At HLF 2026, neuroscientist Dr. Arnab Barik and endometriosis surgeon Dr. Vimee Bindra in conversation with Ponnari Gottipati, revealed why 270 million Indians suffer chronic pain—and why women’s pain, dismissed as “normal,” takes a devastating 7-10 years to diagnose, creating neurological changes that persist even after treatment, Naresh Nunna of Neo Science Hub, reports.
In one of the most emotionally resonant sessions at the Hyderabad Literary Festival 2026– Science and the City stream, three experts converged to examine pain not merely as a medical symptom, but as a profoundly personal experience shaped by biology, psychology, and societal response—particularly for women whose suffering is often doubted, dismissed, and delayed in diagnosis.
The “Pain Pathways” panel, held Sunday afternoon in the Orwell 2 venue at Sattva Knowledge City, brought together Dr. Arnab Barik, a neuroscientist from the Indian Institute of Science who studies pain circuits at the molecular level, and Dr. Vimee Bindra, a pioneering endometriosis surgeon and founder of the Endometriosis Foundation of India, in conversation with Dr. Ponnari Gottipati, Associate Director of Research at L.V. Prasad Eye Institute and co-founder of Superheroes Against Superbugs.
The 50-minute discussion before a packed audience tackled fundamental questions: Do men and women experience pain differently? Why does pain persist long after injuries heal? And what happens when chronic pain is repeatedly dismissed by healthcare providers, employers, and society?
The Universal Experience That Isn’t Universal
Dr. Gottipati, who has lived with chronic pain for over a decade, opened the session with a provocative question: “How you experience pain—is it the same as how I experience it?”
The answer, as the panel revealed, is definitively no. Pain, while universal in occurrence, is profoundly individual in experience—shaped by genetics, neural architecture, past experiences, psychological state, and crucially, by whether that pain is believed and validated.
“Pain doesn’t always work like that simple signal model,” Gottipati explained. “Some pain lingers long after injury is healed. Some pain is severe though the scans look normal. And some emotional pain could be more visceral than any physical injury.”
From Stimulus to Suffering
Dr. Barik, whose laboratory at IISc Bangalore has published over 40 peer-reviewed papers with more than 2,000 citations, provided a masterclass in pain neuroscience, explaining the journey from tissue damage to conscious suffering.
“It’s a game of thresholds,” Barik began, describing how specialized nerve endings throughout the skin and internal organs constantly monitor the environment, distinguishing between innocuous touch and noxious stimuli that cross the pain threshold.
When a stimulus—a pinprick, a burn, tissue damage—exceeds this threshold, specialized receptors (including the PIEZO2 mechanoreceptors Barik helped characterize in landmark 2018 research published in Science Translational Medicine) convert mechanical or chemical signals into electrical impulses. These signals travel through peripheral nerves to the spinal cord, then relay to multiple brain regions including the parabrachial nucleus—a critical relay station Barik’s NIH research identified as essential for generating the emotional and affective responses to pain.
“Pain serves as a basic alarm function,” Barik explained. “It tells you that something can hurt you or cause injuries, and you shouldn’t expose yourself to them often. If you do, it can cause irreparable damage.”
But this protective mechanism can malfunction. In chronic pain—the focus of much of Barik’s current research—the alarm system becomes hypersensitive or continues firing long after the original threat has resolved.
Why Ballet Dancers Don’t Quit
One of the session’s most illuminating moments came when Barik discussed how motivation and context profoundly shape pain perception, using ballet dancers as an example.
“Ballet dancers literally dance for hours on their feet, putting their entire body weight onto their toes in extremely tight shoes,” Barik noted. “This is objectively very painful. Yet dancers—including pregnant women—continue practicing because they love dancing so much that they can motivate themselves to overcome that pain.”
The key insight: “They have taught their nervous system that it doesn’t want to cause any harm, so the alarm system doesn’t work here. Your experiences and your motivation can shape your pain threshold and your perception of pain.”
This context-dependency has profound implications. The same injury can produce vastly different pain experiences depending on genetic factors, prior experiences, psychological state, and the meaning attached to the pain. A soldier injured in combat may report less pain than a civilian with an identical injury—not because of different tissue damage, but because of different neural processing shaped by context and expectation.
