Chronic Pain

Chronic pain is pain that persists beyond the expected healing time — generally more than 3 months. It affects body and mind, work, relationships, mood, and sleep. It is not "all in your head"; but chronic pain involves changes in nerve signalling that make the brain and spinal cord amplify pain signals. Modern chronic pain care is multi-modal — pills alone rarely work.

Common sources

• Musculoskeletal — back, neck, joint, muscle.
• Nerve pain (neuropathic) — diabetes, post-stroke, post-shingles, chemotherapy, trauma.
• Central sensitisation syndromes — fibromyalgia, irritable bowel, chronic pelvic pain.
• Post-surgical.
• Cancer pain.
• Headache, migraine.

What works — multi-modal care

• Movement — regular low-impact exercise; avoids deconditioning.
• Physiotherapy — tailored; not just heat/ultrasound.
• Psychological treatment — CBT for pain, acceptance-and-commitment therapy, mindfulness; reliably reduce pain and disability.
• Sleep, nutrition, stress management.
• Medicines — matched to pain type (e.g. nerve-pain modulators for neuropathic pain). Avoid long-term strong painkillers without a clear plan — they often stop working and add risks.
• Interventional procedures — selected nerve blocks, radiofrequency, epidural steroids — done by pain specialists, for specific indications.
• Treat mood and sleep — they amplify pain.
• Pacing — don't do too much on good days and crash.
• Support groups help many.

India-specific cautions

• Avoid daily self-prescribed painkillers — NSAIDs daily for months cause kidney/stomach damage.
• Avoid unregulated ayurvedic "pain" powders and injections — several have been found to contain hidden steroids or NSAIDs.
• Don't accept "suffer in silence" — chronic pain clinics exist at major Indian medical colleges and specialist hospitals; palliative medicine is also a useful framework for non-cancer chronic pain.
• See a pain specialist if pain lasts more than 3-6 months with significant impact.

Full pain relief isn't always possible. Significantly better function and quality of life almost always is.