Although we do not always wish to be looking over our shoulders with concern at all patient contact, the process exists for patients to be more aware of shortfalls in management and to complain about and query such actions. We are increasingly expected to work within cost constraints, meet targets and offer new treatments. This must be done bearing in mind cost-effectiveness, health care gain and evidence base as standards, or liability may be in dispute. Many drugs are used in pain management outside their normal licensed use; there is therefore a greater demand for information, and details of possible complications and outcomes. This article looks at issues related to liability, consent, the use of unlicensed or off-label drugs, and epidural steroid administration. In addition, possible factors affecting fitness to drive and overseas travel are examined in patients who are undergoing chronic pain therapy. Some of us are involved in giving expert opinion on pain related matters; this too is not without its pitfalls. Such topics often raise more questions than there are answers, but despite this we must be aware of them.
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