Every morning begins the same way. The moment the eyes open, the familiar ache sets in: deep, persistent, and impossible to ignore. It doesn’t matter if it’s a dull throb or a sharp sting; the body already knows it’s there. It’s the kind of pain that’s been around for so long, it feels like a part of who you are now, a constant companion that you can’t escape.
Painkillers may offer a few hours of relief, but the cycle repeats. Each pill, each treatment, each hope that today will be different fades as the pain returns, relentless and unwavering. So what happens when the pain becomes a part of you, and the usual fixes no longer work? And if medication alone isn’t the answer, then what is?
The real battle of chronic pain: Invisible yet overwhelming
Chronic pain doesn’t look the same on everyone. For some, it’s a dull ache in the back; for others, it’s a burning sensation that never lets up. But one thing remains true for all who experience it: it’s a constant, uninvited presence that no amount of time can remove. Unlike acute pain, which has a clear starting point and an expected end, chronic pain doesn’t play by the rules. It lingers. It shifts. It complicates everything, from walking and sleeping to working and simply existing.
Medically, chronic pain is defined as pain that lasts longer than three months, often continuing well beyond the expected healing time. It may result from injury, nerve damage, or even arise without a clear cause. Chronic pain can be nociceptive, neuropathic, or centralised, and over time, it can affect not just the body but also mood, memory, and mental wellbeing. The ongoing stress of living with pain can lead to anxiety, depression, social isolation, creating a feedback loop that worsens the experience of pain itself.
Chronic pain is a major public health issue, affecting approximately 20% of adults globally, yet it remains one of the most under-recognised and under-treated health conditions today.
Dr Ho, a specialist in pain management, points to two conditions that are often missed or misunderstood in chronic pain care.
Complex Regional Pain Syndrome (CRPS) is one key example. Often triggered by a minor injury or routine surgery, this dysfunction of the nervous system primarily affects the limbs and presents with severe pain, hypersensitivity, skin changes, and swelling, typically in the hands or feet. Unfortunately, CRPS tends to respond poorly to medication. However, early intervention through physical therapy, targeted exercises, and spinal cord stimulation offers the potential to significantly improve, or even reverse, the condition.
Fibromyalgia is another commonly underdiagnosed condition. Patients often report widespread muscle pain, fatigue, headaches, and insomnia, along with mood disorders such as anxiety and depression. The underlying cause is believed to be a dysregulation of the central nervous system, which heightens pain perception and contributes to the diverse, often unexplained symptoms. In these cases, Dr Ho says early intervention with patient education, psychotherapy, and exercise is key to managing symptoms effectively.
A gendered disparity
Chronic pain doesn’t affect everyone equally. Women are more likely to experience chronic pain, and less likely to be taken seriously when they report it.
Conditions such as endometriosis, fibromyalgia, and interstitial cystitis disproportionately affect women, yet many go years without a proper diagnosis. According to Yale Medicine, the delay between the onset of symptoms and a diagnosis of endometriosis can range from four to eleven years, during which women are often told their pain is “just part of being a woman".
This widespread pattern of dismissal and underdiagnosis continues to reinforce gender gaps in treatment, leaving many women to navigate years of unrelieved pain without answers.
In some conditions, chronic inflammation plays a key role in ongoing pain. When inflammation persists, such as in autoimmune diseases like rheumatoid arthritis or lupus, it can damage healthy tissues, contributing to pain that doesn’t resolve with time. The challenge is that chronic inflammation doesn’t always present with clear symptoms, meaning it can quietly affect the body long before diagnosis or treatment.
Why more people are in pain?
Chronic pain isn’t just a biological issue; it’s a societal one. A mix of modern factors is fuelling its rise:
Ageing populations, who are more prone to degenerative conditions like osteoarthritis and spinal disorders.
Sedentary lifestyles, which contribute to musculoskeletal pain and deconditioning.
Chronic stress, which can alter how the brain and spinal cord process pain, amplifying sensitivity over time.
Post-viral syndromes, including long COVID, which has introduced a new wave of patients with persistent and often unexplained body pain.
Chronic pain is often endured silently, with many individuals delaying treatment to avoid appearing weak, burdensome, or as though they’re exaggerating symptoms. This stigma adds another layer of difficulty to an already isolating condition.
In recent years, interventional pain management techniques have offered promising options, particularly for patients who have not responded well to conventional medications. Spinal cord stimulation, for example, involves implanting electrodes near the spinal cord to disrupt pain signals. It has been used effectively for conditions such as Complex Regional Pain Syndrome (CRPS) and neuropathic pain following spinal surgery.