Measuring the Immeasurable
Dr. Bindra, who has performed over 4,000 independent laparoscopic and hysteroscopic surgeries and holds the rare distinction of being only the second female surgeon worldwide to receive Master Surgeon in Multidisciplinary Endometriosis Care (MSMEC) accreditation, addressed the clinical challenge of measuring something as subjective as pain.
“We use a visual analog scale from 0 to 10, where 0 is the least pain and 10 is the worst pain,” Bindra explained. “But that is not enough. We ask about the cyclicity of the pain—is it regular or does it happen only at certain times? What aggravates it? What reduces it? How does it affect their day-to-day activities? Are they functional?”
The critical insight: pain cannot be reduced to a number. Two patients reporting “7 out of 10” pain may have completely different functional capacities—one fully mobile and working, the other bedridden and unable to perform basic tasks.
“We cannot compare two individuals with the same scoring,” Bindra emphasized. “There are genetic differences, biological differences. One person with 7 on 10 may be fully functional. Another person with 7 on 10 may be immobile and not able to do any function at all.”
This subjectivity creates a profound clinical challenge: how do healthcare providers validate and treat something they cannot objectively measure? The answer, Bindra stressed, lies in listening, believing, and comprehensive assessment rather than relying solely on numerical scales or imaging studies.
270 Million Indians Living with Chronic Pain
The session confronted a sobering statistic: approximately 20% of adult Indians—roughly 270 million people—suffer from chronic pain. This represents not just a medical crisis but a social and economic catastrophe affecting productivity, relationships, mental health, and quality of life.
For women with conditions like endometriosis, the burden is compounded by diagnostic delays averaging 7-10 years—a decade of suffering before receiving validation and appropriate treatment.
When Pain Is Dismissed as “Normal”
Dr. Bindra’s discussion of endometriosis—a condition affecting millions of women globally where tissue similar to the uterine lining grows outside the uterus—provided the session’s most powerful illustration of how gender shapes pain experiences and medical responses.
“Pain during menstruation is NOT normal,” Bindra stated emphatically, challenging a pervasive cultural myth. “It requires investigation. Yet women are routinely told, ‘You’ll be fine once you get married,’ or ‘You’ll be fine once you have children.’ They keep going to several gynecologists without getting any diagnosis.”
The consequences of this dismissal are devastating. Women with undiagnosed endometriosis suffer not just physical pain but profound impacts on career, relationships, and mental health. They must constantly prove their pain to skeptical employers, family members, and even healthcare providers.
“Living with chronic pain is not easy, and then sometimes you need to prove it to the people around you,” Bindra explained. “They don’t believe that you have pain. You are skipping your work. You are not doing your projects on time. You keep telling them, ‘I am not well.’ How do you prove it?”
This validation crisis creates a vicious cycle: dismissed pain leads to delayed diagnosis, which leads to disease progression, which leads to more severe pain and functional impairment—all while the patient’s credibility is questioned.
The Paradox of Persistent Pain
One of the session’s most important insights addressed a central paradox in pain medicine: why does removing diseased tissue sometimes fail to eliminate pain?
Bindra’s surgical expertise—including successfully removing the largest uterus ever documented laparoscopically (2.2 kg) without large scars, and specializing in deep endometriosis affecting bowel, ureter, and extra-pelvic locations—gives her unique insight into this phenomenon.
The answer lies in neuroplasticity and central sensitization. When pain signals are repeatedly transmitted over months or years, the nervous system undergoes structural and functional changes. Neural pathways strengthen, creating what Barik described as pain “highways.” The brain’s pain processing centers become hypersensitive, amplifying signals and sometimes generating pain even in the absence of ongoing tissue damage.
“What happens in chronic pain is that when the damage has persisted for a certain time, it causes changes in how the nervous system processes information,” Barik explained. “The neural structure transmitting information from the stimuli to the brain can be shaped by our experience.”
This explains why comprehensive, multidisciplinary treatment is essential. Bindra’s approach combines surgical excision with anti-inflammatory diet, pelvic physiotherapy, nerve blocks, and pharmacotherapy—addressing not just the structural disease but the neurological changes it has produced.
