When we are fit and healthy, the world can seem a reasonably pleasant place to live. But if anything goes wrong and we are injured or laid low by a disease, the arrival of pain can turn our world into a distinctly unpleasant place. It's an irony that the sensation supposed to warn us of the need to take action to prevent further injury or seek treatment, becomes a problem in its own right. It would have been better if our bodies had evolved with an off-switch so that, once we got the message, we could relax again. As it is, we can be tormented by pain even though the original causes have been treated. This can swiftly change our mood darker.

The medical profession likes to send out the message physicians are the top professionals. Science has given them the tools to fight disease. There's a cure for every problem. Except they are as human as the rest of us and their marketing is partly to encourage us to trust them with our bodies and partly to justify the high costs of treatment. Would that every doctor was a miracle worker. But that's too much to ask. For all those who are able to walk away with a smile, there are large numbers for whom there's no cure. They are the ones you hear less about who stay home and suffer.

As an example, let's take someone who is injured in a traffic accident. A skillful surgeon can sew the wounded flesh back together and put the bones into splints so they can heal. But if there's damage to the nervous system, no repairs are possible and, unlike soft tissue, nerves do not join up again. This can leave the physical body more or less back in one piece but the pain will not go away. When the treatment of the physical cause has exhausted all options, this just leaves pain management.

Put another way, the continuing pain becomes a problem in its own right and, like any other disease or disorder, it should have specialist treatment. After all, if you had a kidney disease, you would go to a specialist in your local hospital's nephrology department. The same should be true if you have pain independently of a treatable physical cause. Except the majority of hospitals resist the idea of setting up a separate specialist pain unit. Once you have been allocated to one of the existing departments, you tend to stay there for all subsequent treatment. Because you are in pain, this means you will simply be prescribed increasingly powerful painkillers. This works in you favor with only moderate to moderately severe pain. The routine prescription of Ultram gives you relief with few side effects. But if the pain continues to cause you problems, the use of the more powerful opiate drugs can have serious risks. Whereas Ultram is only mildly addictive, all the stronger drugs are likely to make you dependent fast. In a specialist pain clinic, the aim is to give you the skills to manage the pain without becoming dependent on the more powerful drugs. It's a shame this win-win approach is not standard in the medical profession.