According to the Centers for Disease Control and Prevention, approximately 50 million American suffer from debilitating chronic pain. Despite that number, in 2016 the agency issued stringent guidelines limiting opioid prescriptions to a bare minimum. Such drugs are often the first line for treating pain. Unfortunately, although this was an effort to reduce drug overdose deaths, it was unsuccessful. New guidelines offer prescribers much more leeway to use their judgment in managing chronic pain.

The potential causes of chronic pain are too numerous to list. Lyme disease is probably not the first source that comes to mind. Nonetheless, it was a Lyme disease infection that threw columnist Ross Douthat into a desperate downward spiral. He describes the experience of pain along with the difficulties of getting a diagnosis of his Lyme disease.

Lyme disease is a particularly controversial topic. Sadly, the medical profession has become polarized over the treatment of patients who, like Ross Douthat, have persistent symptoms from the infection. In addition, the topic of managing chronic pain is divisive as well.

Mr. Douthat offers his advice for other patients who are suffering from chronic pain or an undiagnosed disease. With the physician’s support, the best approach might be conduction one or several experiments to discover just what actually helps a given patient feel better. Such so-called N of 1 experiments give priority to the patient’s empirical experience.

To get a different perspective on managing chronic pain, we turn to pain expert Dr. Sean Mackey. He specializes in treating patients who are suffering with persistent pain. Dr. Mackey describes a two-fold approach of alleviating the pain and uncovering the source. Given this information, the cause can be treated. Pain that has not been well controlled has a devastating impact on patients’ lives, even impacting their families and their other relationships.

According to Dr. Mackey, the best pain management utilizes individual plans tailored to each patient rather than trying to make patients fit the guidelines. Opioids can certainly be useful, but most people benefit from a range of strategies for managing chronic pain. These may include medications that were initially developed for purposes other than pain relief, procedures such as nerve blocks or implantable devices, pain psychology, physical rehabilitation, integrative approaches including acupuncture or nutraceuticals and self-empowerment. Non-drug approaches can be surprisingly helpful, especially if combined with medications when appropriate.

Ross Douthat joined The New York Times as an Opinion columnist in April 2009. His column appears every Tuesday and Sunday. Previously, he was a senior editor at The Atlantic and a blogger on its website.

Ross Douthat is the author of several books, his most recent being The Deep Places: A Memoir of Illness and Discovery. The photograph of Ross Douthat is copyright of Abigail Douthat.

Sean Mackey, M.D., Ph.D. is Redlich Professor and Chief of the Division of Pain Medicine at Stanford University Medical School. He is Director of the Stanford Systems Neuroscience and Pain Lab and past president of the American Academy of Pain Medicine.

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