Notes on Writing Chronic Pain
WARNING! THIS IS A LONG POST!!
If reading about pain, physical limitations, or chronic illness might trigger difficult memories or feelings for you, please skip this post. I don't want to cause you harm. I know how it feels when those memories surface unexpectedly.
Or If you do read this and have your own insights to add, please share them in the comments. Other writers trying to portray this experience authentically would benefit from hearing your perspective.
Take care of yourself first. đ
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I made this post because I keep reading chronic pain and chronic illness written like a temporary inconvenience. Like itâs just a bad day. Or something a character âpushes throughâ once and then conveniently forgets about.
So, quick reminder before we start. Chronic illness is NOT a plot obstacle you overcome. Itâs NOT a lesson. Itâs NOT character development wrapped in pain and tied with a neat bow.
It does not end. It does not politely wait until the scene is over. And it does not care about pacing.
Chronic pain is a background condition. Itâs always running. Even when nothing is happening. Especially when nothing is happening. Characters donât âdeal with itâ and move on, they carry it. Every day. And this isnât about romanticizing suffering or turning pain into aesthetic whump content. This is about REALISM, RESPECT and about remembering that a body can be both strong and unreliable at the same time.
So before we get into the details, just keep this in mind: If your character can forget their illness when itâs inconvenient to the plot, then itâs NOT chronic. Itâs a prop.
Okay. Now we can start (sorry) âŚ
⸝ Mornings are not fresh starts. Mornings are negotiations with a body that hates them. And these aren't heroic negotiations, okay? These aren't "I will push through and conquer" moments. These are small, pathetic, exhausting little bargains that make them feel like they're losing before the day even starts.
"If I roll onto my left side really, really slowly, maybe my lower back won't seize up like a rusted engine."
"If I sit up in stages, maybe I won't get the head rush that makes the ceiling spin and my vision go sparkly."
"If I put my feet on the floor one at a time and wait thirty seconds between each one, maybe my knees won't feel like they're full of broken glass."
Getting out of bed is not automatic. Healthy people just... do it. They swing their legs out, stand up, walk away. It's nothing. For someone with chronic pain, it's a strategy game they've been playing for months or years, and they are so tired of playing it. They're tired before they even start. The game is rigged and they know it and they have to play anyway because what's the alternative? Stay in bed forever? (Some days that sounds great, actually. Some days they do.
⸝ They learn their body's limits the way people learn weather patterns, and not because it's interesting, not because they want to, but because repetition beats it into them. This movement is fine. That movement is a maybe. That movement over there? That's a fucking mistake and they will pay for it three hours from now, or tonight, or tomorrow morning.
BECAUSE pain has delayed consequences.
You can do something that feels totally fine in the moment, like pick up a bag of groceries, reach for something on a high shelf, sit in a slightly wrong position for twenty minutes, and your body will send you the bill later. Maybe that night. Maybe the next day. You don't always know what you did wrong. You just know you're being punished for something, and you have to play detective with your own body to figure out what the hell you did to piss it off this time.
So they get cautious. Weirdly cautious. Other people see someone who's slow, careful, hesitant. What they don't see is the constant mental calculus: "Is this worth it? Will this cost me later? Can I afford this movement right now or am I already overdrawn?"
⸝ Pain changes how your brain works. Not in a cute, quirky way. In an annoying, frustrating, isolating way.
They drift mid-conversation. They lose the thread of what someone's saying. Their eyes glaze over. And it's not because they don't care, they probably care a lot, they probably want to be present, but their brain is already working overtime just tracking their body's constant error log. It's like trying to have a conversation while someone's car alarm is going off right next to you. Except the car alarm is inside their body and it never stops.
Background noise becomes unbearable. The hum of the refrigerator. Someone chewing. A dog barking three houses away. Sounds they'd normally tune out feel like they're scraping directly on their nerves. Because their nervous system is already maxed out, already overstimulated, already running at 100% capacity just managing the pain. There's no buffer left for normal life stuff.
Small discomforts stack. The tag in their shirt. The waistband of their pants. The temperature of the room. The brightness of the light. Individually, these things are nothing. Together, when their pain is already at a 6 or 7 out of 10, they become everything. Everything feels loud and wrong and too much, and they can't explain why they're suddenly upset about the texture of their socks without sounding unhinged.
⸝ The lies they tell (Mostly to Themselves): "It's fine.", "I'm used to it.", "It's not that bad today.", "I've had worse." They say these things constantly. To friends, family, coworkers, doctors, themselves. And this isn't them being strong or tough or brave. This is SURVIVAL.
Because if they reacted honestly every single time something hurt, they would never do anything ever again. They'd be a sobbing mess on the floor 24/7. So they learn to lie. They learn to minimize. They learn to put on the "I'm fine" face and wear it like armor, even when they're absolutely not fine, even when everything hurts, even when they want to scream.
And People believe them. People take "I'm fine" at face value because it's easier than dealing with the reality. So the character keeps saying it. Keeps performing okay-ness. Keeps pretending. Until they almost forget what the truth feels like.
⸝ Flare-ups are not predictable. This is important. Writers love to make pain logical "they overdid it yesterday so today they're suffering" and sure, sometimes that's true. But mostly flare-ups come from nothing. Or from everything. Or from something so small and stupid it feels like a big cosmic joke.
The weather changed. Barometric pressure dropped. They slept slightly wrong, not even in a weird position, just... wrong. They were stressed. They weren't stressed enough. They did too much. They did too little. Their body decided, for no reason at all, that today is a Bad Pain Day. There's no pattern. No logic or fairness. And that's the horror of it. They can do everything right, like eat well, sleep well, pace themselves, take their meds, and still wake up in agony. Or they can do everything wrong and feel mysteriously okay. There's no control.
