In a simple case where you have had an accident and, perhaps, broken a bone, there will be acute pain lasting for a reasonably short period of time. Under normal circumstances, these physical injuries heal and the pain goes away. But, sadly, there are many medical conditions where the pain does not go silently into the night. In cases of chronic pain, you and the doctors advising you have to come up with strategies to help you cope — to make the best of your life under difficult circumstances. Now, the medical profession has recognized that, independently of the underlying cause, pain itself is something to be treated. To do so, there are a range of different techniques, including:

• the use of drugs;

• different kinds of physical therapy, counseling and psychological support;

• acupuncture and forms of treatment slightly outside the bounds of conventional Western medicine; and

• surgery and other forms of procedures to intervene and relieve.

There is a distinction in the type of pain. Some is classified as nociceptive. Here the nervous system is properly identifying the source of the pain as a specific injury or particular point in the body. The symptoms group into radicular and somatic, depending on where the person feels the pain. The pain is said to be neuropathic when the nervous system is not working as it should, i.e. there is no obvious cause for the pain, but the brain insists that there is an injury in a particular place. This type of pain is more difficult to treat because the underlying cause is more difficult to diagnose.

The problem in every case is to decide the best approach. Not everyone reacts to the underlying medical cause in the same way. There are varying degrees of pain and people respond to that pain in slightly different ways. Some are more accepting. Others grow depressed and turn themselves into invalids. So all pain management decisions start with a review of the individual’s medical history, asking what has been and can be done to treat the underlying cause, what level of pain intensity the person feels, whether the person has a positive or negative mental attitude, and so on. It is possible that more tests may need to be performed. If targeted surgery or other forms of intervention might relieve the pain, this should be tried first.

While waiting for a specific diagnosis or for the treatments to begin, it is probably appropriate to use one of the standard drugs to control the pain. The best drug is tramadol and it is most commonly prescribed to treat moderate to severe pain across a wide range of cases. You should not self-medicate, i.e. do not go online and buy tramadol without first having a doctor check you out and make sure that it is safe for you to take this drug. You should also not resort to the pill bottle every time you have pain. At an early point, you should have effective treatment either for the underlying cause or for the pain itself and live without using drugs as much or at all.