In the early days of medicine, patient care was a covenant between the patient and the physician, with this dyad considered sacred. Sadly, modern medicine, particularly in the American system, has changed to include numerous extraneous stakeholders outside of this dyad. In pain medicine, these stakeholders include the insurance, hospital, pharmaceutical, implantable device, and urine drug testing industry, as well as regulatory agencies. Rather than struggling for control over limited pain care resources, it is proposed that a pluralistic yet mutually cooperative system is not just a reality, but a necessity if the suffering of pain patients is to be ameliorated. An approach to this quandary emphasizing “rapprochement” is offered.