaceutical manufacturers of opioids, but also with respect to whether or not these and other actions ignited and fueled what was to become the overdose epidemic that continues to plague our nation today. This chapter will explore and review my perspective about these and other events which took place starting in 2000 and led to controversies which continue to exist today about how pain should best be managed and the role of opioid analgesics in creating the overdose epidemic. Additionally, this chapter will discuss that even though education has been considered to be a critical puzzle piece in solving some of these controversies, education about pain and substance use still lacks its place as part of the core curriculum for healthcare professionals, living in a conundrum of its own.