Some (hopefully not all!) of what you are about to read in this chapter may strike you as quite strange and perplexing. The reason is that since the rise of more scientifically and technologically oriented medicine in the middle of the last century, physicians and laypersons have had very different (and sometimes even conflicting) views about the relationship between pain and suffering and the responsibilities of the medical profession to effectively relieve them. Surprisingly, before the rise of the modern era, physicians took their responsibility to relieve pain much more seriously than they do now. It is as though the less physicians could do to treat or cure disease, the more assiduously they strived to ensure their patients were at least comfortable and certainly not suffering from pain or other distressing symptoms of illness when the means of relief were available somewhere in the physician's toolkit.

With the rise of modern medicine and the many remarkable advances in medical science and technology, many previously incurable diseases became curable or at least manageable for increasingly longer periods of time. As the focus shifted to making a prompt and accurate diagnosis and then selecting and effectively implementing the most appropriate treatment, what appeared to fade into the background was the patient's experience of illness, including pain and other symptom distress.

Pain – and more importantly, the perceived duty to promptly and effectively treat it – receded so far into the background that by the late twentieth century, there arose what only quite recently (at least when considered in the broad scope of the history of medicine) has come to be recognized as an epidemic of undertreated pain.