You under 40 by any chance? I ask as I used to have the same problem (arthritis). I hit 40, and it was like the GPs opened their medicine cabinet to me.... I'm now on a pain blocker called Pregabalin (it's actually an epilepsy drug originally, but it's also used as a pain blocker and to treat anxiety... As I suffer with various anxiety disorders, bonus... lol) and it has made a massive difference to my pain levels. As in the difference between constant agony that was making it hard for me to walk (hence had to stop brewing for so long...), and just nagging pain that I can function with (hence my return to the hobby now). It's still only partial, but from watching how things have gone with my parents, they open the cabinet again when you hit your 60s, and start dishing out opiates it seems (not that I want those particularly, I'd rather have the Pregabalin and some pain still.).
As to the mess, I'd love to see councils receive more funding to employ street cleaners once again. In an ideal world people would learn to stop littering for sure, and it makes me so angry when they do, but I can't see that happening any time soon.