The easiest way to explain this is to think of a burglar alarm on the empty home next to yours. Just after midnight, it goes off. You call the local cops and a cruiser comes by. The alarm is still blasting out sound at 5 a.m. and your sleep is destroyed. You leave the noise behind you when you go off to work. At least you can get away from it. Now think about pain. It's useful when it first sounds the alarm. But, later, after you and the doctors have done all that reasonably can be done, it still hurts. This makes pain a separate disease or disorder justifying separate treatment. So what happens now? When you were admitted to the hospital, you were allocated to a consultant specialist. This physician is responsible not just for the treatment of the original cause of the pain, but for all the follow-ups. It's at this point you hit a problem. Many doctors are a bit prickly. If you complain you are still in pain this is taken as a criticism of their treatment. Your doctor complains he or she did everything by the book. You should be better already. After a bad-tempered exchange, you get more powerful painkillers. If that fails to work, you get increasingly powerful drugs. At some point, you are an addict and stop complaining.

Pain management should start with a specialist department and a review of your medical history to date. It's entirely possible a new set of eyes looking through your files will find something overlooked. If more tests are indicated, they will be ordered. The aim is to confirm the original diagnosis and that everything has actually been done properly. If remedial work might produce a better outcome, this will be tried. Only when we are certain no one messed up and nothing more can be done as treatment of the original cause, can we move on to treat the pain as a separate problem. The strategy is to pick and mix from:

• a range of different drugs;

• physical therapy both conventional and alternative - there's no reason to stay within the conventional boundaries of Western medicine. Acupuncture and other forms of therapy are accepted as highly effective by millions of people around the world; and

• psychological support through counseling, cognitive behavioral therapy and other forms of talk treatment.

Deciding what works best will be a joint discussion between the patient and the different specialists in the team. This makes the patient the center of attention and, in turn, this helps keep a positive mood going. People who feel they are a nuisance or just complainers often end up with a negative view of the world and feel more pain. All the major research evidence supports this holistic approach but it runs into opposition from all the empire builders within the existing hospital service. Their status is threatened so few hospitals have been allowed to set up one of these pain centers. For now, doctors hand out the Ultram and offer a few words of comfort. In other countries where there is more central direction over practice standards, pain management centers are more common and immensely successful. Ultram is still prescribed but the aim is to get the best quality of life without dependence on any drug.