(MONEY Magazine) - The truth hurts. What's the No. 1 cause of disability in the U.S.? It's not heart disease (despite the 1.2 million heart attacks that will show up in the E.R. this year). Nor is it addiction (despite the 1.1 million people in drug and alcohol rehab). The answer: chronic pain, affecting 50 million Americans.

The truth is also expensive. Chronic pain reduces your productivity at work (to the collective tune of more than $60 billion a year) and may force you to take time off (25% of all sick days are related in one way or another to pain complaints), not to mention the crimp it puts in your tennis game. But while the recent disappearance of popular prescription painkillers like Vioxx and Bextra from the market has made some aspects of pain management more challenging, the following low-cost, alternative approaches may prove even more effective in the long run.

Control the Clock

To effectively control pain with drugs, it's not just which pills you take that counts but when you take them. Instead of waiting the typical four hours between doses of a particular medication, many experts now advise adding in a second pain-relief drug (often an over-the-counter medicine like Advil or Aleve) a couple of hours later so you're never more than two hours away from a new dosage. This strategy has been proven safe when drawn up by a knowledgeable doctor, and more effective at killing pain than the single-drug method.

• WHAT TO DO Ask your doctor about adding a lesser-known prescription medication called nonacetylated salicylate (Trilisate, Disalcid), a type of aspirin that is gentler on the stomach and kidneys than other painkillers. For recurrent joint pain, try the natural supplements glucosamine and chondroitin, which may help rebuild cartilage.

• WHAT YOU'LL PAY A 100-tablet bottle of Trilisate costs $51; a 60-tablet bottle of supplements will run you about $20.

Go Under the Needle

The ancient Chinese practice of acupuncture is rapidly gaining favor among Western doctors as a "new" way to control pain. With good reason. Studies show that acupuncture stimulates blood circulation and pain-relieving endorphins for up to 48 hours, and that these chemical messengers in turn may trigger other key healing responses in the body. The best candidates: People with neck and shoulder pain from repetitive-strain injuries and those with sports injuries.

• WHAT TO DO The latest evidence suggests you'll get the best results from treatments twice a week for two to three weeks vs. the typical once-weekly sessions for up to 10 weeks. If you don't feel better after six to eight sessions, stop going. Notes Jeffrey Ngeow, M.D., a pain specialist at the Hospital for Special Surgery in New York: "There's no point wasting your money."

• WHAT YOU'LL PAY Eight sessions with an M.D. run $500 to $800. Nearly half of health plans now cover it vs. 33% in 2002.

Get Hands-On Help

Physical therapists used to be considered appendages to orthopedic surgeons. You couldn't have one without the other. In recent years, though, PTs have moved out on their own, offering a cost-effective approach to pain relief that doesn't require going under the knife first. By increasing your range of motion and correcting postural faults that can prolong pain or trigger a recurrence, therapy enables you to taper off expensive pain-relief drugs faster. And the benefits may be enhanced if your PT uses a device called a TENS machine, which delivers low-dose electrical nerve stimulation to sore spots. TENS doesn't exactly kill pain, but rather tricks the brain by scrambling pain signals before they arrive.

• WHAT TO DO Consider buying your own portable TENS machine as a complement to physical therapy and exercise.

• WHAT YOU'LL PAY For 10 to 12 sessions of PT, $1,000 to $1,300, usually covered by insurance. TENS units, found in medical supply stores and online, cost $50 to $125.

Curtis Pesmen is the author of The Colon Cancer

Survivors' Guide.

230 Work hours are lost to chronic pain each year by a

typical American employee.