Many times, the cause of chronic pain is hard to diagnose. A fever shows up on a thermometer, and a fracture shows up on an X-ray, but pain over a long period can be felt by a patient without leaving a single trace on a scan or in a blood test. This can make it challenging to identify the cause, with the pain getting worse and affecting daily life, impacting sleep, work, relationships, and mood.
Undiagnosed and unmanaged chronic pain is far more common than most people realise. The global prevalence of pain in the adult population is 20%. An Indian study showed that the prevalence of chronic pain is over 19%, with a higher prevalence in females of over 25%. The incidence of chronic pain also increases after the age of 65 years, with a significant negative impact on daily living and overall quality of life. If chronic pain remains untreated, it can result in unemployment and financial issues, affect marital relationships, lead to mental problems like depression, insomnia, social isolation, and loss of self-esteem.
However, with advances in medical science and the emergence of new super-specialities in pain medicine, patients suffering from chronic pain do not have to "learn to live with it" any longer. There are proven targeted solutions available to manage and treat chronic pain conditions.
Modern pain management shifts the entire focus from chasing the symptoms to locating the source of pain generators. It provides pain relief through minimally invasive pain and spine interventions (MIPSI) rather than a more invasive surgical approach. It focuses on a multidisciplinary treatment approach that includes tailored physiotherapy, psychological counselling, and lifestyle adjustments, along with pain interventions. It’s a more holistic approach with the aim of treating a person as a whole rather than focusing on pain signals.
What are the major categories of chronic pain?
1. Nerve pain (or Neuropathic pain)
Neuropathic pain comes from a nervous system that misfires. Patients experience tingling, numbness, burning, or sudden electric shocks. It can occur in the face (trigeminal neuralgia), the back of the head (occipital neuralgia), or shoot down an arm or leg because of diabetes or a slipped disc. It also occurs in the form of a burning rash that stays after shingles, or as pain in a surgical wound, even after the wound has healed. This condition is quite prevalent, affecting 7-10% of the general population, with increased prevalence seen among diabetic patients. The prevalence of painful diabetic peripheral neuropathy increases to almost 15%.
Treating this condition requires a specific class of medication, and in stubborn cases, targeted nerve ablation is needed. Consulting a pain specialist early is crucial, as prolonged, untreated nerve pain can become harder to reverse.
2. Fibromyalgia
Fibromyalgia cannot be seen in X-rays or blood tests. However, it causes widespread body pain with heavy fatigue, foggy thinking, and disturbed sleep. Because nothing shows up on a test, patients are often told their symptoms are "just due to stress", and the dismissal itself becomes part of the problem.
The condition affects roughly 2.7% of people worldwide, with an average diagnostic delay of about 2.3 years. Indian studies have found that among women presenting with chronic pain, fibromyalgia is the underlying cause in 6.17% of cases. Women are diagnosed far more often than men, though some of that gap reflects how clinicians assess the condition rather than who has it. With unbiased screening criteria, the share of male cases is considerably higher showing that men with fibromyalgia are frequently missed.
A pain specialist can bridge that gap with an accurate diagnosis and educate the patient on why their nervous system is amplifying ordinary signals — which is the vital first step in fibromyalgia management. From there, a plan built around graded exercise, sleep habits, stress management, and the right medication gives most patients a way back to a functional life.
3. Back and neck pain
Modern working lifestyles with long hours hunched over a laptop, poor posture, constant stress, and too little physical activity have made back and neck pain a common complaint. Low back pain stands as a leading cause of disability worldwide, affecting 619 million people in 2020, with a projection scaling to reach 843 million by 2050. India carries a heavy burden, accounting for around 20% prevalence rate, with young adults, women, and people with higher BMI especially affected.
Most people improve with posture changes, physiotherapy, and a short course of medication. For a few, the small joints at the back of the spine, the facet joints, may be responsible. In these cases, carefully selected nerve blocks to confirm the source, which are diagnostic blocks followed by radiofrequency ablation, offer durable relief without major surgery.
4. Pain at the end of life
Chronic pain associated with serious illnesses like advanced cancer is where palliative pain management comes in. In advanced cancer, pain comes from the disease itself and from the treatments aimed at fighting it. The numbers are stark - a study found pain in 64% of patients with advanced or metastatic disease, 59% of those in active treatment, and a third of people who had finished curative therapy. To add to the problems, nearly one in two cancer patients is undertreated for pain.
In these cases, the aim of treatment and managing pain is to provide comfort and dignity to the patient during the sunset days of their lives. Pain interventions such as Plexus blocks, nerve ablation, and careful medication management can bring suffering down to a level that gives patients and their families room to breathe, both physically and emotionally.
Left untreated, chronic pain becomes a disease of its own, which is why it deserves a proper diagnosis and a treatment plan built for the individual rather than a generic prescription. If you or someone you love has been suffering from pain for a long time, a visit to a pain specialist can change your life for the better!
The author is a consultant in pain and palliative care at Kokilaben Dhirubhai Ambani Hospital, Mumbai.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
