Pain: disease or dis-ease? The John Bonica Lecture: presented at the third World Congress of World Institute of Pain, Barcelona 2004.

Chronic pain has only recently been recognized as an important health care issue. There is no widely shared agreement as to the best ways to diagnose and treat chronic pain patients. Pain management is a chaotic component of contemporary medicine. I argue that we need to think of chronic pain as a disease in its own right and develop our specialty of pain management on the basis of evidence for treatment outcomes. The current chaotic state confuses patients, health care providers, and payers. It is possible that pain management may disappear from health care if we do not improve our understanding of chronic pain and how to best treat those who suffer.