Published Jun 24, 2026 | 7:00 AM ⚊ Updated Jun 24, 2026 | 7:00 AM
Representational image. Credit: iStock
Synopsis: India’s chronic pain crisis often begins at the pharmacy counter, not the doctor’s clinic. Experts say workplace pressures, self-medication, and the absence of structured referral pathways delay treatment for neck and back pain, allowing conditions to worsen silently. The result is a hidden burden of reduced productivity, untreated illness, and rising long-term healthcare costs.
India’s pain management pathway runs through the chemist, not the clinician.
Before a working professional with chronic neck or back pain sees a doctor, they have usually spent months, sometimes years, managing symptoms with whatever sits behind the counter at the nearest pharmacy. Ibuprofen. Diclofenac. A muscle relaxant bought on the advice of the pharmacist, or a colleague, or nobody in particular.
This is not a failure of access. It is a pattern of behaviour shaped by deadlines, workplace cultures that treat absence as a problem, and a health system that has never built a clear pathway between a person in pain and the care that pain requires.
“When someone relies on over-the-counter painkillers for years without understanding the underlying cause, the condition often continues to progress silently,” says Surya Maguluri, co-founder and CTO of Curapod, a pain management platform to South First. “By the time imaging and specialist intervention happen, the condition may have become significantly more advanced, making recovery more complex and prolonged.”
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The reasons are practical before they are cultural. A visit to a specialist takes time. It requires an appointment, possibly a referral, almost certainly an MRI, and a conversation about lifestyle changes that feel impossible to implement inside a ten-hour working day. A strip of painkillers costs forty rupees and works within the hour.
Dr Sai Shiva Tadakamalla, consultant endoscopic and spine surgeon at Gleneagles AWARE Hospital, LB Nagar, Hyderabad, says the delay between symptom onset and clinical presentation runs to months in the majority of cases he sees.
“Most people only see a doctor when the pain starts affecting their work, sleep, or daily life,” he says to South First. “Many try home remedies or self-medicate for months before they walk into my OPD.”
Dr Krishna Chaitanya N, neurosurgeon and spine surgeon at Apollo Hospitals, Bengaluru, identifies the workplace as the specific pressure point that keeps people away from care.
“Because of workplace demands and deadlines, they tend to take painkillers and continue working rather than allowing the injury to heal,” he says to South First. “Pain is the body’s way of telling you to stop. When people suppress it with medication and continue working, they bypass that warning signal.”
The consequence, he says, is that people return to the conditions that produced the pain without addressing what the pain was signalling. The problem does not resolve. It waits.
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The more consequential effect of this pattern does not appear in absenteeism data. It appears in something that Indian organisations rarely measure at all.
Presenteeism. The employee who arrives, sits at the desk, attends the meetings, and sends the emails, but operates at a fraction of their capacity because of persistent pain, poor sleep, fatigue, and impaired concentration.
“Most organisations track attendance,” Maguluri says. “Very few measure presenteeism, where employees are physically present but operating below their full capacity because of pain or discomfort.”
The effects he describes are not marginal. Chronic pain disrupts sleep, which impairs memory consolidation and decision-making. It draws on cognitive resources that would otherwise support concentration and problem-solving. It produces fatigue that compounds through the working week. It shortens attention and slows the kind of deliberate thinking that knowledge work requires.
“Chronic pain affects concentration, energy levels, sleep quality, mobility, and overall cognitive performance,” Maguluri says. “India still lacks structured data and large-scale measurement frameworks around how musculoskeletal health impacts workforce performance and economic output.”
For a country whose technology sector depends on sustained cognitive output across long careers, the absence of this data is not a minor gap. It is a structural blind spot sitting at the centre of workforce health policy.
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Dr Tadakamalla puts the referral problem in a single number. “Honestly, 99 per cent of patients come on their own,” he says.
Direct referrals from employers to specialists for musculoskeletal evaluation are rare. Dr Umesh Srikantha, additional director of neuro and spine surgery at Fortis Hospital, Bannerghatta Road, Bengaluru, says some organisations have introduced wellness initiatives that have produced occasional referrals for preventive care. But he describes these as exceptions within a broader pattern of reactive, rather than proactive, engagement.
The gap between what employers currently offer and what the problem requires is structural. Wellness programmes exist across much of the organised sector, particularly in technology companies. They tend to take the form of gym memberships, step-count challenges, and mental health helplines. These are benefits, positioned as additions to compensation rather than components of a health strategy.
What they rarely include is workstation assessment, musculoskeletal screening, early physiotherapy access, or any mechanism for identifying employees who have been managing pain independently for months before it affects their performance visibly enough to register.
“The conversation needs to move from ‘we offer gym memberships’ to ‘we have a structured musculoskeletal health strategy,'” Maguluri says. “That change in mindset has direct implications for productivity, employee engagement, retention, and long-term healthcare costs.”
The cost of delayed employer engagement is not only borne by employees. An organisation that loses a trained professional to a chronic condition that developed over years, across a desk inside its own offices, has absorbed a cost it never counted and therefore never tried to prevent.
The absence of measurement is not accidental. It reflects how musculoskeletal health has been categorised.
Infectious diseases attract infrastructure, surveillance, and policy attention because they spread, they produce visible acute events, and they carry the threat of rapid population-level impact. Musculoskeletal conditions do none of those things. They develop slowly, present individually, and sit outside the frameworks that Indian public health has historically prioritised.
“Infectious diseases have traditionally received greater attention because they pose immediate public health risks,” Maguluri says. “Musculoskeletal conditions typically develop gradually and are often viewed as individual health concerns rather than population-level challenges.”
The result is an almost complete absence of the data that would allow the problem to be sized, tracked, or acted upon at scale. There is no national surveillance of musculoskeletal disorders in the working-age population. No mandatory occupational health screening for desk-based workers. No standardised workstation assessment framework. No mechanism that connects a software professional buying ibuprofen at a chemist to any dataset that might eventually produce a policy response.
Maguluri says this is beginning to change, as employers and policymakers recognise the connection between physical health and workforce output. But recognition without measurement produces awareness, not action.
A structured response to chronic pain in India’s workforce would need to operate at several levels simultaneously.
At the individual level, earlier access to physiotherapy and occupational health assessment, before symptoms become chronic. At the employer level, workstation evaluation, movement policies, and referral pathways that do not depend on an employee reaching a breaking point before the system responds. At the policy level, surveillance frameworks that track musculoskeletal health in working-age adults the way other workforce health indicators are tracked.
None of this requires new medical knowledge. The conditions are understood. The causes are documented. The interventions that slow progression are established. What is missing is the institutional infrastructure to deliver them before the chemist becomes the default.
Until those numbers exist, chronic pain will remain what it is now: a private arrangement between an employee, a pharmacy counter, and a body that keeps absorbing the cost of being ignored.
