The best way to describe the field of chronic pain management in America is a state of internal turmoil and at war, as follows:

• The Drug Enforcement Administration is at war with so-called “pill mills” that hire doctors to write bogus prescriptions for huge amounts of painkiller medications, many of which are re-sold out of state for huge profits. As a result, many physicians are so scared of losing their licenses that they refuse to prescribe opioid drugs.

• Accredited Multidisciplinary programs still compete strongly with non-accredited pain clinics or anesthesiologists that perform short-term relief procedures such as nerve blocks. Legitimate pain management programs continue to battle insurers for reimbursement.

• Patients that really do need painkilling medications may not be getting them, or are denied the treatment they need, or a re forced by insurers to accept a cap on the number of procedures they may obtain in a year.

• The number of anesthesiologists active in pain management continues to grow.

• The number of MDs other than anesthesiologists active in pain management grew significantly, estimated by some to total 7,000-10,000 doctors nationwide. It is very easy to enter the field and no credentialing is required. A doctor can literally be up and running, performing nerve blocks and injections after a weekend “how to” seminar.

• The number of multidisciplinary programs continues to shrink.

• The use/abuse of opioid painkillers such as Oxycodone exploded nationwide, facilitated by illegal “pill mills” that used bogus prescriptions to sell huge quantities of pills. Opening such a “clinic” was very easy and until recently, not policed. All one had to do was find a less than reputable doctor willing to take the chance of signing blank scripts. Some evidence is found that organized crime may be lurking behind many of these pill mills.

• The market for pain management devices has grown, as neuromodulation has become a more popular treatment method.