Pain represents a major clinical, social and economic problem, with estimates of its prevalence ranging from 8 to over 60%. The impact of pain on economies is enormous, with the cost of back pain alone equivalent to more than a fifth of one country's total health expenditure and 1.5% of its annual gross domestic product, while in another, it represents three-times the total cost of all types of cancer. However, decision makers have tended to concentrate their attention on a very minor component of the cost burden, namely prescription costs, which, in the case of back pain, represent 1% of the total cost burden. In addition to its economic impact, chronic pain is probably one of the diseases with the greatest negative impact on quality of life. For example, the quality of life for those with migraine has been shown to be at best equal to that for people with arthritis, asthma, diabetes mellitus or depression. The burden that pain imposes on individuals and the enormous costs that society has to bear as a result clearly demonstrate the need for collective thinking in the decision-making process. A broad, strategic perspective - based on evidence relating to effectiveness (including tolerability), efficiency and equity - is required in determining issues relating to the provision of services and resource allocation.