The Invisible Wound: Chronic Pain amid the Indo-Pakistan War 2025

The year 2025 unfolds under the shadow of an escalating armed conflict between India and Pakistan, which is rapidly becoming a humanitarian and medical crisis. While the primary focus remains on battlefield injuries, an insidious and often underaddressed burden emerges – chronic pain among both military and civilian populations. Unlike acute pain, chronic pain is a long-term sequela that lingers, reshapes lives, and imposes a silent toll on survivors. This brief communication highlights the urgent need to recognize and address chronic pain in this ongoing conflict scenario. Pain is the most common symptom among wounded combatants and civilians during war. In a landmark survey of over 100 battlefield evacuees, 90% reported moderate-to-severe pain during and after evacuation.[1] In the current Indo-Pak setting, the pain burden is being amplified not only by the volume of injuries but also by insufficient triage and logistical bottlenecks. In Ukraine’s recent conflict, a large observational study illustrated how pain management was frequently underresourced and inconsistently applied.[2] The Indo-Pak scenario echoes similar gaps in preparedness and access. Improvised field hospitals near the Line of Control are often overrun and lack dedicated pain physicians or interventional pain setups. Triage tends to prioritize life-threatening trauma, while pain is often relegated. Military trauma-related pain is complex, often polytraumatic and neuropathic in origin, involving amputations, spinal injuries, or penetrating blast wounds.[3] Chronicity begins when acute pain remains undertreated. Back pain, one of the most common musculoskeletal disorders among deployed personnel, may worsen due to inadequate load-bearing equipment, cold weather, and poor rest.[4] Moreover, soldiers reporting pain during service tend to develop long-term pain disability postdeployment. Exposure to fear of air strikes, torture, displacement, uncertainty, and psychological trauma – now increasingly evident in civilian clusters of Poonch, Rajouri, and Punjab border villages – exacerbate the risk of centralized pain syndromes and somatoform disorders.[5] The intersection of posttraumatic stress disorder, sleep disturbances, and depression with pain creates a bio-psycho-social triad that challenges conventional treatment. Emerging data suggest a strong correlation between traumatic war experiences, disrupted interpersonal relationships, and heightened pain sensitivity.[6] Women and children in refugee shelters, already subjected to malnutrition and poor hygiene, now face the added burden of undiagnosed and untreated pain syndromes, especially those with a prior history of trauma. Pain management remains a neglected aspect in war zones. The WHO policy briefs and field reports repeatedly highlight the lack of morphine and other essential medications in conflict settings.[7] Apex pain medicine centers such as AIIMS and Armed Forces Medical Services hubs often come across referrals from border areas, including soldiers and civilians with complex regional pain syndromes, spinal injuries, and musculoskeletal low backaches and cancer patients displaced from ongoing treatment. As emphasized by Aldington, conflict medicine requires a shift from curative to supportive models where pain relief becomes central to preserving dignity and function.[8] Mobile pain units, use of ultrasound-guided regional anesthesia, and early psychosocial screening should be part of disaster medicine protocols. The socioeconomic implications are profound. Chronic pain reduces productivity, impairs caregiving roles, and increases reliance on health infrastructure. As Gallagher and Sandbrink argue, unaddressed pain in war survivors compounds economic recovery and public health goals.[9] To mount an effective response, policymakers must prioritize pain medicine as an essential component of wartime healthcare. This includes training field medics in basic pain relief, expanding access to opioids under monitored frameworks, and integrating telemedicine support from tertiary care centers.[10] In conclusion, the Indo-Pak conflict of 2025 is not only a geopolitical crisis but also a humanitarian emergency that necessitates a pain-focused response. Ignoring chronic pain risks perpetuating cycles of suffering long after the war ceases. The war may not yet be over, but for many, the pain has already begun. And even after a ceasefire, it takes years to decades to head back to “normalcy.” Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.