Initially, Navin Israni, 36, didn’t treat his back pain as much as he furnished around it. A back-support cushion for his work chair, then a medicine ball he tried sitting on and returned for being too large—both ordered online. The cushion on his sofa moved up to act as back support, then a sheet of plywood affixed to provide a firm seat. At doctors’ clinics, he avoided soft couches in waiting rooms whenever he could. The content marketer first felt this sharp ache across his back in late September 2024. It quickly began to shape his days. He works from home, but reached a point where he could no longer sit comfortably at his desk, walk along the inclined road outside his Pune residence or play tennis, a sport he had loved since childhood. Pain had affected every aspect of his life. “I hoped for a day free of pain,” he says.
During this period, Israni’s close friend with a much worse back-and-neck condition underwent surgery. Looking back, he suspects watching that friend’s recovery pushed him “to do something about my pain instead of living with it”. An MRI revealed loss of lumbar lordosis (the lower back’s natural inward curve), along with multiple low-grade disc damages. For the first four months, the medical system frustrated him further. His first orthopaedic doctor was dismissive of his questions, his first physiotherapist handed him standard exercises that only made the pain worse, he says. A second physiotherapist, found via Google Reviews a year later, gave him more basic exercises he could graduate from slowly. Eventually, these exercises, along with supplements— zinc, calcium, vitamin D—started to reduce the flare-ups.
Israni also came across videos by American physician Brad Fanestil and chronic pain coach Maggie Sterling. Both helped him understand psychoplastic, or neuroplastic, pain: the kind that persists even after tissue has healed because the brain’s pain signalling remains heightened. “The damage was real,” he says. “But knowing the stress was making it worse, and that basic physio without surgery could lower it or even take it away, calmed me down.”
This is increasingly sounding like the new urban Indian phenomenon. Doctors unpacking pain in viral videos, a productivity and fitness culture that leaves little room for niggling discomfort to fester, and relief often just a click away rather than a trip to the chemist or a physiotherapist. Together, these forces have transformed how urban India seeks pain relief, all the while reshaping our understanding of pain and our relationship with it. In a culture long shaped by the twin scripts of “mard ko dard nahin hota” (men don’t feel pain) and the woman as the site of endurance—where period pain, labour and other unnamed aches are absorbed without whisper—this shift feels significant.
India’s analgesics market was worth approximately ₹16,757 crore as of March, according to data shared by Pharmarack, a B2B pharma commerce and insights company. It has grown at a steady 9% CAGR over the last five years, and is expected to maintain a growth rate of 5-6% over the next two-three years. And this is only through the offline pharmacy channel. It does not account for online sales, physiotherapy, chiropractic and acupressure treatments, pain-relief patches, muscle-relaxing sprays, roll-ons, ointments, devices, infrared belts, hot and cold packs, ergonomic supports bought online, or the huge amount of money people spend on healing yoga retreats, Pilates and Ayurveda subscriptions.
The same Pharmarack data also shows a steady decline in offline sales of over-the-counter (OTC) analgesics such as Dolo, Calpol, Combiflam across a five-year stretch. Dolo, the household painkiller of the covid years, has shrunk from ₹549 crore in March 2022 to ₹377 crore in March 2026, a roughly 9% compound annual decline. “While a section of these drugs is prescription-driven, they now have a significant share of OTC purchase which may not be prescription-led and happening through modern trade channels, so people are simply buying them on quick commerce and e-pharma apps now,” says Sheetal Sapale, vice-president, commercial, at Pharmarack, explaining the possible reason for dip in offline sales.
Pain relief is now a full-fledged category on quick commerce platforms, sorted by body area (knee, neck, back, abdomen, head), by form (tablet, gel, spray, roll-on, patch, belt), by intent (period pain, gym recovery, migraine, arthritis) and even dosage. You can have a posture-correcting device delivered to your door in under 10 minutes, packed alongside your groceries for the day.
QUICK COMMERCE
This shift has opened up new opportunities for brands in the category. An FMCG marketer whose company makes pain-relief products says their business in this segment has doubled over the past 18 months, almost entirely due to quick commerce. “We’ve built a portfolio of patches and roll-ons designed for today’s consumer—small enough to fit into a work bag, easy to apply without the mess of traditional balms and ointments, which we still make for older users,” he says, requesting anonymity.
The deeper advantage lies in what these platforms know about their users, he adds. “Once a quarter, we build cohorts based on data from quick commerce platforms: people who have searched for terms like ‘headache’ or ‘migraine’. A few weeks later, we surface our roll-ons while they’re ordering groceries, even if they weren’t looking for pain relief at the time.” Nearly half end up adding the product to their cart. “Pain relief is a low-ticket, high-frequency category. You’re serving both the sedentary consumer dealing with inactivity-related pain and the active one managing muscle recovery pain.” What’s driving the growth is who is now living with pain.
