Doctors warn that patients spend years searching for answers while their pain is dismissed as imaginary. Greater awareness is needed to stop the stigma surrounding this invisible condition.
By Jahangeer Ganaie
In Kashmir, where harsh winters, prolonged stress, and mental health challenges shape everyday life, many people continue to silently suffer from a chronic pain condition that often goes unnoticed, undiagnosed, and misunderstood. That condition is fibromyalgia commonly referred to as the “invisible illness”.
Unlike fractures or infections, fibromyalgia does not appear on routine blood tests or X-rays. Yet, for patients living with it, the condition can be physically exhausting, emotionally draining, and deeply disabling.
On the eve of International Fibromyalgia Awareness Day, pain specialists are urging greater awareness about the disorder, which affects millions worldwide but remains significantly underdiagnosed in India, particularly in peripheral and resource-limited regions like Kashmir.
Dr Afaan Qazi, Clinical Fellow in Pain Medicine at Jaslok Hospital and Research Centre, said that many patients spend years searching for answers while their suffering is repeatedly dismissed.
“As a pain physician, I increasingly encounter patients, predominantly women, who arrive after years of suffering, carrying thick files of normal investigations, yet living with debilitating pain, fatigue, poor sleep, and frustration. Being told ‘it is all in your mind’ has silenced patients far too long. It is time to change that narrative,” Dr Qazi said.
Fibromyalgia is a chronic nociplastic pain disorder in which the nervous system amplifies pain signals abnormally, a process medically known as “central sensitisation”. In such cases, the brain and spinal cord become overly responsive, causing the body to experience pain even without visible tissue injury or inflammation.
Patients commonly suffer from widespread body pain lasting more than three months, persistent fatigue, disturbed sleep, headaches, anxiety, mood disturbances, irritable bowel syndrome, and cognitive difficulties often referred to as “fibro fog”.
According to global estimates, fibromyalgia affects nearly 2–4 per cent of the population, with women accounting for nearly 90–95 per cent of diagnosed cases. The female-to-male ratio can be as high as 14:1.
Despite this, awareness around the illness remains low, leading many patients to move from one specialist to another without receiving proper treatment.
Medical experts believe Kashmir’s unique socio-environmental conditions may increase vulnerability to chronic pain syndromes like fibromyalgia.
Dr Qazi explained that prolonged psychosocial stress, trauma exposure, anxiety, depression, harsh winters, reduced physical activity, and widespread Vitamin D deficiency together create conditions that can worsen chronic pain disorders.
“Many Kashmiri patients spend years moving from orthopaedics to rheumatology to neurology, undergoing repeated MRIs and taking painkillers without relief because the core problem often remains unidentified,” he said.
He further noted that social stigma around “unexplained illnesses” often discourages patients from seeking timely psychological and rehabilitative support.
Experts say one of the biggest misconceptions surrounding fibromyalgia is treating it like arthritis or muscle injury.
Since the condition is linked to altered pain processing in the nervous system rather than inflammation, common painkillers and anti-inflammatory medicines often provide little relief.
“The problem is not tissue damage. It is pain amplification by the central nervous system,” Dr Qazi explained.
Doctors stress that fibromyalgia cannot be managed through a single medicine alone and requires a comprehensive, personalised treatment approach.
Patient education, they say, is often the first and most important step.
“When patients understand that they are not imagining the pain, that they do not have a hidden cancer, and that recovery is possible, fear reduces and outcomes improve,” Dr Qazi said.
Lifestyle modifications and physical rehabilitation also play a crucial role in treatment. Experts recommend graded aerobic exercises, stretching, walking, and aquatic therapy to improve symptoms gradually.
“In Kashmir, even simple indoor winter exercise programs can make a remarkable difference,” he added.
Psychological therapies such as Cognitive Behavioural Therapy (CBT), mindfulness, stress management, and proper sleep hygiene are also considered highly effective, particularly in stress-prone regions like Jammu and Kashmir.
While fibromyalgia itself is widespread and centrally mediated, some patients may also develop localised pain areas that can benefit from interventional pain procedures.
According to Dr Qazi, selected patients may benefit from trigger point injections, ultrasound-guided fascial plane blocks, IV lidocaine infusions, and ketamine infusions in resistant cases.
Advanced neuromodulation techniques such as Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS) are also emerging as promising therapies in specialised centres.
Doctors say there is an urgent need for better physician awareness, dedicated chronic pain clinics, multidisciplinary care models, and reduced stigma surrounding invisible illnesses.
“Although fibromyalgia may not be life-threatening, it significantly affects quality of life, productivity, relationships, and mental well-being,” Dr Qazi said.
He said fibromyalgia does not kill, but it steals quality of life, productivity, and hope. As” pain physicians, our responsibility is to validate suffering and restore function. Sometimes the deepest pain is the one nobody else can see, and in Kashmir, it is time we started seeing it,” he said.
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