The practice of clinical medicine is challenging. This is so, even when the clinician has both a reasonable grasp of the pathophysiology underlying a patient’s presenting symptoms and an understanding and knowledge of the therapeutic tools available to manage these conditions. Pain provides a major challenge for the clinician then, as we often fall at both these hurdles. We are challenged by patients presenting with distress of long standing, where pain is often a major component, and the symptom complex does not comply with a medical science based, recognisable distribution …