The world always seems a better place when an acronym really works. In this case, the word is NICE which currently stands for the National Institute for Health and Clinical Excellence (the powers-that-be added the "Health and" later on). Now we all know the Brits live like savages in caves and are routinely culled by doctors working for the death squads sometimes called the National Health Service. But NICE is actually a good idea. It routinely investigates all the potential treatments available for each disease or disorder to find out which work the best. It then only funds the most efficient and effective treatments. If cave-dwelling Brits want the other stuff, they have to pay for it out of their own pockets. This sets national standards for treatments and overcomes the so-called zip code lottery where the quality of treatment depended on whether each local hospital was up with the latest medical research. In the US, everyone in the healthcare industry is in business and sells treatments with the highest profit margin regardless whether the treatments are the best. So, unless you do your own research to find out which treatments actually represent good value for money, you are at the mercy of your local doctors and their for-profit employers.

Anyway, NICE has been steadily working its way through all the major treatments (that’s drugs, medical devices and surgical procedures) and, not so long ago, it reached pain management. This is the emerging speciality that sees pain as a disease or disorder in its own right. So, after you have treated the underlying problem causing the pain and produced the best outcome, you move on to treat the continuing pain. For these purposes, the new hospital departments are cross-disciplinary with contributions being made from specialists who previously had worked separately. Now all come together to find the best solutions for each individual patient. This recognizes everyone as potentially unique with a different medical history, different job constraints and family commitments. The plan is to come up with a holistic treatment program to give everyone the best chance of achieving a good quality of life.

The primary driver in this is Cognitive Behavioral Therapy (CBT). This has been growing in strength over the last twenty years and now has general acceptance throughout the National Health Service. As the name suggests, it does two things. It helps people to a better understanding of their condition, and shows them how to modify their behavior to improve their lives. Like an infection, CBT is spreading in the US market but, so far, it’s not making much progress. It tramples on the toes of the empire builders who make their money with the treatment regimes as they are. No-one wants change when it threatens profits. This means most of us in pain line up to see our primary care physician. Since most pain among us walking wounded is in the range of moderate to severe, the caring doctor gives us a prescription for tramadol. This is a safe and highly effective drug. It keeps pain under control. When everyone knows this is the knee-jerk reaction to pain, we all switch to buy tramadol online. No prescription is required and it’s far cheaper than buying it in the neighborhood drug store. Save money, manage pain.