Tramadol is an essential part of pain management

One of the building blocks of medical treatment is the need for the patient (that's you) to consent to whatever treatment is proposed. Hopefully, the doctor gives you a good explanation of the all costs and benefits, and this allows you to make a properly informed decision. The problems with this in the real world come on both sides of the equation. Some doctors act as if they walk on water and you should do whatever they tell you and be grateful they were actually prepared to speak to you. Some patients come with prejudices and, no matter what the doctor tells them, they don't want to hear anything that conflicts with their own beliefs. In the middle come the doctors who are bad at explaining and the patients who struggle to understand. The result is that many pain management clinics fail to give a comprehensive and satisfactory range of treatments to every patient, i.e. many patients are left in pain.

So what are people afraid of? The most common is the legitimate concern that there's a risk of addiction with some drugs. Some doctors believe they should be protective and not prescribe some painkillers. Some patients refuse to take anything where the risk exits. This has produced an irony. Hospitals have trained thousands of nurses and support staff in the management of pain, but they are not allowed to prescribe drugs. So even when the nurses and the patients may agree on a particular treatment, they have to wait for the attending physician to appear with no guarantee he or she will agree. The traditional physicians are still worried about addiction. This is changing as the new doctors come through training with more understanding of the multidisciplinary approach to managing pain.

In an ideal hospital and clinic, all the staff would cooperate, i.e. the physical and psychological specialists will talk to each other positively, allowing for the possibility of error in diagnosis or treatment, and involving physical therapy, counseling and a range of alternative treatments to play their part. Indeed, even the spiritual should be involved with in-house staff and local churches offering counseling and support for patients in pain.

One of the key problems at every point is to decide whether the doctor is treating pain or depression. This makes a big difference to the selection of drugs. Equally important is to treat the underlying cause of the pain alongside the pain itself. If you are complaining of continuing pain, you are entitled to something more than some extra Tramadol or something stronger. You are entitled to have someone question why you are still in pain. This assumes, of course, you are being honest about how severe the pain is. Unfortunately, some are trying to game the system, e.g. to get more compensation because of an accident or to manipulate relatives in some way. Pain management can involve psychiatric assessments and social workers investigating a patient's background to get as complete a picture as possible. In all this, the routine drug is Tramadol. It offers more support than any of the NSAIDs and has fewer problems of addiction than the more powerful drugs. This is not to say that Tramadol will be given to everyone, but it is genuinely effective in relieving moderate to severe pain.