ain is indelibly interwoven into the fabric of human experience. This supplement's cover image, a detail from Agnolo Bronzino's Venus, Cupide and the Time (Allegory of Lust) shows the unmistakable ravages of pain.*

We are now halfway through the Decade of Pain Control and Research designated by the US Congress, a fitting point at which to review how far we've come and how much remains to be done. This supplement provides that review.

There is not, nor should there be, any proposition that pain should be ended altogether, but the control of suffering remains a touchstone for everything that biomedical science is trying to achieve. How does it measure up?

If this was simply the "Decade of Pain Research" then the report card would be quite positive. As described in the series of articles beginning on page 18, progress has been truly spectacular. Cell and molecular biology, genetics, structural biology, neuroscience, and other disciplines have converged on the processes of pain. The signals that initiate, attenuate, heighten and prolong pain are coming into clearer focus, revealing hints for new management strategies. And although such hints have yet to fully bear fruit, they are helping dissect the mechanisms of action of current drug classes used to treat pain.

But as the "Decade of Pain Control," things are less rosy. New therapies are thin on the ground and those already in use are under close scrutiny. This applies equally to legislative scrutiny--witness the inquisition of doctors who prescribe opiates--and to the discovery of unforeseen side effects. The revelation that cyclooxegen-ase II inhibitors pose cardiovascular risks creates a therapeutic black hole for many patients and has undermined public trust in both producers and regulators. For an overview of current and potential treatment modalities see the series of articles starting on page 30.

Is there any cause for optimism? Absolutely. The gap between an understanding of pain and an ability to treat it will surely narrow, engendering more creative solutions to pain management. But there must also be work to close the gaps in less well studied aspects of pain: the social, cultural and personal dimensions that overlay the basic circuitry. Many patients not only still suffer from chronic pain, they also lack the ability to effectively communicate a sense of that pain to others. To truly make this a successful decade of pain, a psychological perspective must be incorporated.

With this in place, preliminary sketches of a picture of pain relief can be drawn.

We are grateful to Johnson & Johnson Pharmaceutical Research & Development, whose support made this supplement possible.

*The precise nature of the figure’s pain is open to interpretation. Appearing behind Venus who has drawn Cupid’s arrow, the anguished figure has been interpreted as Jealousy, the emotional pain and anger associated with a lover’s scorn. An alternative interpretation is that it is the personification of Syphilis, which had reached epidemic proportions around the time of the painting. Image © Bettmann/CORBIS A Man's Head Based on a detail of An Allegory with Venus and Cupid by Bronzino