Saransh Chaudhary, founder of the wellness brand RESET and CEO of Venus Medicine Research Centre in Panchkula, Haryana, says, “Individuals in their late 20s and 30s are presenting with persistent neck, knee, back and shoulder pain that earlier generations did not experience until much later in life.” He attributes the convergence to a familiar set of pressures—sedentary work, prolonged screen exposure, deteriorating sleep, inflammatory diets, chronic low-grade stress. This, he believes, has led to a self-medication culture that has made NSAIDs (nonsteroidal anti-inflammatory drugs) like Advil, Ibuprofen, Aspirin, their default first response. This tendency to self-diagnose pain isn’t new. It comes from a culture that treats pain as too minor to merit serious attention, leaving many people reluctant to see doctors or wary that their concerns will simply be dismissed as “it’s just pain.” What has changed is the speed and ease of access.
On e-pharmacy platforms, a quick search for a muscle relaxant—often discovered through word-of-mouth—can instantly throw up multiple alternatives, including cheaper versions with the same composition. In many cases, pain relief has become faster, easier, and more economical to access than medical care itself. However, “the long-term implications of this self-diagnosis culture for gastric, renal and hepatic health, while well-documented, are rarely discussed at the consumer level,” adds Chaudhary.
A fraction of these relief-seekers is moving past quick fixes. “Until a few years ago, you saw that patients who wanted immediate solutions for acute pain had learnt to live with chronic pain. Now, thanks to social media awareness, many are starting to look for the root cause of their everyday pain,” says Akshat Chadha, a Mumbai-based general physician who has practised lifestyle medicine for close to 15 years. “Today, 70-75% patients come with pain as the major issue they want dealt with, and in two-thirds of these cases, you can find and treat the root cause.”
A significant cause of these pains, he finds, is psychosomatic—real, physical pain whose source or amplifier is emotional stress rather than structural injury. These include stress-related neck pain, shoulder pain, and pains related to the gut. The International Association for the Study of Pain formally updated the definition of pain in 2020 to acknowledge this duality. Pain, it now reads, is “an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage.” In his practice, Dr Chadha notes that more women than men come to him with pain issues now. “I think it is a sign of women opening up more about their pain, being more receptive to understanding how to deal with it,” he says. “It’s usually the women accompanying men who tell me about the male patient’s pain points.”
The change is visible outside his clinic, too. Period cramp playlists populate music streaming platforms. Many young urban Indian women seem far more comfortable framing their period pain through phrases like “cycle-syncing” and “luteal-phase brain” on social media. Some openly talk about sending care packages on the first day of someone’s cycle.
Mumbai-based Jiahjeet Kaur, 25, represents this transition. As a teenager preparing for her class X board exams in 2017, she developed period cramps so severe she could not turn over in bed; her family physician once flagged the possibility of hospitalisation. “That phase was stressful and my lifestyle wasn’t great,” she recalls. “I was eating a lot of processed food and ordering frequently from online food delivery platforms. That’s when the pain began and progressively worsened.” Her solution at the time was the script most people are handed—pop a painkiller and wait. “Over time my body became so used to them that they stopped working. I was told to increase the dosage.” When that didn’t help either, at 19, her gynaecologist suggested she go on birth control to stem the pain.
“Something in me resisted taking it because I didn’t understand the root cause,” says Kaur, who felt it would just give temporary relief. She chanced upon the documentary Heal by Kelly Gores, whose central claim was that chronic pain is not normal. It helped her see pain as information. “When people shift from seeing pain as an inconvenience to seeing it as communication from the body, that’s when real change begins.” Kaur consulted medical and health specialists and built a lifestyle that included an anti-inflammatory diet, cycle-synced workouts that eased off before her period, pranayama, meditation and journaling. On her 20th birthday during the covid lockdown, she marked the day with an online yoga session. “I realised I had no pain for the first time in my life,” she says. “I teared up… I couldn’t believe I was moving and completely pain-free.” With a degree in nutrition and dietetics and a yoga certification, Kaur today runs a Mumbai-based practice, working with clients dealing with painful periods, PCOS and related conditions. Kaur’s arc would have been nearly unthinkable a generation ago.
Duru Shah, a gynaecologist who has practised for 45 years in Mumbai’s Breach Candy and Jaslok hospitals, remembers a culture in which period pain was something a woman was expected to carry quietly. “Earlier when women complained of period pain—dysmenorrhea—they’d tell their mothers, who would tell them it will go away after you get married and have kids.” Dr Shah runs us through the now-known causes of period pain that earlier generations of patients were never told, forget offering a workaround for. These include ovulation-led cramps that can be treated with oral contraception; fibroids that may be shrunk medicinally or surgically; endometriosis and four other conditions, traceable, in her telling, through “one ultrasound and a month’s observation”.
