ames Murphy is only 26, but some days, he can hardly get out of bed.
Three years ago, Murphy, a North Easton man who used to fix power tools for a living, damaged a disc in his back lifting a steel workbench. The injury allowed the jelly-like material that cushions vertebrae to ooze out and press on a nerve. Pain raged through his lower back and shot down his right leg.
Despite surgery, cortisone injections, pills and numerous visits to a major Boston pain clinic, where, he says, he was told it was all in his head, Murphy's pain is worse.
Murphy became so disgusted at what he feels is the medical establishment's disregard of chronic pain that a year ago he started a web site (http://come.to/painsupport). It now gets 400 hits a week from people, some suicidal, whose lives are ruined by pain.
Chronic pain, defined as pain lasting more than three months, affects 35 to 40 million Americans, says Dr. Russell Portenoy, head of the American Pain Society and of pain medicine and palliative care at Beth Israel Medical Center in New York.
And researchers now know that, far from being all in one's head, it is an all-too-real physiological phenomenon, though the specifics vary depending on whether it's caused by damage to nerves, as in shingles or diabetes; by inflammation, as in arthritis; or by other things, like spreading cancer.
With a nerve injury, for instance, chronic pain may be the body's way of learning to avoid future injuries. When you injure nerves in your finger, nerves in the spinal cord ''reorganize to amplify pain and remember it,'' says Dr. Daniel Carr, a professor of anesthesia at New England Medical Center. This reaction is so ancient - it's been in the genetic structure of animals for 600 million years - it must be crucial to survival.
But despite this new understanding and an explosion of treatments - including non-drug remedies - millions suffer ''because doctors don't believe patients' reports,'' says Dr. Kathleen Foley, a cancer pain specialist at Memorial Sloan-Kettering Cancer Center in New York.
Chronic pain is also undertreated because of the fear that patients - even those who are dying - might become addicted to high doses of powerful painkillers like morphine. And doctors fear running afoul of drug enforcement officials.
In reality, such abuse is rare. One study of 12,000 patients showed only four became addicted. Another found that not one of 10,000 burn patients became addicted. In yet another study of 2,000 patients, only three became addicted.
What does happen is that people don't get enough medication. A major 1995 by the Robert Wood Johnson Foundation showed that 50 percent of dying patients had pain in the last three days of life.
Another found that only 12 percent of cancer patients in nursing homes got basic pain care recommended by the World Health Organization. And a New England Journal of Medicine study of 1,000 cancer doctors showed half their patients had bad pain - and the doctors didn't know what to do about it.
And it's not just dying patients whose pain is inadequately addressed, it's people without terminal illnesses as well.
In a recent Roper survey of 805 people without cancer and with moderate to severe chronic pain, 40 percent said their pain was out of control. The survey, which was sponsored by a drug company that develops pain relief medication, found that half of the respondents had switched doctors at least once, and half had been in pain for more than five years.
Much of that suffering can be avoided, and the first step is to get an evaluation to see exactly what type of pain you have.
If it's arthritis pain, for instance, traditional NSAIDS (nonsteroidal anti-inflammatory drugs) and newer ones called COX-2 inhibitors may help. If your pain is from spreading cancer, opioids such as morphine, hydromorphone, oxycodone, codeine, methadone or fentanyl often help. These drugs all work through a special type of opioid receptor in the brain called mu.
On the other hand, if you have nerve pain, opioids may not be the answer. But other drugs that work through a different receptor, called NMDA, may be, including dextromethorphan and ketamine. Another drug, d-methadone, also shows promise.
Chronic pain also makes many people depressed and anti-depressants often help. But these medications actually do more than simply elevate mood - they fight pain directly.
Older anti-depressants like Elavil work through brain chemicals such as norepinephrine both to reduce transmission of pain signals up the spinal cord and to rev up transmission of pain-killing signals down it. Newer antidepressants like Paxil work by boosting another neurotransmitter, serotonin, which helps control pain just as it elevates mood.
Other drugs besides anti-depressants have this dual use. Anti-convulsants such as Neurontin are now known to block the firing of nerves that have grown new sprouts in response to injury. Anti-anxiety medications such as Valium, Ativan and Klonopin also block transmission of signals along pain nerves.
Researchers are also finding better ways to deliver painkillers in patients who can't swallow or don't want injections. Fentanyl, for instance, comes in patches that deliver a steady dose over several days. Some patches now come with buttons that a patient pushes when relief is needed. There's even a lozenge of fentanyl on a stick, so the drug can be absorbed directly through mucus membranes in the mouth.
If pain is intractable, doctors can implant pumps in the spinal cord to supply morphine or even ''snail slime'' (a substance called SNX-111 that mimics a chemical put out by ocean snails).
At a few clinics, including the Advanced Pain Management Center in Stoneham, doctors are trying to shrink damaged spinal discs with heat. A wire is inserted into the disc through a tube and then heated to 194 degrees Fahrenheit. This seems to shrink collagen in the disc and reduce pain, says Dr. Anil Kumar, who has performed the procedure on a dozen patients so far.
In other patients with back pain, steroids injected near the spinal cord sometimes work, as can injections of local anesthetics into nerve ganglia in the neck or lower back.
In some cases, doctors put electrical devices in the brain or spinal cord to activate the descending pain pathways that block pain. They can also destroy pain nerves surgically or chemically. For tic douloureux, for instance, the trigeminal nerve in the face can be cut by radiofrequency waves; a similar technique is used in the neck in cancer patients.
But nerve destruction is usually done only if patients have a short life expectancy because new pain nerves can sprout, notes Dr. Douglas Merrill, chairman of the committee on pain management for the American Society of Anesthesiologists.
The bottom line is that there is help available. But, as James Murphy have discovered, you may have to fight to get your doctor to take you seriously or to get your insurer to pay.
You may also have to fight your own tendency to let pain become ''a way of life,'' says Merrill. You may not want to hear that you should get off the couch and onto the treadmill. But the ultimate solution may be to ''find something to do with your life other than watch TV and wait for six hours to go around to take your pills again.''
Judy Foreman is a member of the Globe Staff. Her e-mail address is: foreman@globe.com.
Previous ''Health Sense'' columns are available through the Globe Online searchable archives at http://www.boston.com. Use the keyword columnists and then click on Judy Foreman's name.
