by Betty Russell

Living with persistent and excruciating pain can be a nightmare. It can threaten your relationships, hamper your job performance and limit your physical activities.

There's no one-treatment-fits-all approach. If you're in chronic pain, you may have to wade through a lot of hype and controversy that leave you scratching your head and wondering: What works? What's safe? What's my best strategy?

Medications, medical procedures and surgery can all attack pain. But there are other solutions. Lifestyle changes can take the edge off pain.Mental disciplines and complementary medicine may also give you some relief.

The medication dilemma
Deciding whether you should take pain medications, and which ones, has never been more confusing. Some experts warn that Americans take too many drugs, yet others insist that chronic pain is woefully undertreated.

Then there are those widely publicized problems with popular pain medications. Vioxx and Bextra — powerful COX-2 nonsteroidal anti-inflammatory drugs (NSAIDs) — left the market because of safety concerns. These drugs flourished because they didn't cause stomach problems like older NSAIDs. But studies found they also raised some patients' risk for heart attacks and strokes.

Even the older NSAIDs are under fire. A new study shows that ibuprofen and other NSAIDs may up the risk for cardiovascular events, too. The Food and Drug Administration (FDA) now requires that NSAIDs carry warnings about the potential for gastrointestinal side effects, cardiovascular risks and skin reactions.

"We always watch as the data evolve," says Robert Meyer, M.D., director of the FDA's Office of Drug Evaluation II. "When new data warrant changes, we act and inform the public accordingly."

Opioids or narcotics, like morphine and codeine, also dull pain. But in her new book, Living with Chronic Pain, Jennifer Schneider, M.D., Ph.D., says many doctors and patients are too wary of addiction to these heavy-duty drugs.

"Most patients don't get the medication they need for chronic pain,"Dr. Schneider says. "Opioids should be considered when patients have tried many other options and they're still in a lot of pain. The risk for addiction is very small in most patients."

You and your doctor need to choose medications carefully based on the cause and severity of your pain and your personal risk for gastrointestinal, cardiovascular and addiction problems.

"Some patients may see the withdrawal of Vioxx and Bextra as a setback," says Nashville pharmacist Jason Greene, Pharm.D., a spokesman for the American Pharmacists Association. "But they shouldn't be afraid to try something new.Most people will be able to transition to another medication that will work as well if not better."

Blocks, injections and more
Life would be simpler if taking a pill meant the end of chronic pain, but that's not true for most pain sufferers.Medications may not be the best option for mild pain.Medications don't help some patients, and others don't want to take them every day. Even when medications help, many patients still face a lot of pain.

Fortunately, other options, alone or with medication, can help. Here are some to consider:

• Lifestyle changes. Weight loss and exercise can help you ease pain and stay active, flexible and mobile. Dietitians and physical therapists can help you reach your fitness goals.
• Nerve blocks. Doctors can inject pain medications directly into nerves to relieve some types of nerve, tendon, ligament and muscle pain.
• Electrical stimulation. Low-voltage electrical currents can stimulate nerves in the painful area and interrupt the brain's normal pain signals.
• Surgery. Various surgical procedures target conditions that cause pain. For example, new techniques can combat some painful back disorders.
• Psychological support. Antidepressant medications, therapy or both help some pain patients fight related depression.
• Complementary therapies. Many patients find acupuncture, biofeedback, guided imagery, meditation and other alternative therapies ease pain and aid well-being. The degree of evidence supporting such therapies varies.

Come up with a plan
Chronic pain isn't normal, and it's not an inevitable part of aging. But finding a treatment plan that works often takes time, energy, trial and error.

Learn all you can about your condition and treatment options.Work with your doctor to create a complete pain-management plan or ask for a referral to a pain specialist. Your doctor should be a trusted partner who can help make sense of a complex condition.

"Patients should strive for reducing their pain to a tolerable level so they're less focused on the pain and can do the things they enjoy in life," says Dr. Schneider. "Living with chronic pain doesn't have to mean giving up on life."

Oh, the Pain
We all need pain. It tells us we stepped on a nail, have an infection, burned our hand on the stove or broke a leg. Pain should stop when we heal. But that's not always the case. Some people have conditions, such as arthritis, that don't heal. Others have pain that continues long after their injury or illness goes away.

Here are some disturbing statistics:

• About 50 million Americans live with chronic pain.
• Chronic pain is the leading U.S. cause of adult disability.
• Common causes of chronic pain include arthritis, back disorders, headaches, cancer, injuries and diabetic complications.
• More than seven out of 10 people with chronic pain have been living in pain for more than three years. About one in three has fought chronic pain for more than a decade.
• Nearly one in two people with chronic pain say it isn't under control.
• Most people with chronic pain rely on some type of complementary therapy.

Beyond Pain to Peace
Pain is Maggie Buckley's constant companion. She was 13 when she learned she had Ehlers-Danlos Syndrome (EDS), a group of genetic disorders that affects the connective tissues that support the skin, muscles, tendons and ligaments.

"My connective tissues don't have the elasticity they should," says Ms. Buckley, 43, of Walnut Creek, Calif. "So I have a lot of joint pain, and my joints often become dislocated. I bruise easily and heal slowly."

There's no cure for EDS. But Ms. Buckley was determined to do what she could to fight her disease. She found a doctor she felt comfortable with and spent years exploring treatment options. Medications didn't help, but she found simple yet effective ways to cope.

"I watch my weight so I don't add any stress to my joints," she says. "And I exercise every day so I can function. Pilates, relaxation, visualization techniques and distraction really help."

Ms. Buckley once held a demanding job as business manager of a photographic imaging lab. Due to her disease she no longer works, but she has a unique perspective.

"I don't say 'Oh, woe is me,'" says Ms. Buckley, who's now an advocate for those with EDS. "I'm a happier person now with more pain than I was when I worked full time and had a good income. I was so busy rushing around that I didn't have time to enjoy my life. Now, I appreciate my good days and the time I spend having fun with family and friends."

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