For years, Joseph Moore, an Army Vietnam veteran, suffered with constant, agonizing back pain. “I would wake up in the morning, and it was like a dagger in my back,” he recalls. Compounding his misery, the pain had no obvious cause and didn’t respond to treatment, including back braces and pain medications. “It got to the point where I knew I’d soon be in a wheelchair,” he says. “I was 59 and felt like I was 99.”

Last year, Moore’s physician referred him to the 18-day inpatient Chronic Pain Rehabilitation Program (CPRP) at the James A. Haley Veterans Hospital (www.vachronicpain.org) in Tampa, Fla. He soon found himself immersed in a whirlwind of activities, including regimented exercise, relaxation techniques, intense physical therapy, and group lectures about health and nutrition. The hardest part, however, was the diet — a mere 1,800 calories a day to trim down his 294-pound frame.

At first, Moore chafed at the schedule and the rules. “It was like I was back in the military,” he says. But he persevered, telling himself he would give it one more day before he quit. And after the first “killer” week, he began to see results. “I realized my pain had decreased, I could walk without a cane, and I was losing weight,” he says. He also began interacting more with the staff and other participants and soon was leading the pack in group exercise sessions.

After successfully completing the program, Moore was a changed man — not completely pain free, but much more in control. One year later, he still uses the strategies he learned, including exercise, relaxation tapes, and a healthy diet. “I still have pain, but I’m able to cope with it,” he says. “I’ve never felt better.”

Moore still is living with chronic pain — but he’s learned to manage it better than most. Experts say his story need not be unusual. Here’s their advice for managing this mysterious and often frustrating condition.

1. Understand chronic pain.

In some cases, pain can be a useful sensation. Acute pain, which is caused by illness or injury, is the body’s alarm system.

If you twist your ankle in a fall, the pain alerts you that you’ve hurt yourself and motivates you to seek help. Chronic pain occurs when that alarm system doesn’t shut off.

“Most of the time, chronic pain is linked to illness or injury, but instead of subsiding, it persists beyond the time you would expect it to disappear,” says Dr. Michael Clark, clinical director of the CPRP. Sometimes, the exact cause can’t be pinpointed, making the pain even more difficult to treat.

It’s estimated that 50 million Americans suffer from chronic pain. Many shuttle from physician to physician and try a plethora of treatments, none of which brings complete or lasting relief. Or worse, some patients are simply dismissed — led to believe the pain is all in their heads. The consequences of living with chronic, unrelenting pain can be devastating, affecting a person’s body, mind, and spirit.

The key for these people, as Moore found, isn’t a cure, but control. “You may not get rid of your pain completely, but you can learn to not let it bother you as much,” says Clark. “It may take a lot of work, but you can make it better.”

2. Seek help early.

Your primary care physician should be your first stop for pain treatment. In the best-case scenario, he or she will pinpoint the cause and prescribe a treatment that will permanently fix the problem or mitigate the pain until the body heals itself.

Experts advise giving your physician a few months to address your symptoms, as treatments might take some time to work. “However, if you don’t feel a sense of progress or if your pain keeps coming back, it might be time to see a specialist,” says Clark.

Pain medicine specialists can have a variety of backgrounds. Anesthesiologists, neurologists, and psychiatrists all can specialize in pain management, and they all have different diagnosis and treatment phi- losophies. Some rely primarily on medications, others emphasize physical therapy, and others incorporate holistic techniques. To find a specialist who’s right for you, ask your primary care physician for a referral or search the online physician directories at the American Academy of Pain Management (www.aapainmanage.org) or the American Academy of Pain Medicine (www.painmed.org).

You also could seek out a pain rehabilitation center such as the CPRP that offers a multidisciplinary, comprehensive approach to pain treatment. The American Chronic Pain Association (www.theacpa.org) offers advice for finding and evaluating these programs.

The key is to get help early. Ignoring the pain might lead to decreased activity, reduced muscle strength and flexibility, and even depression, all of which can make matters worse. “The earlier you get out of that cycle, the less likely you are to become permanently impaired and suffer severe consequences,” says Clark.

3. Get the most out of your doctors’ visits.

Pain can defy description, but the more clearly you can explain it to your physician, the easier it will be to get appropriate treatment. Be prepared to describe your pain and the circumstances surrounding it as accurately as possible, including when it started, when it seems to get better or worse, and if it’s accompanied by other symptoms. Keep a log of your pain symptoms to help you remember all the details.

Dr. Bruce Nicholson, a pain management specialist in Allentown, Pa., advises bringing a spouse or close friend to your doctors’ appointments. “Often patients are too close to the pain, and they don’t realize how it’s affecting their mood or activities,” he says. A third party can provide a more objective, accurate perspective.

