Chronic Pain Affects Millions in South Africa with Inadequate Management

Nearly one in five South Africans over the age of 15 experiences chronic pain, based on a 2016 survey of more than 10,000 people. The study, published in 2020, found that 18.3% of respondents reported persistent pain, with women more likely to be affected than men.

A more recent analysis, published in March 2026, indicated that 1.7% of the population faces high-impact chronic pain, limiting daily activities such as walking or dressing. This high prevalence suggests a significant healthcare burden, yet the response in South Africa remains insufficient.

Most individuals rely on the public health system, which serves 83% of the population, but access to adequate pain relief is limited. Rural clinics often provide only basic medications like paracetamol or ibuprofen, along with brief consultations.

Chronic pain often stems from an oversensitized nervous system that amplifies minor signals or misinterprets normal sensations as threats. Initial causes may include injury or disease, but persistent pain involves biological, psychological, and social factors.

Environmental influences, cultural beliefs, and past trauma also play roles, with 74% of South Africans experiencing at least one traumatic event in their lifetime. Trauma can activate long-term survival responses, leading to muscular tension and heightened pain sensitivity.

In South Africa, where such experiences are common, this factor significantly contributes to chronic pain cases.

Treatment in much of the country relies on outdated approaches, such as morphine for severe pain and paracetamol for milder cases. Experts emphasize that chronic pain requires a multifaceted strategy, including psychological and physical interventions alongside medications.

Evidence shows that non-pharmacological methods, like cognitive behavioral therapy, education, exercise, healthy eating, and relaxation techniques, are more effective for persistent pain than pills alone. Long-term use of painkillers can cause dependence or gastrointestinal issues.

“We are quite late in recognizing that pain is in fact a complex interaction of biological, psychological and social factors, requiring psychological and physical strategies alongside pharmacological strategies, especially when chronic pain develops.”

The ideal model involves an interdisciplinary team, including prescribers, nurses, therapists, psychologists, and psychiatrists, working with the patient and their support network. Other specialists may join depending on the condition.

The public health system is theoretically better equipped for team-based chronic pain management, as large state hospitals have various specialists on site without additional billing. In contrast, private medicine can become expensive when coordinating multiple experts.

However, few state hospitals implement this approach. Facilities offering interdisciplinary pain management include two in the Western Cape, two in KwaZulu-Natal, one in Gauteng, and one in the Free State. Pharmacists, public health experts, and pain specialists agree that the state system has potential advantages for complex cases, but implementation lags.

A retired anaesthetist noted that private practice struggles with multi-system problems due to cost structures.

The lack of effective pain management contributes to disability and reduced quality of life for millions. Women bear a disproportionate burden, highlighting gender disparities in health outcomes. Addressing this issue could involve expanding interdisciplinary programs in public hospitals to better serve the population.

Recent research underscores the need for updated training for healthcare professionals to recognize pain's complexity beyond tissue damage. Integrating trauma-informed care could also improve outcomes given the high prevalence of traumatic experiences in South Africa.