Each year, $100 billion is spent on pain care, yet 40% of Americans experience daily pain, including 50 million people with chronic pain and 25 million people with acute pain. The prevalence of pain has a tremendous impact on business, with an estimated annual cost of $60 billion plus in lost productivity. Despite advances in the treatment of pain, the quality of pain care remains far below the potential for optimal care, and ineffective pain treatment continues to be a growing problem in the United States. The historic progress of pain care in the United States has encountered contemporary barriers.