Both health-care professionals and patients must understand their respective responsibilities in the effective management of chronic pain. Through this partnership, a balance between the prevention of diversion and misuse of prescription opioids, and the assurance of the availability of these medications to all who need them for the relief of pain is achieved. This concept of "balance" has been clearly described by the Pain and Policy Studies Group at the University of Wisconsin (51).

The purpose of effective pain management in any patient population, including those suffering from substance-use disorders, is to reduce pain while improving function. When a drug does "more to you than for you, and yet continues to be used,'' an active addictive disorder must be considered. Failure to identify such a comorbid state will render even the most ardent efforts at pain management ineffective and frustrating. As Marquis de Sade said about pain in "120 Days of Sodom,'' "No kind of sensation is keener or more active than that of pain; its impressions are unmistakable.''

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