Gender and Pain: Biology, Psychology & Social Dismissal
While the session notes indicate the panel addressed gender differences in pain, the discussion revealed a complex interplay of biological, psychological, and social factors.
Biological factors include hormonal influences on pain perception, differences in receptor distribution, and neuroinflammatory responses that may make women more susceptible to certain chronic pain conditions including endometriosis, fibromyalgia, and migraines.
Psychological factors include gender-specific stress responses and the mental health toll of having pain repeatedly dismissed or attributed to psychological causes rather than physical pathology.
Social factors proved perhaps most significant: women’s pain is systematically undertreated, under-believed, and under-researched compared to men’s pain. The diagnostic delay for endometriosis—7-10 years—has no equivalent in male-predominant conditions.
Listening as Treatment
Perhaps the session’s most powerful clinical insight came from Bindra’s emphasis on validation as therapeutic intervention.
“First of all, we have to believe them, talk to them, diagnose them,” Bindra stated. “Listening is the key where we can help them.”
This seemingly simple prescription—believe patients, listen to their experiences—represents a radical departure from pain management approaches that prioritize objective findings over subjective reports. In conditions like endometriosis, where pain severity often doesn’t correlate with disease stage visible on imaging, patient testimony becomes the primary diagnostic tool.
“My diagnosis is therapeutic for any kind of pain,” Bindra explained. “When somebody tells us they have pain, whether they have been diagnosed, whether they have been validated, whether they have been believed—that is the most important thing. If they have been dismissed, the pain is going to aggravate and they are going to live with it for more years till they are diagnosed.”
From Molecules to Meaning
The pairing of Barik’s molecular neuroscience with Bindra’s clinical expertise created a powerful synthesis, demonstrating how understanding pain mechanisms at the cellular and circuit level can inform more effective, compassionate treatment.
Barik’s research on specific ion channels (PIEZO2, Nav1.7), parabrachial nucleus circuits, and stress-induced analgesia mechanisms provides the scientific foundation for understanding individual variation in pain perception. His work on how anxiety interacts with pain circuits helps explain why psychological interventions can produce real physiological changes in pain processing.
Bindra’s clinical experience translates these mechanisms into treatment strategies: recognizing that pain persisting after surgical excision may reflect neuropathic changes requiring different interventions; understanding that central sensitization means pain can spread beyond the original disease site; appreciating that multidisciplinary approaches address the multiple levels at which chronic pain operates.
Research, Recognition & Reform
The session concluded with implicit calls for systemic change across multiple domains:
Research priorities: Continued investigation of pain mechanisms, particularly gender-specific factors; development of objective biomarkers for chronic pain conditions; studies of why some individuals transition from acute to chronic pain while others don’t.
Clinical practice: Training healthcare providers to believe and validate patient pain reports; implementing comprehensive assessment beyond numerical scales; adopting multidisciplinary treatment models that address biological, psychological, and social dimensions.
Social awareness: Challenging cultural myths about “normal” menstrual pain; educating employers and institutions about chronic pain’s impact on function; reducing stigma around invisible disabilities.
Healthcare systems: Reducing diagnostic delays through better education and referral pathways; ensuring access to specialized care for complex pain conditions; supporting research into understudied conditions affecting women.
A Personal and Universal Crisis
Dr. Gottipati’s opening acknowledgment of her own decade-long experience with chronic pain grounded the session in lived reality. Pain is not merely an academic subject or clinical challenge—it is a daily experience for hundreds of millions of people whose suffering is often invisible to those around them.
The “Pain Pathways” session at HLF 2026 demonstrated that understanding pain requires integrating multiple perspectives: the molecular mechanisms Barik’s laboratory elucidates, the clinical realities Bindra confronts in her surgical practice, and the lived experiences of patients like Gottipati who navigate a world that often doubts their suffering.
As India confronts the reality of 270 million citizens living with chronic pain—disproportionately affecting women whose pain is systematically dismissed—the insights shared in this session provide both scientific understanding and a moral imperative: to listen, to believe, and to recognize that pain, while subjective, is no less real for being invisible.
** **
