Betty Crandall: surviving chronic pain with a healthy dose of Scripture.

Pain in her hands forced Betty Crandall to visit her doctor the day before the moving vans arrived. She'd initially blamed the persistent hurting and blisters on overuse and exposure to cleaning solutions during the days leading up to the interstate move.

"But it got to the point that I could barely stand to hold silverware or grip a steering wheel," she remembers. Her doctor gave her pain medications until she could get properly diagnosed in her new hometown. That's when, at age 51, her blood work revealed lupus.

"I had never heard of it," she says. In the 21 years since, the disease has forced the resident of Deer Lodge, Tennessee, now 72, to take charge of her health and come to terms with the prospect of long-term pain. Experts have said that patients who do both these things reap the best results.

"Pain management is an interactive process. There's no one-size-fits-all," explains Dr. Kathryn Mueller, associate professor at the Occupational Medicine Center at the University of Colorado's Health Sciences Center in Denver. "The patient needs to take a very active role; otherwise, they're not going to get better."

For many, "better" doesn't mean pain-free. It means functional.

Split Personality

The process begins by understanding pain's split personality. It's either acute--a word derived from the Latin word for "needle," because tissue damage from surgery, illness, or injury is sharp--or chronic, which stems from the Greek word for "time."

Doctors can attack acute pain with tried-and-true tools ranging from aspirin to morphine until the body heals and the pain vanishes. They understand it better than chronic pain and, despite the associated discomfort, consider it a valuable sentinel to warn of danger or illness.

Chronic pain can logically stem from chronic conditions including such autoimmune diseases as lupus, cancer, fibromyalgia, and migraines. But other less-identifiable causes can tangle nerve functioning enough to make pain a pathology unto itself.

In someone with undamaged pain receptors and circuitry, the unpleasant signal's pathway to the brain begins at nerve endings called nociceptors. According to the Mayo Clinic, millions of nociceptors throughout the body pick up signals ranging from pressure to temperature to disease or injury or infection.

Nociceptors are much more concentrated in vulnerable parts of the body, such as fingers and toes. Up to 1,300 nociceptors may be present in just one square inch of skin in those areas. Far fewer nociceptors exist around the better-protected muscles and organs. Regardless of location, when nerve endings detect pain, they immediately shoot an electrical message to the spinal column and up to the brain.

Expensive Condition

The National Institutes of Health have stamped a $100 billion price tag on chronic and acute pain, given their annual productivity and healthcare impacts in the US. Quality-of-life losses are beyond calculation.

In Crandall's case, fitness, good food, and faith in God helped her put her pain at bay just enough to enjoy her postdiagnosis life.

"It takes lots of water--I've been drinking 92 ounces a day for two decades and plenty of raw fruits and vegetables," reports Crandall. "It also takes some sunlight every day, and enough exercise." Betty and her husband walk two miles three to four times a week.

Ultimately, however, faith has proven most helpful in coping with a disease that flares up with no warning.

"A flare up is like a bad case of the flu," she explains. "You hurt so badly that you feel like your bones are going to crack. The pain isn't there 24/7, 365. But when it's there, it's there."

During those times, Crandall says, she meditates on I Thessalonians 5:16-18: "Rejoice evermore Pray without ceasing. In every thing give thanks: for this is the will of God in Christ Jesus concerning you."

That passage, she says, has encouraged her to stop asking God "Why me?"

"Sometimes I think, 'Lord, I'm having a hard time saying that today.' But when I open my Bible and read those words, I'm reminded to look around. There are still a lot of things for which to be thankful."

Pam Mellskog is a freelance health writer based in Boulder, Colorado.