4. Learn about your options.

There are many ways to treat pain. Some people get good results with a single method; others benefit from a combination of treatments. Here are some of the interventions your doctor might recommend.

Prescription medications vary in their potency and in the way they tackle pain — some interfere with pain signals to the brain, some alter the perception of pain in the brain itself, and some do both.

Although pain medications eliminate pain, they don’t cure the root cause, and they should be used with caution. Keep in mind that nearly all medications have side effects and risks; in fact, two popular prescription pain medications, Vioxx and Bextra, recently were withdrawn from the market because studies suggested that long-term use was associated with an increased risk of cardiovascular and other health problems.

A similar medication, Celebrex, remains available, though the FDA has required the maker to include strict warnings on its labels.

Some physicians say the risks of these medications are marginal for some patients, and they point out that many patients were left with few options when the drugs were withdrawn. The decision to take prescription medication is a personal one. Nicholson points to his mother, who was taking Vioxx and tried many over-the-counter medications before being prescribed Celebrex.

He says she considers the side effects and risks to be acceptable trade-offs for living a functional life.

To advise people who had been taking Vioxx and Bextra, the American Chronic Pain Association, the National Pain Foundation, and the American Pain Foundation (APF) have jointly created a consumer guide that answers questions about treatment options and provides resources for managing pain. You can find the guide at www.theacpa.org.

Your tolerance to pain medication might increase over time, requiring you to take larger doses to get the same results. Consequently, many physicians prefer not to prescribe pain medications for extended periods, instead combining them with other treatments that could help resolve the cause. To help your doctor find the medication and dosage that will be most effective for you, inform him or her about all your medical conditions, take medications exactly as prescribed, and let your doctor know how they are affecting you.

Transcutaneous electrical nerve stimulation (TENS) units are small, battery-powered devices that deliver a low-voltage electrical current through the skin, which can provide pain relief for some people. There are different theories as to why TENS units work; the electricity might interfere with the pain signals to the brain, or it might help the body produce natural painkillers called endorphins.

Pain injections deliver a powerful numbing drug, such as a steroid, directly to the site of pain. Relief can last from several weeks to several months.

Alternative medicine treatments gradually have become accepted in mainstream medicine; examples include acupuncture, massage, and biofeedback, which involves using a series of monitoring procedures and equipment to control involuntary physiological responses, such as heart rate and muscle tension, that can affect how individuals feel pain. “Alternative treatments can do great things,” says Col. Paul Reynolds, USA-Ret., a San Francisco Bay Area pain medicine specialist, who has recommended hypnosis, relaxation therapy, and acupuncture to patients.

Physical therapy, which can include stretching, strengthening exercises, and aerobic conditioning, can confer a variety of benefits, such as increased strength and flexibility and decreased pain. “Many treatments come in and out of vogue, but physical therapy is a mainstay,” says Reynolds. Through one-on-one treatment and individualized home programs, physical therapy gives patients the tools for long-term pain management, as it did for Moore. After learning how to exercise at CPRP, he has maintained a routine, which includes walking, biking, and strengthening workouts. “It’s like a religion to me,” Moore says.

In some cases, the simplest measures can work remarkably well. Lt. Col. Barbara Springer, USA, chief of physical therapy services at Walter Reed Army Medical Center in Washington, D.C., often recommends her patients try rest, ice, compression, and elevation (referred to as “RICE”) before they attempt anything else. Over-the-counter pain remedies such as creams and pads that provide a heating or cooling sensation can provide temporary relief as well.

Surgery generally is a last resort but can be effective for intractable pain. Surgery can be used to correct problems, such as a pinched nerve, or to implant devices that deliver a continuous flow of electricity or medication to the site of pain.

Support groups can provide the opportunity to share experiences, coping strategies, and resources. Realizing you are not alone can go  a long way. To find a local support group, check with your doctor or hospital. The Web sites listed throughout this article also can lead you to local groups.

The APF and Disabled American Veterans have banded together to launch a nationwide support program called Veterans and Pain. The program offers opportunities for veterans to share their stories and coping strategies with fellow veterans and their family members. For more information about the program, go to www.painfoundation.org.

5. Be patient and proactive.

One of the biggest mistakes people make is expecting quick results with minimal effort. “People tend to want a magic pill, but they need to be active participants in their health care,” says Springer. Nicholson agrees: “We need to view chronic pain as we do diabetes and hypertension — as a condition that can be managed. The vast majority of chronic pain patients can find ways to control their pain, live with it, and maintain function.”