Chronic pain is as common as it is debilitating. And its cost to the economy is huge, reports Sally Dawson

Recent news that experts are to study a radical treatment for a controversial pelvic condition has brought into focus an issue which gets few column inches: chronic pain.

Society pays chronic pain little attention - especially when it has no obvious cause (unlike, say, cancer). Pelvic pain falls into this category. It often has no identifiable cause, it is common (as migraine and asthma) and it can be debilitating. And as a result physicians are often at a loss in deciding how to treat it.

Where all conventional treatments have been tried and failed (there has been speculation that the pain originates from instability of the pelvis following childbirth) some women can have an operation which involves cutting the nerve which transmits pain signals to the brain. Specialists at the Birmingham Women's Hospital are studying the results of this operation - laparoscoptic utero-sacral nerve ablation or "LUNA” - to hopefully provide a definitive answer as to whether women really benefit from it.

The cost of pain is not just psychological. Back pain, for instance, is estimated to lose the UK 11 million working days a year, costing the economy up to £5 billion. Studies appear to show that chronic pain is widespread and under-reported. Using a definition of "pain or discomfort, that persisted continuously or intermittently for longer than three months" a 1999 study undertaken in the Grampian region of Scotland found that half of the respondents reported experiencing chronic pain.

And whilst half categorised their pain as "low disability / low intensity", 11 per cent said their pain was "high disability / moderately limiting", and 16 per cent rated their pain as "high disability / severely limiting". The study found that the two most commonly cited reasons were back pain, which varied little with age, and arthritis which afflicted a quarter of people in their 60s and older. "Women's problems" (such as pelvic pain) were found in five to eight per cent of women aged 25-54 years.

"About half of people in the community suffer chronic pain, and for about half of these the pain is significant," the study concluded. "The indications are that much of the pain is poorly treated and that there is a potentially large demand for more or better pain relief services for the community."

This view is backed-up by the British Pain Society which says that pain management services are not given the priority they need. Society member, Dr Chris Wells, said that there was a vast "disparity" in the quality and provision of pain management services in the UK. "Where there are energetic health professionals with the drive to set-up good pain management services, the provision is excellent, but there are some areas with huge waiting lists, and very little provision," he said. As a result many people end-up suffering in silence.

This is borne-out by Jane Campbell's experience. Four years ago she hit the back of her neck on a shelf whilst drinking in a bar. "My first reaction was, actually, 'how embarrassing, let's pretend I didn't do that'." Though she doesn't remember any real pain at the time, within days the pain had become unbearable. "Moving my head suddenly became a conscious task," she says. "After a hospital X-ray confirmed there was no serious damage, I was sent home with the diagnosis of 'bad bruising'."

With no advice or follow-up and just some "welcome" pain-killers, Jane went back to work. But working on pain-killers proved "difficult, the room span, my head span". Every bump was an agony, sleeping comfortably was an impossibility - depression, she says, began to sink in when she discovered "even carrying two cans of Coke back from the shop was too heavy".

Jane says that in her case she was "lucky". A friend referred her to an osteopath and the combination of therapy and sound advice on exercise, posture and weight-loss did the trick. "After three months I was pretty much okay. But even now a bad knock sends me into a panic that the pain might return," she says.

With the "patchy" provision in pain services, and long waiting lists, many of the people seen by pain management clinics have been through this cycle of pain and depression - leading to loss of mobility - over a number of years by the time they have been referred to a specialist.

Research has shown that people experience pain in different ways. The reasons for this may be genetic but there is also evidence that our ability to "cope" with pain may be influenced by previous experiences of pain and how we anticipate it. Through a combination of targeted medication - pain killers and / or anti-depressants - and cognitive behavioural therapy (CBT) many patients attending pain management clinics have been successfully helped to resume a normal life.

But as scientists develop a better understanding of how the brain processes pain, and possibly even discover the cause of non-determined pain, it may eventually be possible not just to treat but to prevent some types of chronic pain altogether.

Meanwhile sufferers of pelvic pain are waiting to see if LUNA holds the answer to their problems. "I had chronic pelvic pain and I mean chronic. I was taking painkillers all the time and was off work constantly," says Rachel Parker, 33.

She had the pocedure last year: "I'm 100 per cent better and feel absolutely great. I've not had a day's pain since the operation - fingers crossed."