As recently as 20 years ago, people with chronic pain were too often dismissively told that their problem was "in their heads" or that they were hypochondriacs. But in the last decade, a handful of dedicated researchers learned that chronic pain is not simply a symptom of something else -- such as anxiety, depression, or a need for attention -- but a disease in its own right, one that can alter a person's emotional, professional, and family life in profound and debilitating ways. Today, doctors have yet to fully apply this knowledge.

Some 50 million Americans have chronic pain and nearly half have trouble finding adequate relief. But the outlook is good: Ongoing research is revealing the promise of novel treatments, including new medications, devices and injections, alternative therapies such as biofeedback and acupuncture, and an all-encompassing mind/body approach. The point? If patients' whole lives are affected by pain, the treatment must address their whole lives.

I sat down with Scott M. Fishman, MD, to find out what's new in pain management -- and what doctors still need to learn to help their patients. Fishman is the president and chairman of the American Pain Foundation; he is also the chief of the division of pain medicine and professor of anesthesiology at the University of California, Davis. He wrote The War on Pain: How Breakthroughs in the New Field of Pain Medicine Are Turning the Tide Against Suffering. A University of Massachusetts Medical School graduate, he is board-certified in internal medicine, psychiatry, and pain and palliative medicine.

Q: About chronic pain: have researchers learned anything new about the origins of chronic pain that might lead to better diagnosis or treatment?
A: Absolutely -- we know exponentially more today than we knew even 10 years ago and much more than we knew 50 years ago. For one, we've learned a great deal about how pain is produced and transmitted and perceived. Fifty years ago, when someone hurt, we thought it was just a symptom of something else. But we now know the symptom of pain can become a disease in and of itself, and that disease is similar to other chronic conditions that can damage all aspects of someone's life.

New information has emerged in the last 10 years from one of the most active areas of pain research, neuroimaging. Functional MRI (magnetic resonance imaging) scans that look at brain activity when it's in pain or when it's receiving a pain reliever now tell us that when someone is in chronic pain, the emotion centers of the brain are more activated than the brain's sensory centers, which are more involved in acute, not chronic, pain. That's why pain is likely an emotional experience.

For all we've learned, however, we have not translated most of these advances to the frontline of medicine. Every time we take one of these discoveries and treat accordingly, we find unwanted side effects because pain is so pervasive. For instance, it's very hard to give someone pain relief without making them sleepy. It's very hard to turn off the nerves that transmit pain without producing the risk of seizure or heart rhythm problems.

But we're making advances. We're learning more about the electrical channels involved in nerve function. And we have many more candidates to target, and we're very hopeful that's going to translate into drugs with far fewer side effects.