RESEARCH PLAN AND METHODS: The two approaches to opioid use will be operationalized using medication prescription guidelines as two separate groups (Tolerable Pain Dosage vs. Adequate Relief Dosage) to be tested in a randomized trial. For the Tolerable Pain group, opioid medications will be prescribed at initially low doses with the expectation that low dosing will be adequate to reduce pain to a tolerable level. Dose increases are done slowly and only based on reports of some relief with low dose, with the goal of low and stable dosing to prevent dependence and tolerance. For the Adequate Relief group, opioid dosage is initially rapidly increased until the patient indicates adequate or substantial relief, at which point dosage is stabilized. For this group, tolerance and dependence are viewed as signs of inadequate dosing and handled typically with dose increases. Both groups will share some common guidelines such as monthly monitoring, random screens for other drug use, and prescriptions limited to a single clinic. Outcome will be measured with respect to primary outcome variables of pain relief, quality of life, and addictive behaviors, with secondary outcome variables of medication use, mood, illness beliefs, treatment satisfaction, and health care utilization. These variables will be assessed at study entry, and at 4 month, 8 month and 12 month follow-up visits. In addition, the following individual difference variables will be examined to determine patient characteristics that may impact on treatment outcome: psychosocial factors (e.g., history of substance abuse, economic status, environmental support), type and chronicity of pain problem, mood, medication use, quality of life, and illness impact. These variables will also be assessed at study entry and at 4 month, 8 month and 12 month follow-up visits.