Physical pain strikes or develops in different ways and has many causes, some obvious and some obscure. Over time, any given pain can become intractable and chronic if it gets “centralized” or fixed in our brain. Chronic pain is often complicated, becoming associated with various nerve networks, and thus is not easy to treat. Among treatment options narcotic painkillers have been widely used in our society. Their use is controversial and sometimes complicated by serious problems: under and over prescribing, intolerable side effects, dependence, diversion and suicide. The latter two problems have become prevalent and are receiving national publicity. These issues and newer treatment strategies for specific pain conditions will be presented.