Today, Dr Shah sees at least one woman a day who comes simply for pain. “Career women are the ones desperate to get period pain relief now. Over time, painkillers are not enough, some come early on, others are forced to take action after being taken to the emergency ward in the middle of the night. Those are the patients who possibly require surgical intervention.” The Indian medical system has also begun to access what was once available only abroad: GnRH (Gonadotropin-releasing hormone) oral antagonists that can ease endometriosis-related pain while lifting patients’ quality of life, says Dr Shah.
The flip side, she notes, is that the same channels that have raised women’s awareness have also raised the volume of noise. “Almost everyone coming to me with period pain issues thinks they have endometriosis because of the reels they’re watching,” she says. Dr Shah doesn’t fret though.
“Forty-five years ago, when I started my practice, I used to worry about asking a woman if she was sexually active.” Today, she’s seeing women approach her with issues like dyspareunia, or painful intercourse. “There are now tools to help women suffering from this, ranging from counselling to medication and exercises.” The system around women in pain has been slower to change. “Pain during active labour was taken for granted earlier,” says Dr Shah. “Today, we have epidural anaesthesia . However, epidural facilities are not easily available across the country, not even all over Mumbai. We don’t have so many trained anaesthetists to administer epidural throughout roughly four hours of labour.”
Even when the option exists, hesitation is built into the system. M.R. Rajagopal, chairman emeritus of Pallium India, a palliative care trust based in Thiruvananthapuram, experienced this with a family member recently. “A young relative of mine opted for an epidural for labour. In the process of signing the consent, the nurse asked her, ‘Are you sure you want this?’ That put a seed of doubt in her mind. And in a little while, the nurse in the labour room asked her the same question again. If we had not discussed this within the family, the young woman could well have been frightened enough to accept the needless pain.”
In India, the forms of relief reserved for the most severe of pains—from labour to post-surgical and terminal illnesses like cancer—still run up against systemic gaps that the country is yet to address. Dr Rajagopal has spent four decades working on access to pain relief. He led the campaign for India’s 2014 amendment to the Narcotic Drugs and Psychotropic Substances (NDPS) Act, intended to ease medical access to morphine. The amendment passed, but the rules that followed introduced new hurdles; a revised draft submitted in 2017 remains pending, and the gap in implementation persists, he explains.
The misconceptions that restrict morphine, Dr Rajagopal says, are as common among doctors as they are among families: that it is only for the dying, and that it inevitably causes addiction. He does not dismiss the risk. “If you ask me whether oral morphine can cause addiction, I must say yes, but rarely,” he says. “When morphine is used orally in the right doses to treat cancer pain, the chances of addiction are remote.” He doesn’t contend whether the risk exists, but the magnitude with which Indian medicine has historically treated it. The greater cost of withholding morphine, argues Dr Rajagopal, also an adjunct professor of global oncology at Queen’s University, Canada, is cognitive. “Pain strips patients of the mental space needed to make decisions, including whether to continue treatment. Once the pain is treated properly, they would have the mind space for clarity of thought and tend to undergo cancer treatment.”
The lived shape of that gap sits in a home in Wardha, Maharashtra. S. Tiwari has been looking after his mother, 65, through cancer for three years and two months now. “She finished schooling at the secondary level, married early, has lived independently across several Indian cities, and is acutely capable of reading her own scans,” he tells Lounge. “On a difficult day, she wishes for her life to end rather than suffer the pain that hits her in waves.”
Three out of five times, he says, his mother stabilises before morphine. The other two times, a 10mg morphine tablet at bedtime can avoid the alternative—a drive to the local hospital’s palliative ward for injectable pain management. Tiwari sees opioids like morphine as the only silver lining in this rather tough journey. “Any caregiver as well as a person suffering from the pain of an oncological condition will tell you that side effects are not even their last thought. Pain relief overrides everything else,” he says. “I’d drive a hundred kilometres just to access a few pills, if needed.”
While opioids remain difficult to access in India, they have driven a new wave of pain research in the West. Arnab Barik, assistant professor at the Centre for Neuroscience at the Indian Institute of Science (IISc), Bengaluru, studies the neurology of pain and itch. The field, he says, had largely gone quiet until the mid-2010s opioid epidemic in the US pushed researchers back toward the central nervous system. Until then, pain medicine had focused mostly on the peripheral nervous system—the network of nerves outside the brain and spinal cord. “You detect pain via the peripheral nervous system. Researchers are now investigating why it occurs by studying the central nervous system that actually feels and responds to the pain.”
This shift has opened up non-invasive approaches such as electrical and magnetic brain stimulation, reducing reliance on surgery or long-term medication. At the core of current research, Barik says, is a simple premise: changing how pain is perceived may change how it is experienced. Where exactly that perception is constructed in the brain, however, remains an open question.
