The research shows that a range of treatments not relying on medication produces good results. This includes massage and rehabilitation therapy designed to keep muscle tone and get the body moving again after injury or disease has reduced mobility. The benefits come both from the physical work done by the therapist, and also from the supportive bond that can develop between the patient and therapist. This can be allied with learning relaxation techniques and rediscovering swimming as an excellent form of exercise for the muscles not relying on joints overcoming gravity. Moving into the fringe world of technology, there is the long-running TENs machine and the newly emerging pulsed magnetic field equipment (which, as yet, does not have FDA approval). Such machines are said to produce significant relief among patients who believe in the power of the machines – not unlike acupuncture which also requires the patient to have confidence in the system. However, the best approach is cognitive behavioral therapy which teaches people how to maximize their mobility within the limitations imposed by the pain.

The point of these therapies is to avoid you becoming too dependent on the pill bottle for pain relief. If at all possible, you should keep drug costs under control and avoid the risk of a habit forming. That said, there are a number of analgesics or painkillers that can help you manage the pain. The strongest are the opiates. These are narcotic and should only be used in short bursts unless you are managing a severe pain following an operation or a terminal condition like cancer. The middle ground is held by opioids like tramadol which have fewer problems of dependence. The strategy is to slowly build up the dosage until you feel the best level of pain relief and the lowest level of side effects – most commonly constipation, nausea, vomiting and drowsiness. The problem with tramadol is that you also slowly build up tolerance, i.e. your body gets used to the drug and it has less effect. If you have been learning how to get a good quality of life with a cognitive behavioral therapist, this is not a problem. You should be phasing out the drug in any event. But if you have not been learning how to cope without medication, you may be tempted to increase the dosage. This is dangerous because you may end up dependent.

Chronic pain can be caused directly by an injury or disease, or it may be a side effect or complication following surgery, caused by drug interactions, etc. Always liking to produce lists, doctors have classified pain into the following categories:

Nociceptive where you feel a sensation in a specific location. This may be somatic and so felt in the joints, bones, muscles and ligaments, or visceral which is felt in the internal organs such as the heart, lungs, liver and kidneys. The latter can be more difficult to localize because the pain simply comes from inside the body.

Non-nociceptive may be neuropathic, i.e. pain generated by the nervous system and not tied to a specific location in the body. When the nervous system is damaged, the messages become more difficult to interpret and the brain is often confused by random effects. The result is unpredictable feelings of tingling, numbness, pins and needles and other unpleasant symptoms. Alternatively, there may be sympathetic pain where the skin and tissue around an injury become unusually sensitive and restrict movement.

No matter which variety of pain you may have, there are a range of analgesics or painkillers available to relieve any suffering. The less powerful drugs are the nonsteroidal anti-inflammatory drugs (NSAIDs) which reduce swelling and inflammation in the joints and elsewhere. The more powerful deal with moderate to severe pain with tramadol being the most commonly prescribed because it is less likely to cause dependence than the opiates. Tramadol works by changing the way in which the neurotransmitters carry messages in the nervous system. Because of this, it is equally effective no matter what the cause of the pain, i.e. localized or arising from the nervous system itself. The messages are not carried to the brain or not clearly interpreted as being pain messages. Thus, you can have a reasonably good quality of life even though the source of the pain remains active in your body.