X is 28 years old. His hips and hands are the most severely affected joints. X's health problems started at the age of 17, following a fall on a cross-country run. He consulted his general practitioner multiple times with increasing levels of pain and disability. Over the years X has tried the full range of pain medications. A review of his past prescriptions reveals trials of over 15 different analgesics and anti-inflammatory drugs, covering the full range of the analgesic ladder. His current medication, oxycodone, has so far been the best choice, optimising pain relief whilst minimising side effects.