Evidence continues to amass, revealing that many patients, and especially the terminally ill, experience serious, debilitating pain, in a variety of medical settings. 1–4 Only recently has pain at end of life been viewed as a public health problem of significant enough proportions to instigate widespread efforts at improvement. 5,6 Traditionally, pain (other than that associated with painful medical/surgical procedures) has been seen as a harbinger of illness and as a symptom whose patterns are useful to aid in diagnosis. However, it became clear a few decades ago during the expansive years of critical care, surgery, and anesthesiology that pain was more than a symptom signaling tissue injury, inflammation, or ischemia. Uncontrolled pain with its resultant physiological stress responses contributed to pathophysiological events, leading to preventable morbidity and mortality from cardiovascular and pulmonary catastrophes. Aggressive treatment of pain in perioperative and trauma settings is becoming the standard of care, as a response to the ethical obligation to prevent and cure disease and its manifestations when possible. What has been slower to develop is the same sense of urgency around researching and treating persistent debilitating pain associated with chronic progressive disease states. This, in spite of overwhelming evidence pointing to the high prevalence rates of pain that greatly impact quality of life and functional capacities in many chronically ill patients. At one end of the spectrum are patients with imminently life-limiting diseases, such as those with advanced malignancies, that account for more than 20% of deaths in the United States. 7 On the other end is the common occurrence of chronic pain associated with osteoarthritis, other joint and spinal degenerative disorders, postherpetic neuralgia, diabetic neuropathy, post-stroke central pain, and many more common conditions experienced by our aging population. 8