It should be automatic. When you are in pain, a doctor gives you a pill and the pain goes away. At least, if you believe the TV ads, that is. Unfortunately, life is not always so conveniently magical. There are many times the pain does not disappear. At this point you hit difficulty. Unfortunately, the medical profession has been talking with the pharmaceutical industry and the insurers. There's general agreement the best approach is to give you pills. This saves the doctor's time. If the doctor spends less time with you, the insurers save money. If doctors give you more pills, this increases the profit of the drug manufacturers. So everyone on the supply side of the process makes more money by giving you drugs. Unfortunately, this is not always the best solution for your problems.

Although we give the Europeans a hard time when it comes to their healthcare services, they have one feature we lack. Their approach is "evidence-based". There are both national and European review bodies to look at all the evidence on every drug and treatment. This helps everyone decide which work the best (and which do not work at all). So, when it comes to authorizing payment, public funds will only pay for those treatments where the clinical evidence shows them effective. There's nothing to prevent Europeans from buying private health insurance and, if they fall ill, claiming any treatment no matter whether it's shown to be effective. But come back to our system and we find the FDA does nothing more than licence a drug as safe and more effective than the placebo. There's no formal procedure to monitor the performance of drugs and medical devices once they are released into everyday use. This means we could be prescribed a drug or have some other treatment where there's no evidence it's going to help in any way.

It might surprise you to learn the European approach to pain management is not simply to prescribe painkillers. They prefer a holistic strategy which focuses on the patient and his or her needs. So it becomes a team effort. Counselors will discuss problems with the patient, visiting their homes and the workplace, demonstrating how everyday tasks can be performed with less difficulty. Physical therapists will devise exercise programs to build up muscle strength and improve mobility. Cognitive behavioral therapists will devise more general coping skills for improving the quality of life.

All this, of course, is labor-intensive. We will not go down this line unless you have a top-of-the-range insurance policy that will pay for one-to-one time with a range of specialists. Sadly, the politics of our healthcare service focus on the profit to be made out of our suffering, rather than on how to improve our lives so we suffer less or not at all. Our service gives you Tramadol because it usually works and it's cheap. If you are still in pain, the doctor will increase the dosage of Tramadol. If you are still in pain, there are more powerful drugs to try. Not surprisingly, the Europeans give us a hard time for failing to make you, the patient, the focus of our doctors' attention.