What Is Adequate and Appropriate Pain Treatment?

To the Editor.  —We disagree with Dr Hill's¹ assertion that "relief of pain... must be the standard for success." Although appealing in its simplicity and apparent advocacy for patients, it does not apply to chronic nonmalignant pain.Hill intimates that with opioid treatment, pain relief is a realistic goal. We agree with that goal for acute conditions and applaud efforts to better manage cancer pain, but disagree when he extrapolates from cancer to chronic pain. Chronic pain differs from acute and cancer pain as being a noncurable, lifelong condition.² The overriding mandate in medicine is to do no harm. Efforts to relieve chronic pain risk harm by fostering reliance on the health care system, eroding self-efficacy, and endowing the provider with the "solutions." Many patients seek relief from a system that has exhausted its treatment options. Patient report of adequate pain relief as the sine qua non for