Transforming pain medicine: Adapting to science and society


  • D. Borsook,

    Corresponding author
    1. Center for Pain and the Brain, Harvard Medical School, Boston, USA
    • P.A.I.N. Group, Department of Anesthesia and Radiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
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  • E. Kalso

    1. Institute of Clinical Medicine, University of Helsinki, Finland
    2. Pain Clinic, Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Finland
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  • Funding Sources

    Support was provided by a Grant to DB from NINDS (K24) and the Herlands Fund for Pain Research.

  • Conflicts of interest

    None declared.


David Borsook



The field of chronic pain medicine is currently facing enormous challenges. The incidence of chronic pain is increasing worldwide, particularly in the developed world. As a result, chronic pain is imposing a growing burden on Western societies in terms of cost of medical care and lost productivity. This burden is exacerbated by the fact that despite research efforts and a huge expenditure on treatment for chronic pain, clinicians have no highly effective treatments or definitive diagnostic measures for patients. The lack of an objective measure for pain impedes basic research into the biological and psychological mechanisms of chronic pain and clinical research into treatment efficacy. The development of objective measurements of pain and ability to predict treatment responses in the individual patient is critical to improving pain management. Finally, pain medicine must embrace the development of a new evidence-based therapeutic model that recognizes the highly individual nature of responsiveness to pain treatments, integrates bio-psycho-behavioural approaches, and requires proof of clinical effectiveness for the various treatments we offer our patients. In the long-term these approaches will contribute to providing better diagnoses and more effective treatments to lessen the current challenges in pain medicine.