i think that the pain population has had a ruined reputation due to the assumption that all you deal with all day are narcotic-seekers....
some pain centers are designed to function as narcotic pushers and they dig their own grave by having to service drug-seekers... when in fact those patients should be in rehab or at an addiction center.
however for the most part, most pain patients truly need expert help.... For so long, pain has been a misunderstood field and poorly studied. Our options in the past included over narcotizing them on one extreme or over operating on the other.
If you think about what motivates a patient to see a doctor - pain is almost always their first complaint.
So most of the pain centers I know of now, don't prescribe narcotics - that has fallen back into the realm of primary care doctors (the pain doctor can always make recommendations on how to tweak those meds but doesn't prescribe them), and thus focus on the management of the pain with other modalities.
The reason why some people have talked about "shady ethics" is because for so long, pain specialists were using alternative, non-mainstream therapies that often weren't reimbursed by insurances and thus required cash.... Now that more and more hard literature is coming out in the main-stream journals (New England Journal, Pain, Neurosurgery, etc...), the "shady ethics" is falling away as the procedures we do now are actually pretty effective.... A good example would be IDET, Vertebroplasty, Laser discectomy, nucleoplasty, facet joint radio-frequency ablation, etc....
now i won't dispute that there are a lot of psychological components to pain, and I truly believe the ideal pain center is a multi-disciplinary approach where every body is seen by a psychologist/psychiatrist (psychotherapy for behavioral modification does wonders!!! just think of the marathon-runner who sprains his ankle with a good ligament tear who finishes the race - that is behavioral modification at its BEST), with exposure to a Pain specialist, a surgeon, a neurologist and possibly chiropractic/acupuncture etc...
lifestyle is different from anesthesia... anesthesia is more shift work where you don't have to worry about building a practice (as the surgeons and hospitals do that for you), and pain is more like being in the clinics again... most pain guys i know who have an anesthesia background still do a day or two in the OR... for many reasons...
