By Therden van Heerden
She came into my practice, shy and withdrawn, even apologetically. Her husband was loud and talkative, answering her questions before she could get a word out. Soft spoken and anxious, it took a while for her to find her own voice.
“I hurt all over, doc. I can barely walk, so I lie down and sleep. When I wake up, the pain is still there. I know I am overweight, but I am so overwhelmed and discouraged by all of this that I have given up.”
The rest of her history was straight forward: Hypertension, Diabetes type 2, and a lifelong struggle with weight gain. The whole family were “big people”, as she puts it with a wry little smile. Examining her revealed the extent of damage to her joints: poor flexibility, stiffness and general deconditioning which made her move slowly and with effort. She was still young at 41 years of age, but the combination of persistent pain and morbid obesity made her seem older.
Chronic pain is a common affliction, with a general prevalence estimated at 26%, and in people above age 45, as high as 46.7%. Most people with persistent pain will cross our paths after spending months or years suffering from pain, and having tried a plethora of medications, remedies, and therapies. Sometimes we stumble upon a person who has barely had any treatments at all, but they are the exception.
Persistent pain is the neglected relative of modern medicine: no specialty wants to take responsibility for it. Try referring a person with persistent pain to a specialist, and the analogy quickly becomes clear. Yet here we are, volunteering to specifically care for people with persistent pain.
So: what became of the woman in this story?
Imaging confirmed extensive disc degeneration in her spine, combined with facet joint osteo-arthritis. Her large joints revealed significant cartilage loss of hips and knees, with her knees being the worst affected. No wonder she found it hard to walk! It would be even harder to find an Orthopaedic surgeon willing to risk a knee replacement in someone with such a high BMI.
I listened patiently and allowed her to elaborate on her pain experience – to tell her story. We concluded the consultation by identifying small, attainable next steps and an agreement to reconvene in 4 weeks. For the first time I saw something else in her eyes that had been completely absent an hour ago – the warmth of hope was softening the lines on her face.
Hope is an active, goal-focused mindset: constructing a path to your goals and finding the inner motivation to persevere through challenges. It is not a passive and vague optimism that simply hopes for the best. C.R. Snyder described it in detail in his book The Psychology of Hope: You can get there from here.
Will the journey to better health and less pain be hard? Most definitely! Will it be worth it? For her, yes – she now has hope.
References:
1. Jeremy Sutton, Positive Psychology, 15 October 2025
Hope Theory: How Pathways thinking can help your clients
2.Ashok Kumar et al, Indian J Med Res, March 2026
Prevalence of Chronic pain in the general population: A systematic review and meta-analysis