The pharmaceutical treatment of chronic pain has for many years entailed the use of antidepressants, anxiolytics, anticonvulsants, and opiates, usually in combination, a practice known as polypharmacy. Although these drugs can be quite helpful, their effect is often unpredictable, and finding the right drug or combination of drugs usually involves a scattershot, trial and error approach. It is time-consuming, financially wasteful, and discouraging to both the patient and the physician. This may all be changing. There is increasing awareness now that pain is often an expression of the bipolar spectrum, that is, classic bipolar diseases and also attention deficit disorder and narcolepsy. This has invited increasing use of stimulants such as Ritalin (for ADD and narcolepsy). Surprisingly, stimulants have been discovered in many cases to be effective analgesics. Almost simultaneously with this has come increasing awareness that opiate therapy, particularly with Methadone, can be not only analgesic but also mood-stabilizing in the painful bipolar. It is now possible to tailor drug or drug combinations for an individual patient with an anticipation of success, sometimes immediate, undreamed of but a few years ago. This, in my opinion, represents a quantum advance, and the promise for effective drug treatment for chronic pain is bright indeed.