Acute and chronic pain has a major impact on the individual, the family, the National Health Service and society. Acute pain is common following surgical procedures and often only partially controlled. Chronic pain currently affects around 7–8 million people in the UK, and in the USA, estimates suggest that more than 75 million people live with chronic pain.1 It is likely that the number of people with chronic pain will continue to grow as a result of increasing longevity, rising prevalence of co-morbidities such as diabetes mellitus and obesity, and improving survival rates for cancer and trauma patients. Rather than solely being a normal adaptive response following tissue injury, we now understand pain as an evolving plastic phenomenon that can be influenced by a variety of physiological, pharmacological, psychological and environmental factors.

Until recently, acute and cancer pain management predominantly consisted of opioids and compassionate care.2 3 Treatment of chronic non-cancer pain may be regarded as even more of a challenge, given the complex interaction between physiological, cognitive and social factors and the need for sustainable and safe long-term management.

Novel therapies and techniques, combined with our improved understanding of the pathophysiological processes of pain and the complications associated with current management strategies, offer hope to patients. In this issue, Snidvongs and Mehta provide an overview of the current guidelines and trends in opioid prescribing for chronic non-cancer pain (see page 66).4 The rise in opioid prescriptions is highlighted and the potential implications for both the individual and society are discussed in relation to the unmet need in pain management. The latter is well documented, …