By Dr. Zainab Saifee (PT)
Chronic Pain Specialist
Published: January 21, 2026 | Reading Time: 12–14 minutes
The healthcare system operates on a simple assumption: suppress the symptom, healing follows.
This works for acute conditions. If you have an infection, antibiotics kill the bacteria while painkillers prevent you from splinting your body. If you have postoperative pain, pain relief allows you to move and prevent complications.
But for chronic musculoskeletal dysfunction—the kind of pain that persists for months or years—this approach backfires.
The core problem: Suppressing pain without addressing underlying dysfunction, causes further tissue damage. When body’s signal is muted.
Think of it this way: If your check-engine light turns on in your car, disconnecting the light doesn’t fix the engine. It just masks the problem while the damage continues.
This principle applies to every symptomatic drug class:
- Pain killers (opioids, analgesics)
- Anti-inflammatories (NSAIDs like ibuprofen, naproxen)
- Muscle relaxants (baclofen, tizanidine, cyclobenzaprine)
- Nerve pain medications (pregabalin, gabapentin)
- Corticosteroids
Each works through different mechanisms. But all share the same flaw: they address the signal, not the problem generating it.
How Symptomatic Medications Work: The Universal Pattern
Let me explain using a real-world example that most people can relate to.
Chronic Neck & Shoulder Tension
Imagine this scenario (it happens to thousands of people):
You work at a desk 8 hours a day. Your posture gradually shifts—shoulders slouch, head moves forward. Your cervical spine (neck) becomes unstable. Your upper trapezius and shoulder muscles work overtime to stabilize this unstable spine.
Your body’s response: Increased muscle tension (protective guarding). Pain develops to signal: “Stop using this posture. Fix the instability.”
Your pain score: 4/10. Manageable but annoying.
This is your body’s intelligent warning system working correctly.
What Happens When You Take Symptomatic Medication
You visit a doctor. They prescribe a muscle relaxant (say, cyclobenzaprine).
What the medication does: It chemically suppresses the motor neurons controlling your neck muscles. The muscles relax. The tension disappears.
Your pain drops: 4/10 → 1/10. You feel “solved.”
But here’s what’s actually happening:
Your cervical spine instability persists. Your forward head posture is unchanged. Your upper trapezius weakness remains. The nervous system’s protective muscle tone is chemically suppressed, but the reason for that protection—the underlying instability—is still there.
Why This Strategy Fails (The 5-Stage Cascade)
Time frame may vary from patient to patient.
Stage 1 (Week 1–3): Pain suppressed. You feel better. You resume normal activities because pain isn’t signaling danger anymore.
Stage 2 (Month 3–4): Medication tolerance develops. Your nervous system adapts. Neurotransmitter levels shift to counteract the drug’s effect. The medication becomes less effective.
Stage 3 (Month 5–6): You return to your doctor. “The medication doesn’t work anymore.” Dose increases. Temporary relief. Then tolerance develops again.
Stage 4 (After 1 year or more): After months of medication without addressing the underlying problem:
- Your deep neck stabilizers remain weak
- Forward head posture worsens
- Cervical joints stiffen (lack of proper movement rehabilitation)
- You’re now weaker than when you started
Stage 5: Pain breaks through despite medication. You now present with:
- Worse neck dysfunction
- Greater muscle atrophy
- More severe headaches
- Radiating pain into your arms (nerve root irritation from spinal instability)
Your doctor orders an MRI. It shows cervical spondylosis, disc bulge, and facet arthropathy (degenerative changes).
Clinician’s conclusion: “This is structural. Surgery might be necessary.”
The hard truth: These structural changes developed because the original biomechanical problem (weak stabilizers, poor ergonomics, forward head posture) was never addressed. The medication masked the symptoms while the underlying dysfunction accelerated and worsened.
Why This Happens: The Science Behind Medication Limitations
What Research Shows
A 2024 systematic review of 44 scientific studies examined long-term use of muscle relaxants for chronic pain. The findings were striking:
Effective for: Specific acute conditions (trigeminal neuralgia, acute painful cramps, short-term acute neck pain)
Not effective for: Chronic low back pain, fibromyalgia, chronic headaches, and most long-term musculoskeletal syndromes
The critical finding: “Long-term use of muscle relaxants may only be beneficial for certain syndromes; clinicians should consider deprescribing if pain-related goals are not met.”
Why NSAIDs (Anti-Inflammatories) Create the Same Problem
NSAIDs (ibuprofen, naproxen) suppress inflammation and pain, which seems logical. But here’s the paradox:
Inflammation is your tissue’s repair mechanism.
