The experience of chronic pain is very personal. What bothers one person badly might not trouble another very much. For some people, pain may resonate as more emotional than physical. For others, it overwhelms the body, but they battle it with their mind. However, it is experienced — as mild, bothersome or high-impact — chronic pain affects more than 50 million Americans. Around 7 per cent of sufferers describe their pain as high-impact, causing persistent psychological distress and seriously interfering with daily activities.

Current research estimates chronic pain adds up to nearly $300 billion a year in lost productivity — and the price it exacts on health and happiness is far greater. Studies have found that 25 per cent to 85 per cent of people with chronic pain also contend with severe depression.

In a study published in Pain, researchers used pain info from the Centres for Disease Control and Prevention’s National Health Interview Survey to get a picture of what is causing all this discomfort and agony. They found that back, hip, knee and foot pain were the most common troublemakers. Injury, osteoarthritis, obesity, muscle and ligament strains and sprains, tendinitis, bursitis, pinched nerves, plantar fasciitis, bunions and tissue tears (like to the meniscus) are common causes. Once chronic pain sets in, it can spread. A problem in one area of the body — say, foot pain — can throw off your gait, putting a strain on your lower back that causes chronic pain there as well. Or pain may settle into your lower back first and throw off your gait so that your knees start hurting.

Chronic pain can also develop from a chronic disease, like diabetes. Five million people — that’s 20 per cent of the 26 million with diagnosed diabetes — have diabetic nerve pain. It can make it difficult to walk and interfere with sleep.

Less-common causes of chronic pain include illnesses like fibromyalgia that trigger body-wide aches that don’t have a specific trigger, such as a torn tendon or arthritic vertebrae. Migraine and some cancers are also culprits. But whatever the cause, untreated chronic pain can turn your life upside down.

What can you do? Chronic pain is real, but perception of and reaction to pain is highly variable. You can do a lot to put chronic pain in a back corner instead of centre stage.

Some management techniques involve changing your reaction to pain — especially useful when there is no treatment or therapy that will make it go away entirely. One study in the journal Pain found that hypnosis, cognitive therapy, hypnotic cognitive therapy and pain education all make a significant difference. They gave volunteers with chronic pain four sessions of those treatments and found that all forms had a medium to large impact on pain intensity — and the improvements lasted through 12 months of follow-up.

The Cleveland Clinic says meditation, tai chi, biofeedback, Reiki and aromatherapy and other stressreduction techniques also can help lessen the impact of chronic pain on your life. And for conditions like fibromyalgia, exercise, good quality sleep and a diet free of simple sugars, added syrups, simple carbs, red and processed meats, egg yolks and cheese, along with stress-relief techniques, can help.

Medical treatments for chronic pain include physical, occupational and massage therapy, acupuncture, TENS (transcutaneous electrical nerve stimulation), topical creams containing capsaicin, cortisone, or NSAIDs, and nerve blocks. Sometimes cortisone shots are helpful. And surgery can be a very positive solution for joint pain and other injuries. Using pain medications is also smart, sometimes. Overthe-counter anti-inflammatories, such as ibuprofen, can ease discomfort, as can prescription NSAIDs, and there are times when opioids are needed. But always combine medications and surgery with aggressive, self-directed solutions that relieve stress and upgrade your lifestyle habits.

Chronic pain is definitely a pain in the (fill in the blank), but you can make it more manageable — and even make it go away. Talk to a pain management specialist who focuses on the widest range of approaches.

-MICHAEL ROIZEN, M.D., AND MEHMET OZ, M.D.