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If you're a migraine sufferer, or someone plagued by severe arthritis or recurring bouts of shingles, you know all too well chronic pain can severely erode your quality of life. My patients with debilitating back pain frequently complain about the emotional toll that goes with the relentless discomfort.

Trying to cope with constant pain is exhausting and disheartening for patients. Doctors, too, find it frustrating that sometimes little can be done to make chronic pain go away.

Pain is defined as "unpleasant sensory and emotional experience" associated with actual or potential tissue damage. However, the Canadian Psychological Association says "pain is what the patient says it is." As a physician, that definition resonates with me. Chronic pain is a perception the patient has; as a doctor, I have to rely on their description of what is happening to them.

Acute pain has an identifiable cause (a broken wrist, for example), is of relatively short duration and responds to treatment. Chronic pain, however, is dysfunctional pain that lasts at least six months. Alternatively, it is pain that continues longer than expected for a specific condition. Its cause is often unclear; an ultrasound or CAT scan, for example, may offer no immediate answers why a person has crippling back pain. Coping with chronic pain is often multipronged, employing a variety of treatments.

About 70 per cent of Canadians lives with chronic pain at some point. More women are thought to be affected than men, and the numbers increase with age. Chronic pain is a leading cause of absenteeism and lost productivity.

Musculoskeletal causes of chronic pain, such as arthritis, are a major concern as our population ages. One in six Canadians over age 15 have reported arthritis as a long-term condition. Within a decade, one million or more Canadians are expected to have some kind of joint disease resulting in chronic pain.

More than half of chronic-pain sufferers can't carry out normal household chores, such as cleaning or cooking, or take part in recreational activities, whether it's going for a walk around the block or riding a bike with their kids. Two-thirds of people with chronic pain can't attend social events, such as going to a dinner or movie with friends. It is easy to understand how someone whose life is so curtailed can feel anxious, frustrated and depressed.

A doctor assessing chronic pain will ask detailed questions about the location of the pain, its intensity and characteristics (Does it hurt more if you walk or sit? Are you able to sleep or does the pain wake you? Is it stabbing, throbbing or a general ache?) Any factors that make the pain better or worse are noted, as they can help pinpoint the cause. A physical examination is done to look for any signs of swelling, redness or change in appearance of the affected area. An ultrasound or other tests may be ordered to examine the tissues and bones.

Patients often ask for prescription drugs to relieve the pain, which should spark a discussion about the risks of dependency. Some patients try to alleviate pain with alcohol, or over-the-counter medication, but those self-medicating tactics are equally risky.

So what can be done to treat, or at least manage, chronic pain? Physical supports such as splints, canes or other aids can help. Physiotherapy, exercises to strengthen and stretch the body, massage, chiropractics and acupuncture may also be helpful. Then there is hypnosis, stress management, behavioural therapy, biofeedback and other therapies. Surgery can alleviate some types of chronic pain (such as hip, knee and spinal pain). Psychological support is critical -- especially when other treatments offer no relief.

If there were an ideal pain-reliever drug, it would be one that is extremely effective, quick-acting, long-lasting, has few side effects, doesn't interact with other drugs and, most importantly, would not lead to dependency or addiction. Unfortunately, the ideal wonder drug is still an ideal.

But doctors do have a host of medicines to work with, including acetaminophen, codeine, toradol and tramadol, to name just a few. Anti-inflammatory medications (sometimes called NSAIDS) are useful but may cause gastric problems. Stronger pain relievers, such as narcotics, are an option but must be used with caution, given the potential for abuse or tolerance buildup. Anti-depressants and anti-convulsants have also proven helpful in managing chronic pain. Some patients benefit from "nerve blocks," medicines (such as anesthetics or steroids) that are injected into a specific area to deaden pain.

All pain medications have advantages and disadvantages, so you should discuss them in detail with your doctor, along with fully exploring all other options for treatment and pain management.

Dr. Marla Shapiro can be seen Tuesdays on CTV's Canada AM. Questions about general health issues can be sent to her at: health@globeandmail.com.

(Please direct queries about personal health issues to your doctor.)