Medical training in pain management has been notoriously uneven. Although primary care physicians generally handle pain treatment, fewer than one percent of those doctors have been trained as pain specialists. Medical schools and textbooks give the topic minimal attention.

At the same time, more than 50 million Americans live partially or totally disabled by chronic pain. Some specialists call chronic pain the number one health problem in the elderly.

According to the American Pain Foundation, the annual cost of chronic pain, including medical expenses, lost income, and lost productivity, is estimated at $100 billion; lost work days resulting from pain are estimated to cost $50 million a year alone.

Pain advocates believe significant change is on the horizon. An Act of Congress in 2000 designated this as the Decade of Pain Control and Research. Last year, the national organization which accredits hospitals and other healthcare settings mandated that pain should be considered the fifth "vital sign," along with blood pressure, temperature, heart rate, and respiration, and must be assessed in every patient and treated.

Yet pain experts agree perhaps the greatest challenge is to pain patients themselves: to make themselves heard.

"There are numerous reasons people don't talk about their pain," says Ellyn Radson, a Florida nurse and president of the North Florida chapter of the American Society of Pain Management Nurses.

"Some may have voiced their pain and been 'blown off' or belittled for it. Some may be afraid of the treatments, or they don't want to take drugs."

At the same time, she warned, "The longer pain goes on, the more sensitized the nervous system becomes. The longer people have pain, the more physically and emotionally disabling it becomes."

Numerous nonmedical therapies can also help patients get to the roots of pain and help them cope -including biofeedback, acupuncture, meditation and massage. Yet patients need to be educated on the options available in order to work with their physicians toward a treatment goal.

Says Robert Yezierski, director of the Comprehensive Center for Pain research at the University of Florida, "Pain is the responsibility of the person who has it. If you have it, you can't unload it on someone else and make them responsible for taking care of you. You have to address it yourself."

For more information:

Partners Against Pain, a good website for patients and caregivers about managing pain.