Chronic pain as a disease

Abstract This chapter argues that changes in our values about pain and opioids were much more important than increases in the prevalence of chronic pain in creating the opioid epidemic. Central to these changes was the argument that chronic pain is not just a symptom of disease, but also a disease itself that deserves its own treatment. Pain intensity measurement was used to determine the need for pain treatment and the success of that treatment. This assessment strategy was joined with the titrate-to-effect treatment strategy first utilized in cancer pain treatment that declared that the proper opioid dose is the dose that significantly reduces the pain intensity score. The pain-as-disease model is intended to increase the scientific and clinical legitimacy of chronic pain, but it tends to exclude the patient from the process of treatment and recovery and may produce iatrogenic harm.