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Over the past 8 years, I have acquired a degree of notoriety relating to my scathing criticism of the badly broken American pain care system. In the three-part series on the crisis in pain care in the United States that I coauthored with Dr Jim Giordano in 2008,1–3 we performed an ethical analysis of our system, examining the need for a paradigmatic revision if we were to adequately treat a disease as complex as is chronic pain, given the system’s economic realities. Due to the insurance and hospital industries’ adherence to the “business ethic” of cost-containment and profitability (as opposed to patient well-being), we were witnessing the profound undertreatment of pain in conjunction with a growing reliance upon technophilism, ie, an emphasis on technologically driven pain care sorely lacking a reasonable evidence-basis. Early in the following decade, Dr Alan Lebovits and I guest-edited a special series in Pain Medicine on the unfortunate devolution of the “profession” of pain medicine to the “business” of pain medicine.4 This series featured a number of highly critical articles, including examinations of the health insurance industry’s refusal to cover interdisciplinary pain management programs,5 the corporatization of American pain management and the resulting benefits to certain special interests and concomitant increases in disparities in pain care,6 physician complicity in the transformation of pain medicine from a profession to a business,7 the increase in pain management spending without any evidence of improved patient outcomes,8 the overutilization of interventional procedures and spine surgery by physicians who have “questionable” relationships with industry,9 conflict of interest relating to industry and its impact on pain education,10 and our failure to adequately address the ethical dilemmas that have been plaguing pain medicine for centuries.11 Although these articles, written by luminaries in the field, provided extremely entertaining (yet disturbing) reading, I question whether they had a significant impact on the ethical imbroglio that was (and still is) American pain medicine.

A glimmer of hope in American pain medicine?