ALTERNATIVE THERAPIES
When medical science doesn’t have all the answers, many patients turn to alternative therapies. Santoshi Kurada, co-founder of Alleviate Pain Clinics in Bengaluru, has observed that landscape up close. “Yoga and meditation are great for down regulating the nervous system.” But alternative therapies can prove dangerous when applied to acute injury. She remembers a patient with a clear disc prolapse who spent a year getting “vigorous massages” from a local healer. The trauma of the massages caused the disc to break off, leading to a surgical emergency marked by sudden leg weakness and loss of bladder control. “It was a preventable surgical emergency, caused by the delay of ‘alternative’ promises,” she says.
CBD (cannabidiol) is among the newer entries on this fringe, and Dr Kurada is careful about it. “CBD acts very well as a powerful adjunct in chronic inflammatory conditions like arthritis, and in neuropathic pains like diabetic neuropathy,” she says. The problem is when it is treated as a replacement for proven medication, she adds. “The CBD medications available over-the-counter are usually under-dosed, and some are mixed with heavy metals that can cause more harm than benefit. It should not be used in mental disorders like acute psychosis and clinical depression—where stopping proven medications like SSRIs or antipsychotics can lead to significant relapse.” Her summary is narrow: best for arthritis and nerve pain; not yet enough evidence to make CBD a mainstay for anxiety.
In her decade-long practice, “I’ve seen patients with completely normal scans suffer with unbearable pain, and the ones with herniated discs on the MRI run marathons,” she says. “Most often, patients are not just living with physical injuries. They are living with a nervous system that is severely unregulated.”
This does reframe, with some irony, a line long used to dismiss patients: the pain is, indeed, all in your head. That language is not theoretical for Gurugram-based dentist Anubha Mahajan, 34, who has lived with it for over a decade. She developed complex regional pain syndrome (CRPS) in 2014, “owing to a medical negligence,” she says. It’s a condition in which “dysfunction in the central or peripheral nervous system” drives severe, persistent pain. The first year was a “hazy mess of days and nights coalescing into one big ball of pain shooting through the body.” Tests and consultations led nowhere. “Most of the doctors didn’t take it seriously, or gave the incorrect diagnosis,” she says. “I began wondering if it was all in my head…”
Relief came a year later, when a correct diagnosis led to a multidisciplinary plan: medication, an anti-inflammatory diet, and cognitive behavioural therapy (CBT), which works by changing how the brain processes pain—the same mechanism the current global pain management research is beginning to map. Meanwhile, living with the condition has reshaped Mahajan’s relationship with it. “Instead of constantly thinking about it, I made it my life’s purpose,” she says. In 2017, she founded Chronic Pain India, a not-for-profit that supports patients through community and advocacy. Her current push is to have chronic pain recognised under India’s Rights of Persons with Disabilities Act, framing it as an invisible disability that demands visibility.
At the far end of that invisibility, in a darkened bedroom in Bengaluru, sits Ikyatha Yerasala, 39. She hasn’t had a pain-free day in over a decade. Without medication, her pain stays at a 9 or 10. She lives with three diagnoses—fibromyalgia, postural orthostatic tachycardia syndrome (POTS), and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a “neuroimmune, multi-system illness” whose hallmark, in her case, is severe brain inflammation. “My brain has very low tolerance to light, sound and electronic screens, so even minor exertion can lead to a crash,” she says. Her room stays dark, screens dimmed, noise kept low. “I haven’t stepped out of my house in months.”
The treatments that bring some relief feel like they sit at the edge of current pain science. Fibromyalgia, notably, remains one of the conditions with no clear or complete path to pain relief, only management. “I take medicines for POTS to help regulate my nervous system. For pain, I am currently trying the Stellate Ganglion Block procedure (where an injection of local anesthesia is administered into a bundle of nerves in the front of the neck called the stellate ganglion.)…Another treatment that gave me relief from chronic pain was taking ketamine infusions. I have recently started a new migraine injection…” Energy healing did not help. “For me, it’s only western medication that has worked.”
A media professional who runs Instagram channel Slangaluru on Kannada slang, she stays connected to the outside world largely through her phone. Her closest support is another ME/CFS patient in Mumbai, who is also bed-bound and whom she met online. They speak every day. “Because we understand each other’s conditions and what our lives are like, it’s become routine for us to talk every day.” It has reduced life to the simpler things, says Yerasala. “A healthy person can have a thousand problems,” she says, “but for a person who doesn’t have health, there is only one problem.”
For Israni, pain is the one problem standing between him and the sport he has loved since childhood. “I keep watching interviews of tennis players playing on the pro tour with chronic injuries,” he says. “It motivates me to recover to get back to playing tennis.” The rally, in other words, is still on.