If you go to Europe, you encounter not just people who speak funny languages, but also a different culture when it comes to health care. The attitude is completely different because, unlike our approach, all the major hospitals and clinics are run by the state or rely on state funds. This means the managements are not accountable in terms of profit. Why should this matter, Well, if you take the standard US hospital or clinic, doctors are expected to pay their way. They will be given a minimum number of patients to see and financial targets for billing purposes. Often this means you do not spend more than a few minutes with each doctor, and you will be referred for a lot of tests, all of which are billable. In the European equivalents, the measure of performance is whether the patients recover well. Indeed, to ensure the hospitals maintain a good standard, many states require them to publish statistics showing whether patients have to be readmitted (suggesting poor care on the first stay).

The more interesting information comes from the forced release of statistics showing the survival rates for each main type of treatment. If a particular specialism shows an unusually high death rate, national teams appear and carry out an investigation. On paper, the interests of the patient come first although, truth be told, doctors and their managers have devised many ways of avoiding the worst of the state’s investigation powers.

Anyway, it’s standard for patients to be treated by a team of specialists. If someone is suffering chronic pain, there will be a reference to physical therapists and cognitive behavioral therapists (CBT). All the evidence shows that a combination of strength and mobility building exercises, supported by CBT, produces significant improvements. In the US, one doctor retains control over your treatment and only rarely calls others in for a consult. If you want CBT in our healthcare service, you have to pay privately.

What is CBT, The cognitive means an attempt to explain your body and the way it works. Your mind is able to control the body more effectively when you understand why it is acting in this way. Then the therapist looks at your behavior and makes practical suggestions as to how how might change your lifestyle to reduce the pain and live a more normal life. So, for example, the therapist will visit your home and workplace, observe how you perform the routine tasks and then demonstrate how even small changes can produce major improvements. The intention is to change your environment or the way you relate to it, and so make your life better. When backed up by physical therapy and guided exercises to improve your strength, the results are usually highly satisfactory.

At one level, you might expect an improvement because a specialist is actually engaging with you as a person and making your life the focus of attention. With focused professional help, most people improve. This does not mean you can do without painkilling drugs like Ultram. There will always be moments when the level of pain rises and something reliable like Ultram will bring things back under control. But the general expectation is that you will be able to cope for most of the time without having to rely on drugs.

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