From Tokyo: there is a particular kind of exhaustion that comes not from the pain itself, but from the endless effort of convincing others that the pain is real. In Japan, where social harmony and stoicism are deeply ingrained cultural expectations, patients with chronic conditions frequently describe a double burden: managing their symptoms while simultaneously managing the scepticism of those around them, including their doctors.
It is a pattern familiar far beyond Japan's borders. A first-person account published in the Sydney Morning Herald captures it with quiet precision: a writer who began experiencing significant pain at the age of ten, yet spent years, well into adulthood, before the medical system took that pain seriously. The specific details of the condition are less important than the structural reality they reveal. Pain that resists easy categorisation is pain that too often gets dismissed.
Dr Simon Gordon, whose patients feature in the broader reporting around this piece, works with individuals who have experienced some of the most severe forms of that dismissal. Their stories carry a common thread with experiences far less dramatic in circumstance but no less real in consequence: a deep, sometimes desperate need for the physical reality of suffering to be acknowledged by another person, particularly one with medical authority.
What Australian observers often miss about how Japan and many East Asian societies handle chronic pain is that the underdiagnosis problem is not simply a product of outdated medicine. It is partly cultural. Expressing persistent pain, particularly among women, has historically been framed as weakness or hypochondria across many societies, and the Asia-Pacific region is not immune. In Australia, research from the Pain Australia organisation estimates that one in five Australians lives with chronic pain, yet access to specialist pain management services remains inconsistent, particularly outside major urban centres.
The fiscal argument for taking chronic pain seriously is actually quite strong, and it is one that tends to cut through where appeals to patient wellbeing alone have not. Untreated or undertreated chronic pain drives up emergency department presentations, reduces workforce participation, and inflates long-term healthcare costs. The Australian Institute of Health and Welfare has documented the economic burden of chronic conditions in considerable detail, and pain-related disability features prominently. Scepticism of big-spending government programmes need not extend to properly resourced pain clinics, which by most analyses represent sound preventive investment.
The counterargument, and it deserves honest engagement, is that medicine must also grapple with the limits of subjective reporting. Pain cannot yet be objectively measured the way blood pressure or bone density can. Clinicians working under enormous time pressure face genuine diagnostic complexity, and the risk of over-medicalising normal human discomfort is real. Critics of certain pain treatment models point to the opioid crisis as a cautionary example of what happens when patient-reported pain becomes the sole driver of prescribing decisions. These are not trivial concerns.
But the answer to that complexity cannot be reflexive disbelief. The writer who first felt pain at ten years old was not seeking opioids. She was seeking acknowledgement. The failure there was not one of caution; it was one of listening. As the Fair Work Commission and workplace health bodies increasingly recognise chronic pain as a legitimate disability requiring accommodation, the gap between legal recognition and clinical practice remains troubling.
Across the Pacific, communities facing the compounding pressures of under-resourced health systems and cultural stigma around illness find themselves in an even more constrained position. For Pacific Island nations with limited specialist medical infrastructure, the question of who gets believed and who gets treated is bound up with resource scarcity in ways that make the problem harder still.
Japan's approach to chronic pain offers a revealing contrast to Australia's. Multidisciplinary pain clinics have expanded significantly in major Japanese cities over the past decade, supported by Japan's Ministry of Health, Labour and Welfare through integrated care frameworks. The model is imperfect and access outside Tokyo and Osaka remains uneven, but the philosophical shift, from pain as a symptom to be suppressed to pain as a condition to be managed holistically, is meaningful.
The experience described in this account, childhood pain, adult disbelief, delayed diagnosis, is not a rare edge case. It is, in various forms, ordinary. That is precisely what makes it worth taking seriously. The complexity of diagnosing and treating chronic pain is real; the need to begin from a posture of belief rather than suspicion is also real. Both things can be true, and holding them together is where good medicine, and good policy, needs to land.