Invisible pain is real: Why medics must hear what patients don't say

Woman with pain on her shoulder. (Courtesy/GettyImages]

For millions around the world, pain isn’t just in their imagination. It’s their everyday reality. From pounding headaches to aching joints and stabbing nerve pain, they live with it daily.

Pain is something we all experience, but not in the same way. Some people shake it off; others feel overwhelmed. According to Prof Bart Morlion, a global expert in pain medicine at KU Leuven Cancer Institute in Belgium, it’s because pain is not just about the body.

“By definition, pain is a biopsychosocial phenomenon. It’s influenced by our physical state, our emotions and even our environment,” he says. 

Prof Morlion was speaking in Nairobi during the launch of the Haleon Pain Management Institute a global initiative aimed at improving access to better pain care.

Some people might cry from a minor burn, while others barely flinch after a fall. That’s because pain is deeply personal. “We don’t yet have instruments to measure pain objectively. We rely on what patients tell us, how they feel from 0 to 10,” Prof Morlion explains. 

The number is subjective, but it is the gold standard in clinical practice.

There are also variations in pain tolerance. While pain thresholds, the point at which pain begins, are relatively stable, tolerance, how much one can bear, differs widely. This can depend on mindset, mood and even upbringing.

Painkillers are often the first thing we reach for when pain strikes, but how they really work varies. Different types of pain medications act in different ways. Paracetamol helps your brain feel the pain less intensely, while anti-inflammatory drugs, such as ibuprofen reduce the chemical messengers in the body that trigger pain. Opioids, such as morphine go further by activating the brain’s own pain control system.

In simple terms, some medicines reduce the pain signal, others change how we feel about the pain, and some do both. But here’s the catch: while these drugs are helpful, they’re not without risk.

Paracetamol is generally safe if taken in recommended doses. “The danger lies in overdose,” Prof Morlion warns, which can lead to liver failure.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac or ibuprofen are widely used, but long-term use can cause stomach ulcers, bleeding and kidney damage. For older adults with heart issues, they may increase the risk of stroke or heart attacks.

Opioids, though powerful, are a double-edged sword.

“Even without a history of addiction, about eight per cent of patients can develop dependency,” Prof Morlion says.

In some, this can happen in just a few weeks. That’s why their use needs to be tightly controlled.

One can become sensitive to pain over time. One phenomenon Prof Morlion warns about is chronic pain, which occurs when pain lasts beyond the original injury or cause.

“If acute pain is not treated properly, it can become chronic,” he explains.

This happens because the nervous system becomes more sensitive over time, causing you to feel more pain even after the original cause has healed. There’s also rebound pain, which happens when you stop pain medication too suddenly and the pain returns even stronger. This is common with NSAIDs used for conditions like arthritis.

Some pain conditions, such as fibromyalgia, don’t come with obvious signs like a cut or swelling. “Patients feel widespread muscle pain and tenderness,” Prof Morlion says, adding; “There’s no clear tissue damage, but the nervous system becomes hyper-sensitive.”

This condition is more common in women and can be deeply misunderstood, with sufferers often dismissed or misdiagnosed.

It turns out mental strength plays a big role in managing pain. “The brain is a powerful instrument. With mind-body techniques like breathing, distraction or even meditation, we can teach the brain to feel less pain,” Prof Morlion says.

This doesn’t mean you should suffer in silence. But learning techniques to shift focus, reduce stress, or stay positive can complement medical treatments.

Dr Diana Marion, Secretary General of the Kenya Medical Association, emphasises the need for a holistic approach to pain management. She advocates for treating all forms of pain, not just the most severe, to prevent long-term physical and emotional consequences. Ignoring pain can lead to delayed treatment and exacerbate the condition.

Mark Pfister, General Manager for Haleon Sub-Saharan Africa, states that the company’s goal is to reach an additional 20 million people with improved pain care by 2030. This initiative aims to ensure that patients are heard and healthcare professionals are supported in managing pain effectively.

In Kenya, access to comprehensive pain management remains a challenge. Collaborations between organisations, such as Haleon and the Kenya Medical Association are working to enhance training, raise awareness, and update guidelines to improve pain care across the country.

Professor Morlion concludes that pain is more than just a symptom; it is an experience that affects all aspects of life. By adopting a biopsychosocial approach, healthcare providers can offer more effective and compassionate care, moving beyond treating pain as a mere physical ailment to understanding it as a complex, multifaceted experience.