Evidence-based approach is the key to the success of any specialty in medicine, so pain management cannot be an exception. In the last few decades, significant progress has been made towards   understanding the basic and clinical science underlying the various pain syndromes. In spite of this progress, pain remains inadequately and inappropriately treated throughout the world. Chronic pain as a symptom (now also a disease) has a variety of facets, which at times, make it difficult to manage.

  Chronic pain conditions are complex and require the total dedication of physicians capable of managing these conditions with a full appreciation of their underlying pathophysiology.

  Pain physicians often face a dilemma of how to reach correct diagnosis of a particular symptom, such as backache, headache, neck pain, neuropathic pain, ischemic pain, and cancer pain.

  There is unacceptable variation in clinical management of pain due to inadequate training; distorted physician beliefs; inadequate application of pharmacological, behavioral, interventional, and alternative methods of pain management; and on top of it, lack of access to evidence-based approach. It can be either at the level of pain physician or the surroundings in which he/she is working.