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It sent Richard Miles, 46, of Laurel Hills, to Western Psychiatric Institute and Clinic to break him of his addiction to painkillers that weren't deadening the pain anyway.

A spinal cord stimulator ended Lewis' 37-year battle with chronic back pain, but the device only created more health problems for Miles, whose eight-year search for relief included nine surgeries and a host of medications and treatments.

Trial and error is a frustrating but necessary approach to treating chronic pain since nothing works for all patients, even those with the same underlying problems, specialists say. The longer chronic pain lasts, the harder it is to cure and the more likely it will spread to other parts of the body, they say.

"We now have research indicating there's a memory of chronic pain," said Dr. Doris K. Cope, director of chronic and cancer pain for the University of Pittsburgh Medical Center.

"It changes the genic code sometimes, it changes the biochemistry, and it causes new proteins to be formed."

That means even if the pain in the original problem area is cured -- or eliminated by amputation -- other nerves will have pain, she said. Therefore, it's crucial to treat acute pain to keep it from growing into a chronic problem, she said.

Doctors now realize chronic pain is a "state, not just a symptom," she said.

About 75 million Americans suffer chronic pain -- recurring pain or pain lasting more than six months, according to the National Pain Foundation. That costs $100 billion in medical expenses each year, according to Tame the Pain, Lewis' education campaign sponsored by Medtronic, the company that makes the spinal cord stimulator he uses.

Patients are increasingly turning to pain specialists for relief. Business has skyrocketed at the Western Pennsylvania Hospital's Institute for Pain Medicine, which grew from one doctor, a part-time nurse and part-time secretary eight years ago to a full-time staff of three doctors, six nurses and three secretaries now, said Dr. Jack Kabazie, the institute's medical director.

In his first year there, he saw 25 to 30 patients a week; he may now see that many in one day, he said. The institute treats 7,500 patients a year, a continually increasing number, he said.

One patient, Miles, who then was a school security officer, injured his lower back breaking up a fight between two 15-year-old high school students. He had a spinal fusion and missed about four years of work. A week after returning to his job, he injured his neck while breaking up another fight between two teenagers.

Sidelined with that injury -- which required cervical fusion of five vertebrae -- his back began hurting from degenerative disease and never relented. He tried powerful pain medications, nerve blocks, acupuncture, physical therapy, various medical stimulators and devices and nine surgeries before finding adequate relief.

"It's been real rough. When you don't have your health, everything collapses around it," he said.

A temporary morphine pump was put in his spine in January, followed in June by implantation of a permanent hockey puck-sized pump in his abdomen. The pump has reduced his pain so dramatically -- although not eliminated it -- that he considers it a miracle and thinks he may be able to work again some day.

The pump, called an intrathecal pump, continuously infuses a small amount of morphine into the pain receptors in Miles' spinal cord, Kabazie said. One milligram of morphine injected through the pump is as powerful as 300 milligrams taken orally, he said. The pumps must be refilled by injections every 30 to 90 days, he said.

West Penn plans to participate in a study to determine whether an experimental medication made from sea snail venom will effectively control pain when used in the pumps, Kabazie said.

Medications given orally or through a patch control some patients' pain, but side effects -- including vomiting, nausea, lethargy, constipation and respiratory problems -- often are too severe to make long-term use practical, Kabazie said.

Surgery and treatments, such as disc decompression, are available, depending on where the pain is located, but when those don't work, doctors and patients turn to mechanical devices such as pumps and stimulators.

Lewis said the spinal cord stimulator implanted in his back in April 2002 virtually ended the chronic back pain he suffered doing repeated pratfalls while performing.

The stimulator blocks pain messages from being sent to his brain by causing vibrations. Patients adjust the intensity, or stop it completely, with a remote control.

Lewis said he can shut off the stimulator for nearly eight hours before the pain returns, always suddenly and with full force.

The night following surgery, he said, "I was running down the hall of the hospital that night. I couldn't walk 5 feet without a wheelchair prior to that."

The stimulator is "really a last resort," said Dr. Donald Whiting, surgical director of the spasticity and movement disorder program at Allegheny General Hospital. "You're only treating the symptoms, not the problem, and you want to try to treat the problem first."

"Pain is a perception in the brain. There's (still) nerve inflammation or sensation in the nerve, but if you're not really sensing it, is the pain still there?" he asked.

Kabazie said he has used the stimulators successfully on a patient who had undergone breast surgery and another who suffered from polycystic kidney disease.

"They typically describe it as a pleasant vibration in an area where they typically have pain," he said.

In some cases, surgeons also destroy nerves or sections of the spinal cord to keep pain signals from reaching the brain.

Kabazie said that procedure, known as neuroblative surgery, generally gives relief for a limited time -- perhaps three months -- but that may be enough for some patients, such as those dying from terminal cancer, who need relief but do not want to be sedated.

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