Why is pain so poorly managed and undertreated, despite advances in treatment options? In this monograph, the authors address underlying causes and the application of continuous quality improvement techniques to pain management and the implementation of performance measurement processes. The use of a multidisciplinary systems point of view is described and the Cycle for Improving Performance, a structured approach to improvement activities, is outlined. Factors that influence an organization's ability to implement change and improve performance are also discussed. In addition, the real-world experience of four organizations in improving pain management is described. The examples provided encompass diverse settings and experiences and suggest strategies for overcoming obstacles to pain management improvement initiatives. This monograph is written for clinicians, pain management teams, quality improvement professionals, and researchers.