Q. Would you write something on how I can survive the pain I'm in, and still work, run a house and take care of myself? I have a physical discomfort that has been ongoing for some time now and the doctors can't help.
A. You're not alone. One out of three people has some chronic pain, and it's severe enough to change the lifestyle of one person out of eight. Most pain responds to some kind of treatment, at least to some degree. Moreover, there are many new treatments and more to come, since pain is registered in the central nervous system, where so much medical research is now focused.
There is a catch, however. You'll need patience, optimism and an open, curious mind to find the treatments that work best for you, and to change them as the nature of your pain changes. It takes chronic effort to deal with chronic pain.
A pain clinic can be quite helpful, but a good primary-care doctor who knows the latest treatments, or a pain management specialist should be much cheaper and just as effective.
The doctor may order old-fashioned heat to soothe pain and relax the muscles or ice to dull pain and reduce swelling; physical therapy to make the body more supple; painkillers, such as aspirin; anti-inflammatory drugs; antispasmodic drugs; or opiates, like codeine, but there are other approaches.
Ultrasound delivers heat beneath the skin, to the muscles and tissues, and electrical stimulation, such as TENS, interferes with the pain message to the brain.
Antidepressants, which affect the neurotransmitters, are another option. They affect pain perception as well as moods and are prescribed at a low dose for pain alone, and at full strength if depression is a problem, too.
You have another ally: your own body. Three different genes, in three different parts of the brain, make natural painkillers -- endorphins, enkephalins and dynorphins -- and many treatments trigger the body to make more of them. Acupuncture works this way, and it's usually covered by health insurance if it's ordered by the doctor.
In this periodic treatment, the acupuncturist uses very thin, disposable needles -- they're really wires -- to balance the flow of energy in the body. Studies show that this treatment is particularly effective for back pain, allergies and addictions.
Exercise also is recommended because it can reduce pain by releasing beta-endorphins, and one method of biofeedback can switch the brain to operate on lower, calmer alpha waves, while another type of biofeedback can relax the muscles. Meditation, relaxation and yoga also can ease pain remarkably well.
There are also more than 100 manual techniques -- from chiropractics to osteopathy, to massage, to therapeutic touch -- which are worth pursuing, even if they're not covered by insurance.
Distraction also might help. If you do something you enjoy or give help to someone who needs it, you can keep your mind off your condition better and get a real sense of accomplishment. A positive attitude minimizes your pain.
Pain support groups also help, and there are more than 1,000 of them nationwide.
Send a long, stamped self-addressed envelope to the National Chronic Pain Outreach Association, 4922 Hampden Lane, Bethesda, Md. 20814 for the name of a group near you. This clearinghouse has tapes on relaxation and self-hypnosis, too, at $10 each; a number of publications, including a directory of pain management professionals and clinics in this area for $5, and a newsletter for members.
You also may want to order "Relieving Pain," a free booklet from Clinical Center Communications, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 1C255, Bethesda, Md. 20892, and a moving, informative account of one woman's slow victory over pain, "Releasing Arthritis" by Linda Frazer Fleming ($12 at LF Publishing, Box 3175, Falls Church, Va. 22043).
You also might ask your library for "Living With Chronic Illness" by Cheri Register (Bantam; $9.95); "Life Without Pain" by Richard Linchitz (Addison-Wesley; $14.95); "Minding the Body; Mending the Mind" by Joan Borysenko (Bantam; $8.95); "The Chronic Pain Control Workbook" by Ellen Mohr-Catalano (New Harbinger Press; $12.50) and "The Scottsdale Pain Relief Program" by Neal Olshan (Ballantine; $3.95).
You need information as diverse as your treatment, so you can be strong, for your family as well as yourself.
If you still have trouble, go to counseling. A United Way agency or the county mental health office will have a sliding scale to suit your income. It's one of the best investments you'll ever make.
Questions may be sent to P.O. Box 15310, Washington, D.C. 20003.