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Suck it up. Gut it out. Don't be a whiner.

That's what many people with chronic pain are often told.

It's also why 16 percent of chronic pain sufferers in Mississippi have never sought medical attention. And many of those who have seen a healthcare provider for their pain are happy just to maintain their function instead of alleviating pain altogether.

"Function is everything for these individuals," said Dr. B. Todd Sitzman, director of advanced pain therapy for Forrest General Cancer Center in Hattiesburg and president-elect of the American Academy of Pain Medicine. "Yet the reluctance on the part of their physicians, usually primary care physicians, to use opioid analgesics in the treatment of chronic pain, is a major issue despite the fact that it could be an important factor in achieving that person's normalcy.

"This is a prevalent problem nationwide, not just statewide. The physicians are educated on the proper use and management of opioid analgesics, but they're concerned about maintaining that medication month after month, and fearful of oversight by the DEA and the state board of medicine. 'Am I doing it correctly? Am I dotting my i's?' There are some obligations to physicians when we prescribe controlled (drugs) for chronic pain."

Two years ago, Sitzman participated in the state's first prime pain prevalence survey, which involved surveying 3,637 adults in the Deep South. Supported by the American Cancer Society, the Mississippi State University (MSU) Social Science Research Center completed "The Social and Cultural Dimensions of Pain: An Overview of the Southern Pain Prevalence Study."

"In general terms, we found (that) pain was pervasive in this sample of southern adults, many individuals were experiencing chronic pain, and substantial numbers judged their pain to be either moderate or severe," said Arthur G. Cosby, PhD, director of the Social Science Research Center. "When this data was projected to the six-state region, it was clear that several million individuals were living with chronic pain conditions. "Although the impact of pain on everyday life is very complex, one inescapable conclusion from the data is that pain has a broad-based effect upon the productivity of individuals and, hence, the wealth of society."

Overall, the findings indicated:

· More than half of those reporting pain said they experienced pain on a daily basis; 75 percent reported having pain several times a week.

· Seniors aged 65 years or older were twice as likely to report pain as young adults aged 18 to 24.

· Nearly half of all respondents said that medications should be saved until the pain worsens.

In Mississippi, these findings included:

· 41 percent experience pain on at least a monthly basis.

· 27 percent suffer from moderate to severe pain.

· Of those who experience pain on at least a monthly basis, 65 percent experience moderate to severe pain.

· Of those living with chronic pain, 99 percent said pain interferes with daily activities, such as relationships with loved ones, work, recreation, and/or sleep.

"Why is pain an extremely common and pervasive health condition when modern pain experts tell us it can almost always be controlled and can often be eliminated altogether? While there may be a number of answers to this question, the survey results point to a number of widely held beliefs and attitudes that appear to result in major barriers to reducing or eliminating pain, including the extent to which pain is seen as a 'normal part of life' to be endured," said Cosby. "Interestingly, there appeared to be greater satisfaction with healthcare providers than the effectiveness of their pain management."

Loss of sleep was often reported as a consequence of pain, Sitzman pointed out.

"Participation in recreational and leisure activities and the ability to work were also everyday activities that were substantially limited by pain," he said. "Mental health impacts were also reported as common negative consequences of pain, including feelings of depression, anxiety, and loneliness. About one-half of respondents said their pain interfered with sexual relations."

To alleviate pain and to improve their patients' quality of life, some of the issues pain specialists are buzzing about include pain treatment for cancer patients, aggressive pain therapy, deep brain stimulation, motor cortex stimulation, and electrical neuromodulation (spinal cord stimulation) for a variety of refractory pain conditions.

"Even though spinal cord stimulation has been around for 20 years, refined technologies and improvements have opened up its availability for many other indications," explained Sitzman. "Before, it was strictly for clear-cut extremity radicular pain, but now we're using it more for many chronic neuropathic pain conditions, everything from post-shingles to neuropathies. Of course, stimulation is for the top one percent of those patients who do not respond to anything else."

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