“A patient comes to the health center for only two reasons, either their pain is unbearable, or their anxiety is,” says Dr. Dilip Mathai, former Professor of Medicine at Christian Medical College, Vellore.
Pain is the most common symptom that brings a person to a doctor. It can manifest in various forms - headache, stomach ache, generalized body pain, or even a vague heaviness in the chest. However, only some types of pain receive a doctor’s full attention, such as pain on the left side of the chest radiating to the jaw or left arm (a classic sign of a heart attack), sharp, severe headaches, or pain accompanied by visible injuries like protruding bones.
Generalized aches, chest heaviness, or dull, nonspecific pains often fall into the "wait and watch" category. These are usually treated with a painkiller, regardless of the underlying cause. This means that health providers will hand a painkiller to someone with anemia, calcium deficiency, or even early-stage blood cancer without evaluation until the condition progresses to the point of demanding emergency care.
Medical Education in India: Painfully Inadequate
In the first year of medical school, students learn about the receptors and chemical pathways that generate the sensation of pain. By the second year, they learn about drugs that can block these pathways. But when it comes to real-life clinical training, there is a glaring gap - no one teaches students how to assess or manage pain effectively.
Take, for instance, the WHO pain ladder, a theoretical framework taught in pharmacology. Despite learning the sequence of drugs to prescribe, students receive little to no hands-on experience applying this knowledge in every day practice. This lack of practical training, combined with a limited understanding of side effects, breeds fear and misconceptions from early on.
The half-baked understanding that drugs like diclofenac and other NSAIDs can cause kidney damage leads many physicians to under-prescribe or restrict their use unnecessarily. Similarly, the stigma and fear surrounding morphine, due to misconceptions about the drug or confusion over regulatory laws, deny patients, especially the ones with chronic life-limiting diseases, adequate pain relief. As a result, fewer than 4% of people in severe pain in India receive appropriate treatment.
This overly medicalized view of pain has led to the automatic prescription of pills for every complaint, even those rooted in emotional distress. It is a fact that psychological pain often manifests physically, yet doctors frequently overlook this connection in clinical settings.
In most cases, it is possible to understand and address the root cause of pain appropriately based on proper history and clinical examination. However, the focus of medical education in India has steadily shifted from common conditions that affect the majority to rare and complex diseases that affect a few.
Beyond Education: Gender Bias Blocking Pain Relief
“This is the Jama Masjid syndrome,” a doctor once said. This is a term that health professionals use to casually dismiss complaints of generalized body aches among Muslim women from lower socio-economic backgrounds, usually in their 30s or 40s, often without so much as a clinical examination. “My seniors taught me this. They want to get out of the house and use pain as an excuse,” he added.
This kind of bias isn’t unique. Across the country, similar labels exist: “Haathan Pairaan mein dard syndrome” in the North and “Kai Kaal Valippu syndrome” in the South. In nearly all instances, it’s women who are affected. Their complaints of generalized pain are often seen as fake, exaggerated, or linked to underlying psychological issues like depression or anxiety, while common causes like osteoporosis, anemia, and fibromyalgia are usually not even considered.
Psychosomatic pain (physical pain caused by psychological distress) is a legitimate diagnosis. But it is a diagnosis of exclusion and as such should only be made by a doctor after ruling out all all other causes. Instead, these women are routinely given multivitamins and advised to “wait and watch,” relying on the placebo effect rather than proper care.
There is also a common perception among providers that women have a lower pain threshold. As a result, they expect them to tolerate treatable pain. In an online survey conducted in India, only 7 out of 10 anesthesiologists reported providing pain relief to women during childbirth.
“My doctor told me to stop complaining and said I’d already had enough painkillers,” my aunt shared after being denied relief following a gallbladder surgery. They discharged her from care despite being in significant pain. That same day, she landed in the emergency room with unbearable pain, where they found her to have a perforated intestine. This life-threatening complication had been missed, likely due to the doctor’s unconscious bias.
Reform Medical Education to Make India Pain-free
The root cause of poor access to pain relief in India is the inadequate coverage of pain management within the medical curriculum. A foundational step toward addressing this is training the medical college faculty trainers so they can confidently teach pain management without misconceptions.
Unless educators are well-informed and skilled, medical students will lack the competence to provide adequate pain relief. At the same time, we need to address the attitude toward pain. Considering that high tolerance to injustice, pain, and suffering is the norm in our communities, health professionals should any person presenting to the health center with pain seriously.
To signal its importance, we must also integrate pain management into medical assessments in university examinations and competitive entrance tests. Clinical skills should be emphasized as a core component, enabling future doctors to identify the underlying causes of pain and provide appropriate, empathetic care. Additionally, educators must actively address biases in pain treatment to ensure equitable care for all patients.
Finally, there is a need to thoroughly inform healthcare professionals and law enforcement officers about the legal framework surrounding controlled substances. Only when there is a shared understanding of the importance of safe and accessible pain relief can we move toward a pain-free India.
Edited by Radhikaa Sharma
Image by Gayatri
