As we get older, pain quietly becomes a background feature of life. Aches after the weekend. Stiffness in the morning. A lingering knee or shoulder that never fully resolves. Over time, we almost accept it as inevitable. “You’re aging,” we are told. “Of course you’ll have pain.” For many years, I accepted that story without questioning it.
That belief was deeply challenged during my mother’s final months battling cancer. The disease itself was untreatable, but the pain was overwhelming. What struck me most during that period was not the inevitability of suffering, but how much of it could be reduced. I witnessed firsthand how targeted pain management did not change the diagnosis, but dramatically eased her physical distress. That relief mattered more than words can express. It changed how we experienced her final months, and it permanently changed how I think about pain.
Those experiences are why I was especially eager to host Dr. Kashinath Bangar, a pain management specialist whose work I first encountered during the most difficult periods of my family’s life. At the time, I did not even know pain management existed as a distinct medical specialty. What Dr. Bangar did for my mother did not cure her cancer, but it restored comfort and dignity when they mattered most. Today, as my father navigates his own health challenges, my sister and I feel more empowered simply because we are aware of the pain management options that exist.
In this blog post (#64), I have tried to distill the most important insights from my hour-long conversation with Dr. Bangar.
When pain persists: Acute vs chronic pain
We began with a deceptively simple question. What is the difference between acute pain and chronic pain, and why does the body sometimes continue to hurt long after an injury has healed?
Acute pain is short-term and usually easy to explain. You injure a finger, and you feel pain. The source is obvious and the pain resolves as healing occurs. Chronic pain is different. It persists for months or years, sometimes even when scans and blood tests show nothing abnormal. A classic example is post-herpetic neuralgia after shingles, where the rash resolves but nerve pain can linger for months or even years.
One of the most reassuring things Dr Bangar explained was this. Pain that does not show up on imaging does not mean you are imagining it. It often means medicine does not yet have the tools to detect what is happening at the level of nerves and pain processing.
Pain is not just a signal from injured tissue. It is a system. Signals travel from peripheral nerves to the spinal cord and then to the brain. Along this pathway, the body normally dampens pain signals, much like shock absorbers in a car. This means the brain perceives less pain than the raw stimulus. When pain persists over time, those shock absorbers can fatigue. The nervous system may even flip from dampening pain to amplifying it. As a result, the brain can receive stronger pain signals even after the original injury has healed. That is why chronic pain feels real, overwhelming, and exhausting.
Many of the same chemical messengers (neurotransmitters) involved in suppressing pain are also involved in regulating mood. When those systems are depleted, pain intensifies and mood drops. This helps explain why chronic pain and depression so often coexist. Telling someone that their pain is “in their head” only deepens that cycle.
Pain, aging, and quality of life
In my younger years, pain after a game or workout felt manageable, but I assumed it would only worsen with age. Paradoxically, the opposite has happened. As I better understood pain and invested in strength training, lifestyle changes, and in some cases targeted medical interventions, the amount of pain I experience today is far lower than it was years ago. That personal contradiction made the science we discussed feel immediately real.
We then discussed why Dr Bangar chose pain management as his specialty. His answer mirrored my own experience. Watching his mother suffer from cancer pain, and seeing how targeted interventions transformed her final months, shaped his career choice. Pain management may not cure disease, but it can restore quality of life. That purpose matters deeply.
From there, we moved into the most common pain conditions he sees today.
- Headaches and migraines dominate younger age groups, often driven by stress.
- Neck pain has become epidemic due to prolonged screen use and poor posture. For those interested in how this affects kids, do attend the live podcast I will be doing with Dr. Janhavi Melinkeri this Thursday (January 15th, 2026) at 9 pm IST.
- Spine, knee, and joint pain dominate middle age, often amplified by sedentary lifestyles and loss of muscle strength.
- Cancer-related pain remains among the most complex and severe, involving multiple pain generators at once.
A critical insight here was that cancer pain rarely comes from a single source. Bones, nerves, inflammation, tissue damage, and treatment side effects often overlap. This is why cancer pain management must be multimodal, using several approaches together. As endorsed by the World Health Organization, the realistic goal for many cancer patients is often to reduce pain below four on a ten-point scale. Zero is not always achievable, but meaningful relief is.
Lifestyle and modern pain management
Lifestyle factors came up repeatedly. Exercise, nutrition, sunlight, and sleep are not optional extras. They are foundational to pain prevention and recovery.
One of the clearest examples of exercise came from spinal discs. Discs have very limited direct blood supply. Unlike most tissues, they rely on movement, compression, and release to receive nutrients and remove waste. Without regular movement, they degenerate. Exercise also releases endorphins, the body’s own morphine-like pain relievers, which further reduce pain perception.
Sleep matters just as much. Poor sleep increases excitatory pain chemicals and reduces inhibitory ones. Even the sleep position plays a role. The simple rule is neutral alignment and comfort. If you consistently wake up in pain, something about your sleep setup is likely contributing.
When we turned to treatments, many people would be surprised by how much pain management has evolved. It is far more than painkillers. Modern approaches include dry needling, nerve hydro-dissection, regenerative therapies using a patient’s own blood or bone marrow, targeted nerve blocks, radiofrequency and cryoablation, spinal cord stimulation, and intrathecal pumps for severe cancer pain. Most of these are minimally invasive, image-guided, and require little or no hospital stay.
I was especially curious about when surgery is recommended versus physiotherapy combined with interventional pain treatments. This question came from my own experience, where I was once advised surgery after a soccer injury, yet fully recovered with non-surgical care. Dr. Bangar’s view was clear. In the absence of red flags such as infection, fracture, nerve damage, or cancer spread, conservative and interventional pain management should come first. Surgery should be the exception, not the default.
He also addressed opioids honestly. Used appropriately and for the right indications, particularly cancer pain, they are invaluable. Used casually or long-term for non-cancer pain, they often create more harm than benefit. Modern pain management aims to minimize or avoid opioids when possible. In practice, severe cancer pain accounts for most situations where an expert still recommends them.
Key takeaways
My personal takeaways are simple.
Pain management is grounded in solid medical science that has been quietly advancing for years. We should become aware of it, because nearly all of us will need it at some point.
From post-viral joint pain after chikungunya, to frozen shoulder around menopause, to post-herpetic neuralgia, the recurring theme was hope. Many conditions people assume they must live with are treatable if addressed early and correctly.
Pain is not “in your head.” When medicine cannot yet explain it, that reflects the limits of science, not the legitimacy of your experience. For me, that belief alone can change how people seek help, ask better questions, and reclaim quality of life. That is exactly why these conversations matter.
As always, I welcome your thoughts and would love to hear your experiences in the comments.
Disclaimer
Views expressed above are the author’s own.
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