When you injure muscle tissue, inflammatory cells (macrophages) flood the area. These cells release healing factors (VEGF, FGF, IGF-1) that trigger muscle stem cells (satellite cells) to rebuild tissue.
NSAIDs suppress this entire cascade.
Research demonstrates that NSAID use reduces satellite cell recruitment by approximately 40%. Result: Incomplete healing. Weak scar tissue (fibrosis) forms instead of quality muscle tissue. One-third of hamstring injuries recur early because NSAIDs allowed premature return to activity during the compromised repair phase.
Why Central Nerve Medications (Gabapentin, Pregabalin) Miss the Real Problem
These medications suppress pain signals in the brain—useful for genuine nerve damage pain (diabetic neuropathy). But most chronic musculoskeletal pain isn’t a nerve problem. It’s a mechanical problem: weak muscles, poor movement patterns, postural dysfunction.
Research from 2025 analyzing decades of pain treatment outcomes found that medication benefits have declined while placebo responses increased. Translation: These drugs work well for specific neuropathic pain but show modest efficacy for mechanical or structural pain.
Giving a patient with weak stabilizers and poor posture a nerve pain medication is like treating a broken car engine with premium fuel. You’re addressing the wrong system.
The Universal Problem: All Symptomatic Drugs Share This Fatal Flaw
| What’s Suppressed | Root Cause Left Untreated | What Actually Happens |
|---|---|---|
| Pain signal (Pain Killers) | Underlying tissue dysfunction (weak muscles, poor movement patterns, biomechanical errors) | Patient continues stressing dysfunctional tissue. Deterioration accelerates silently. |
| Inflammation (NSAIDS, Steroids) | Tissue repair cascade | Incomplete healing occurs. Weak scar tissue forms, increasing re-injury risk. |
| Muscle tone (Muscle Relaxants) | Postural dysfunction, weak stabilizers, biomechanical instability | Poor posture or faulty movement persists. Deconditioning worsens and dependency increases. |
| Nerve pain signals ( Neuro Suppresants) | Peripheral dysfunction in mechanical pain cases | Pain persists because the mechanical problem remains. Medication tolerance develops. |
What Should Have Been Done Instead: The Integrated Approach
In the neck tension example, here’s what works:
8–12 weeks of integrated treatment resolves chronic neck tension without ongoing medication:
- Ergonomic correction – Adjust desk, monitor, chair positioning
- Postural retraining – Conscious correction of forward head posture
- Deep stabilizer strengthening – Exercises targeting longus colli, deep neck flexors
- Muscle lengthening – Release upper trapezius and levator scapulae through stretching and movement
- Movement retraining – Correct shoulder blade mechanics and cervical mobility
- Short-term medication (2–3 weeks only) – As a tool to enable rehabilitation, not as the solution
- Sleep and stress management – Address factors that increase muscle tension
Outcome: Problem solved. No ongoing medication. Patient maintains improvement through correct ergonomics and strength.
The Bottom Line: Decode the Problem, Don’t Just Suppress the Signal
The healthcare system has spent decades asking: “Which medication suppresses this symptom best?“
But the right question is: “What dysfunction generates this symptom, and how do I systematically correct it?“
When clinicians and patients ask the second question, medication becomes a tool to facilitate rehabilitation rather than a replacement for it. Pain becomes a signal to decode, not an enemy to suppress.
That shift—from symptom suppression to root cause correction—transforms outcomes from temporary relief to genuine recovery with lesser number of surgeries.
Your body isn’t trying to cause you pain. It’s trying to protect you from further damage. Listen to the signal. Address the cause. Recover for real.
References
https://pmc.ncbi.nlm.nih.gov/articles/PMC11119417/
https://journals.physiology.org/doi/full/10.1152/japplphysiol.00044.2013
https://pmc.ncbi.nlm.nih.gov/articles/PMC4871801/
https://www.ijoro.org/index.php/ijoro/article/download/3391/1907/18729
About the Author
Dr. Zainab Saifee is a Senior Physiotherapist and Holistic Rehabilitation Specialist with 15+ years of clinical experience. She is the Founder and Chief Physiotherapist of Fitness Plus Physiotherapy and Rehabilitation Centre and Zainab’s Wellness in Indore, India.
Dr. Zainab specializes in chronic musculoskeletal pain, spinal disc disorders, and postural syndromes through biomechanical correction and evidence-based rehabilitation. She holds certifications in Yoga Therapy, Clinical Nutrition, Dynamic Neuromuscular Stabilization (DNS), dry needling, and myofascial release. Her integrated approach has helped 5,000+ patients and prevented 100+ surgeries by addressing root causes rather than suppressing symptoms.
Medical Disclaimer
This article is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider before making changes to your pain management regimen, starting new exercises, or discontinuing medications.
