ABSTRACT
This chapter reviews the evidence of the prevalence and for the clinical effectiveness and cost-effectiveness of treatments for chronic pain patients. Chronic and recurring pains are significant problems for a substantial portion of the world population. The direct costs for the totality of the approaches are astronomical and underscore the extremes undertaken to ward off the human suffering associated with chronic pain. Health-care expenditures comprise only a portion of the costs associated with chronic pain. The majority of the costs are associated with disability compensation, lost productivity, and lost tax revenue, among others. Long-term use of medication raises concerns about tolerance, tolerability, drug misuse and abuse and side effects including neurotoxicity. Studies of chronic pain patients taking opioids on a long-term basis suggest that over 45% may be engaging in aberrant drug-taking behaviors. Many treatments for chronic pain may actually increase rather than decrease healthcare utilization. For example, placing patients on long-term opioids requires additional medical monitoring.
