There are millions of people living with chronic pain in the U.S., but often their voices are silent. They are too busy dealing with the everyday challenges they face as a direct result of their pain. Because it is important that their voices are heard in the midst of their struggle, here are nine things that chronic pain patients really want you to know, followed by six things they really want to thank you for.

1. Yes, it really hurts

Chronic pain is like motion sickness. Some people get nauseous just thinking about driving in a car on a winding road. Others could scarf down a greasy burger and sail a boat on choppy waters without any tummy rumbles. Just as it is hard for someone with an iron gut to understand someone with nausea, it is hard for those not suffering chronic pain to understand that it hurts, every day. Some days less than others, but it doesn’t quite go completely away.

2. People with chronic pain want to do things with family and friends

When they call and cancel plans at the last minute again, it’s not you. It’s the pain. They will do the best they can to schedule time together during their best times of day, but sometimes even during those times they are exhausted from a night spent tossing and turning or a morning of getting the kids off to school.

3. Just because you can’t see it doesn’t mean it’s not real

Chronic pain is an “invisible illness.” Sufferers don’t always use crutches or a cane or a wheelchair, so the dirty looks they get when they park in handicapped spots with their handicapped tag are not necessary. On that day, they may be physically incapable of walking farther than the ten feet from the car to the store entrance. Don’t make it worse.

4. Sometimes chronic pain patients are embarrassed about their chronic pain

They worry that it is interpreted as weakness or wimpyness. Sometimes people make jokes about it, not knowing that it is a point of sensitivity.

5. Those with chronic pain are not lazy or slackers

Sometimes the pain is so intense that their bodies shut down completely, and they may fall asleep. They may sleep all day, wake up feeling better, and then overdo it and land themselves in the same place. But know that they want to be productive, working, contributing members of society. And when they feel good, they are.

7. Chronic pain sufferers try very hard to look well

It may be exhausting, but when possible, chronic pain patients take extra care to dress well and seem as if they aren’t feeling as awful as they may be feeling.

8. In general, chronic pain patients have tried pretty much everything to treat their pain

Sometimes chronic pain is a result of physical nerve damage that cannot be helped with an essential oil. Although your health suggestions reflect your concern for your loved one, on the very worst days they may not go over well.

Since knowing these nine things can be hard to comprehend, here are six things that chronic pain patients really want to thank you for doing so well. We turned to Twitter and the hashtag #chroniclife for some insight into what chronic pain patients appreciate most about their friends and loved ones.

1. Pizza

Or really, any food that they did not have to prepare for themselves or their family when they were feeling poorly. You could