ABSTRACT
Chronic pain is conveniently defined as any pain that persists for at least three months despite sensible treatment. It ultimately affects almost half of all adults and is most likely to occur in older people. Chronic pain is known to have significant effects on health and well-being and is a major cause of lost work days. Prevalence data alone does not capture the burden of pain, or the disability which goes with the pain. For many conditions there is no certain remedy, so that health care needs have to consider prevalence, the burden of the pain (and disability), and just how treatable the pain is. In addition, health care needs for chronic pain extend from community through to hospital care. Patients with some chronic pain conditions, such as migraine, may manage with over the counter medications; others will require prescription medication and some will need other interventions. One organisational dilemma is the overlap of pain management between community and hospital care and the overlap between pain services and other hospital services. Between primary care and the pain service there are several groups of patients who may need referral. Between the pain clinic and other hospital services the reality is that patients who fail to respond to the best endeavours of the other services find their way to the pain clinic.
