At the beginning of the twenty-first century, a vast array of interventions is available to help patients; unfortunately the full gamut of treatments is poorly appreciated by medical professionals and, worse yet, pain therapists, and is ill-applied. CP remains one of the most ill-diagnosed and ill-treated entities among chronic pain syndromes, as proved by recent literature concerning patients submitted to, among others, gabapentin, carbamazepine, baclofen, opioids, tramadol, behavioral therapy and psychotherapy (Helmchen et al. 2002) or phenytoin, carbamazepine, valproate, baclofen, fluoxetine and trazodone (Fukuhara et al. 1999), all ineffective or only poorly effective agents.

Up to now, trial-and-error has been the norm in the treatment of CP. As months or years go by, the typical CP patient finds no or unsatisfactory relief from the handful of drugs the average pain therapist knows and administers. Many patients often end up intoxicated or develop important side effects, with addiction to opioids and benzodiazepines. Useless surgical procedures can also be attempted, usually without lasting relief. Even moderate enduring pain after any treatment can still be crippling and in time can “relapse” as the patient forgets about the previous level of suffering.

The goal of treatment is the abolition of all pain, permanently. Here, we will attempt to make the treatment of CP less empirical and more evidence-based. An important caveat should be borne in mind: time is not an option.