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I get up periodically - to change from a cramped position, to drive to interviews or to give a speech that was scheduled months ago. I do these things with painkillers tucked in my purse, hoping I can function through the fog.

Chronic pain is new to me. I have been blessedly strong and healthy my entire working life, and I admit to sympathy laced with what I sheepishly admit was vague impatience at people who were not. Then, I woke up one morning with stabbing pains shooting down my right leg. It mostly hurt when I sat. Or stood. Or lay down. An M.R.I. revealed a herniated disc.

But being in pain is not new to the 50 million Americans who are partly or totally disabled by things like arthritis, headaches and joint or back problems. A study published last November in The Journal of the American Medical Association estimates that more than a third of working-age people miss work because something hurts, resulting in $60 billion in lost productivity each year.

Karen Heerspink is one of those workers. A computer specialist for Herman Miller Inc., Ms. Heerspink suffers from migraines that can last for days. When they hit, she has often found herself crawling into a closet to escape noise and light (light is a particular problem since it can feel like a laser attack during a migraine, and her job involves staring at two computer screens.) If the headache persists, she has to be hospitalized, which can happen as often as several times a month.

Irene Tamaras suffered a severe back injury 12 years ago when she fell off the top step of a playground slide. Bedridden at first, she can now function but, like Ms. Heerspink, only at the whim of the pain.

"I need to really listen to my body and adjust my activities depending on what each day is like," she said. "I must dictate when and how much I work, whether it is early in the day or later in the evening, when my husband can help. I can't commute. I have to work at home."

These workers tell me that even worse than the pain is the realization that they are not pulling their weight at work. And that others are looking at them with the same veiled annoyance that I now realize I have shown over the years.

"Every time I would say I had a doctor's appointment, there would be tension," says Lynne Matallana, who was running a Southern California advertising agency 10 years ago when she started experiencing symptoms of what was eventually diagnosed as fibromyalgia. "Imagine the worst flu you could ever have," she says. "It hurt throughout my entire body. It was like a blowtorch to my arms and legs. Stabbing pains. Multiple types of pain. Never ending."

But because pain is invisible, she says, "people think it's something you should rise above and do what you usually do." That was how her business partner apparently felt. Ms. Matallana says she was at home in bed, surrounded by files and doing work over the phone, when her partner "walked in, picked up my files and said, 'It's over.'"

For Ms. Heerspink, there was no such moment. Her employer of 27 years has been nothing but helpful, she says. But she knows her absences take a toll on her computer team . "Our goal is 80 percent first-call resolution," she says. "That drops when somebody's not there. Do I feel annoyance from some co-workers? Yes."

Fear of that annoyance is what led Ms. Tamaras to create her own company, Dynamic Pain Relief, which allows her to sell products and advice from her home. It led Ms. Matallana to found the National Fibromyalgia Association in Orange, Calif. Ms. Heerspink, in turn, has started receiving monthly nerve block injections, which have reduced the frequency of her migraines to about one a month. She warns her co-workers when she is scheduled for her next shot because, she says, "I get a little goofy that day, and they'll help me through."

As for me, I have been icing and heating and going to physical therapy twice a week. I feel fortunate to have a job that can be done sitting down - or, when that starts to hurt, while standing up or hobbling around. And I am resolved to spread the gospel of kindness toward the worker in the next cubicle. Odds are decent that they are in pain.

Source: The New York Times (online) 11/07/04