The Pain Revolution

In the 1990s and 2000s, a campaign to correct undertreated pain changed medicine. Clinicians were told pain was the “fifth vital sign,” metrics demanded its eradication, and powerful analgesics were promoted as low risk. The result: expanded access without safeguards, dose escalation without structure, diversion without oversight. What began as relief became dependence, poisoning, and death. This episode traces how good intentions met perverse incentives, how policy and profit intersected, and why true relief requires more than prescriptions—it requires systems that balance compassion with control.

By Niklas S. Osterman BHPRN, MA Addiction Specialist