Lorna looks normal. She smiles often and tries to take part in as many activities as she can. But few people realize that Lorna suffers almost continuous back pain and takes strong medication to enable her to carry on.

It’s invisible but for those who suffer it, pain is very real. About one in five Canadians lives with chronic pain — the type that just won’t go away.

Chronic pain affects both sexes and, while most common in middle age, it can occur at any stage of life. It can make simple movements hurt, disrupt sleep, and sap energy. It can impair work, social, recreational, and household activities — and can have a negative impact on psychological well-being.

Pain is more than just a companion of disease or injury. According to the Canadian Pain Society (CPS), it's a damaging process in its own right and requires prompt treatment to counter its destructive effects. This is why CPS launched its "Patient Pain Manifesto," a public awareness program aimed at alerting and educating patients and their families about the right to effective pain management.

"A surprising number of people believe that suffering is part of being in hospital and being ill," explains CPS researcher, Dr. Celeste Johnston. "We want to make sure that patients are fully aware that they have the right to receive treatment to keep their pain under control and help them reclaim their lives."

Medications are used to combat severe chronic pain. In addition, medical specialists, trained in pain management, offer options such as nerve blocks and epidural steroid injections in joints or around nerves. Neurosurgeons specializing in this area offer surgical alternatives including spinal cord stimulator implant systems, intraspinal drug-infusion pump implants and nerve destroying surgery to treat severe intractable pain that does not respond to other therapies.

But while painkillers are the usual course, some alternative therapies have been used for centuries. Several of these that appear to safely relieve stress and reduce discomfort, and are gaining acceptance in mainstream medicine.

Biofeedback falls under the category of mind-body therapies. Using feedback from a variety of monitoring procedures and equipment, the sufferer learns to control certain involuntary body responses including brain activity, blood pressure and heart rate. This can then be used to help treat a wide range of mental and physical health problems, from preventing a panic attack to taming a migraine or curing incontinence.

A variety of relaxation techniques including meditation, deep breathing, guided visualization and even self-hypnosis can reduce stress and discomfort when taught as part of a pain or arthritis self-management program. These can also prevent flare-ups of rheumatoid arthritis.

One of the oldest methods of health care practice is massage. It involves use of manipulative techniques to move muscles and soft tissues in order to improve circulation in the muscle, increasing the flow of nutrients and eliminating waste products. Massage can reduce the heart rate, relax muscles, improve range of motion in joints and increase production of the body's natural painkillers. It often helps relieve stress and anxiety. Studies have shown that massage confers short-term benefits on psychological well-being as well as on physical symptoms.

Both acupressure and acupuncture stem from the Chinese belief that 14 invisible pathways, called meridians, lie beneath the skin. They believe that when the life force that runs through these meridians is interrupted, this causes illness. Practitioners restore the flow of the energy by applying pressure with their fingers (acupressure) or by inserting very fine needles (acupuncture). Research on the benefits of acupressure is inconclusive. In 2005 the province of Ontario took steps to regulate acupuncture, recognizing its widespread use.

Regular exercise can help control pain. When a person is inactive, the muscles — including the heart — lose strength and work less efficiently. The risk of high blood pressure, high cholesterol and diabetes increases. Inactivity can increase fatigue, stress and anxiety as well. "Years ago, people who were in pain were told to rest," says Dr. Edward Laskowski, a physical medicine and rehabilitation specialist and co-director of the Sports Medicine Center at Mayo Clinic, Rochester, Minn. "But now we know the exact opposite is true. When you rest, you become de-conditioned — which may actually contribute to chronic pain."

Consult a doctor for help designing an exercise program that meets specific needs. The doctor may recommend stretching, strengthening and aerobic exercises. Swimming, biking and walking are often good choices. Gentle exercises that foster relaxation — such as meditation and yoga — may also be helpful.

Electrical stimulation of the nerves that control muscles can be a safe and effective means of controlling muscle-related pain such as in the neck and low back. Transcutaneous electrical nerve stimulation (TENS) delivers mild electric impulses to nerve endings beneath the skin and can be safely used at home several times a day.

Laser and light therapy uses infrared photo energy applied to wounds and injuries to increase circulation, stimulate healing and relieve pain. Light-emitting diodes come into direct skin contact. Patients report warmth and tingling as circulation increases.

Ice and heat therapy provide short-term relief. Ice is effective with acute pain while heat tends to work best with chronic pain such as joint stiffness. Ice reduces swelling and can relieve muscle spasms. Heat increases blood flow which aids in healing and helps joints move more easily.

Before deciding on an alternative therapy for pain, always discuss it with a doctor to ensure it is safe and best suited to the need.