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The historical background of neurological surgery for pain demonstrates a remarkable honesty in outcome assessment. Because of apparent concentration on technological break-throughs, the contemporary focus is less directed to socially important issues. Because of the importance of outcome management in the current political environment, it is important to return to basic principles. A more socially and economically responsible approach is desperately needed in the neurosurgical community at this time. Standardization of outcome reporting and issues of societal impact must be included to justify the real value of new technology.