Another valuable technique is intrathecal drug delivery, in which a small implanted pump delivers medication directly to the spinal cord. This approach is often used in cases of advanced cancer, where pain is widespread and difficult to control.
Although these procedures are not entirely new, public awareness remains limited, partly because only a small number of pain specialists in Singapore are trained to perform them.
The limits of painkillers
Despite evolving guidelines, painkillers remain the first response for many people living with chronic pain. Over-the-counter options like paracetamol or NSAIDs (non-steroidal anti-inflammatory drugs) are widely used, and in more severe cases, doctors may prescribe stronger medications, including opioids.
Opioids such as morphine, oxycodone, tramadol, and in some cases, fentanyl, have long been used to treat chronic pain. While they may offer short-term relief, especially in acute or cancer-related settings, their use in chronic non-cancer pain has come under increasing scrutiny. Over time, many patients develop tolerance, requiring higher doses, and in some cases experience dependence, addiction, or overdose.
The rise in opioid misuse and overdose deaths, driven in part of illicit synthetic opioids like fentanyl, has forced a global reassessment of how chronic pain is treated. In the U.S. alone, tens of thousands of deaths each year are now linked to opioid overdoses.
According to the U.S. Centers for Disease Control and Prevention (CDC), opioids should not be considered a first-line or routine treatment for chronic non-cancer pain. The CDC instead recommends non-opioid treatments, such as physical therapy, cognitive behavioural therapy (CBT), and lifestyle modifications. If opioids are used to all, they should be prescribed at the lowest effective dose, with clear treatment goals and close monitoring.
Yet, despite updated clinical guidelines, public awareness remains low. Many still assume that prescribed painkillers are both safe and sufficient; highlighting the need for broader education around the risks of long-term opioid use and the value of comprehensive, multidisciplinary pain management.
With growing concerns around opioid dependence, Dr Ho recommends a range of evidence-based strategies to manage chronic pain while reducing reliance on opioids. These include:
- Physical therapies, such as structured exercise programmes and Transcutaneous Electrical Nerve Stimulation (TENS).
- Psychological approaches, including cognitive behavioural therapy (CBT) and mindfulness-based techniques.
- Lifestyle modifications, such as pacing daily activities, making dietary adjustments, and improving ergonomics at home and work.
- Multimodal therapies that combine non-opioid medications with appropriate interventional pain procedures.
This shift reflects a deeper understanding that chronic pain is a complex condition, often influenced by physical, psychological, and environmental factors. Painkillers may still have a role, especially during flare-ups or post-surgery, but they are now viewed as just one part of a much broader, longer-term approach to managing pain.
The integration of psychological support is a vital part of comprehensive pain management. Approaches such as cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness-based interventions have shown proven effectiveness in addressing not just the physical experience of pain, but also its emotional toll. These models help patients reframe their relationship with pain, reduce distress, and regain a sense of control in daily life.
It's time to rethink how we treat pain
Chronic pain is real and it's rising. It’s not just a symptom or a medical condition; it’s a life-altering experience that affects how people work, sleep, connect, and cope. For those living with it, every day can feel like a negotiation with their body.
While painkillers may still offer temporary relief, they’re no longer seen as the definitive solution. Lasting progress comes from understanding pain, not just suppressing it, and recognising that effective care goes beyond medication.
As our understanding of pain continues to evolve, Dr Ho emphasises the importance of moving beyond standardised treatment protocols and embracing precision pain medicine. This approach considers genetic, psychosocial, and lifestyle factors to guide more personalised treatment plans, which he describes as the next frontier in pain care.
According to Dr Ho, applying precision medicine principles allows clinicians to:
- More accurately identify the underlying sources of a patient’s pain, along with any co-existing health conditions.
- Address psychosocial factors, such as past trauma or mental health challenges, that can significantly influence the pain experience.
- Develop targeted interventions tailored to each patient’s specific needs, preferences, and biological profile, resulting in care that is both effective and patient-centred.
If you or someone you know is struggling with ongoing pain, don’t wait for it to “just go away.” Seek support from a qualified pain specialist.
Dr Ho Kok Yuen
Specialist, Pain Management & Anaesthesiology
The Pain Clinic, Singapore
Instagram: @thepainclinic.sg
This article was produced by Healthful For You. The views and opinions expressed throughout are those of the authors and do not necessarily reflect those of the Expert Contributor. The Expert Contributor has provided input solely for the EXPERT INSIGHT and TIP segments, based on their professional expertise. These comments are intended to offer general guidance and may not apply to all individuals. Any interpretations or conclusions beyond that section are those of Healthful For You. This article is not a substitute for personalised medical advice, diagnosis, or treatment. Please consult your doctor or a healthcare professional regarding your specific health needs.
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