⸝ PAIN AFFECTS MEMORY. This is real and documented and nobody fucking talks about it enough.
They forget words mid-sentence. Forget what they walked into a room for. Forget plans they made yesterday. Forget entire conversations. Their brain is so busy processing pain signals that everything else gets fuzzy and distant and hard to hold onto.
Pain affects focus. They start tasks and abandon them halfway through. They read the same paragraph five times and retain nothing. They zone out during important meetings and have no idea what was said.
Pain affects mood. They're irritable. Snappish. Short-tempered. They snap at someone they love over something tiny and feel immediately, crushingly guilty. Or they withdraw completely, go quiet and distant, because explaining why they're upset (they're not upset, they're just in pain, but pain makes everything feel like being upset) is almost as exhausting as the pain itself.
⸝ IMPORTANT: Pain meds DON'T make pain vanish. Anyone who thinks they do has never taken them for chronic pain.
They blur it. Muffle it. Turn the sharp stabbing into a dull ache. Trade the ice-pick-in-the-spine for a whole-body heaviness. The pain is still there. It's just quieter, Like someone turned down the volume but didn't change the station. And there's a trade-off. ALWAYS.
They can think clearly and hurt more, or hurt less and think through fog. Neither option feels good. Both feel like loss. They have to choose between being present-but-suffering or comfortable-but-absent. Between doing their job well while gritting their teeth or doing it poorly while floating three feet outside their own body.
Some days they skip the meds because they need to be sharp for something important. And they suffer for it. Some days they take the meds and feel guilty about being sluggish, slow, not themselves. There's no winning. Just different ways of losing.
⸝ AND YES PLEASE. There are GOOD DAYS.
Days when the pain is a 3 instead of a 7. Days when they can move almost normally. Days when they almost feel like themselves again.
And good days are fragile. They treat them like spun glass. They're careful not to push too hard, not to overdo it, not to ruin it. They hoard good days. Savor them. Try to squeeze every possible moment of normal out of them before they end.
But good days are also haunted. Haunted by the knowledge that this is temporary. That the pain will come back. It always comes back. So they can't fully relax into the good day, can't fully enjoy it, because they're waiting for the other shoe to drop. Waiting for the pain to return. Bracing for it. And sometimes, the good day makes the next bad day worse. Because they overdid it (or their body thinks they did). Because they forgot to be careful. Because they got a taste of normal and their body punished them for it.
SOOOOOO...... Chronic pain doesn't pause your life. It doesn't press the big red STOP button on everything you are and want to be. It just makes everything harder. More complicated. More exhausting. But people still do things. They still have lives. They still want things, achieve things, love things, create things.
Let them fall in love. Let them get butterflies and stay up too late texting someone and feel that giddy, ridiculous hope, even though they're lying in bed at a careful angle with a heating pad pressed to their lower back. Let the excitement be real. Let the pain be real. Let both things exist in the same moment because that's how life actually works.
Let them be good at their job. Let them be the person everyone goes to for answers, the one who trains new people, the one who solved that problem nobody else could figure out. Let them have expertise and competence and pride in their work. Let them also need to sit down halfway through their shift. Let them work from home on bad days and still deliver excellent results. Let their pain not erase their capability.
Let them make art. Let them write or draw or play music or build things with their hands, even if their hands hurt. Let them have to stop frequently, shake out the stiffness, take breaks. Let the process take three times longer than it used to. Let them finish anyway. Let them create something beautiful while their body protests every minute of it. Let the art matter more than the pain.
Let them be a good friend. Let them show up for people. Let them remember birthdays and give thoughtful advice and send memes at 2 AM and be someone their friends genuinely treasure. Let them also cancel plans sometimes. Let them do both. Let their friendships survive the cancellations because they're worth keeping around. Let them be loved not despite the pain but as a whole person who includes it.
Let them have hobbies that aren't "gentle" or "pain-friendly." Let them hike, even if they have to go slow and take breaks and choose easier trails than they used to. Let them garden, even if they can only do twenty minutes at a time and need a special stool. Let them dance in their kitchen to a song they love, even if it's just swaying, even if they'll pay for it later. Let them decide it's worth it.
Let them be funny. Let them crack jokes about their own situation, dark humor, self-deprecating humor, whatever gets them through. Let them make their friends laugh until they cry. Let them be the funny one in the group, not the tragic one. Let their personality be bigger than their pain.
Let them travel. Let them plan trips carefully, build in rest days, choose accessible options, bring extra medication. Let them also stand at the edge of the Grand Canyon or on a beach in another country or in a museum they've wanted to visit for years. Let them have those moments. Let them ache the whole time and still think it was worth it.
Let them raise kids. Let them be parents who play on the floor (for ten minutes, then need to get up). Let them coach little league from the bench. Let them braid hair and help with homework and give piggyback rides on good days and watch from the sidelines on bad days. Let their kids love them fiercely. Let them be good parents who sometimes hurt too much to lift their toddler and find other ways to connect instead.
Let them get promoted. Let them achieve the thing they've been working toward. Let them earn recognition, respect, success. Let them also need accommodations. Let them work from home sometimes or take breaks or use mobility aids. Let these things coexist. Let their pain not disqualify them from ambition.
Let them be vain. Let them care about how they look. Let them dress up, do their makeup, style their hair, feel hot. Let them choose comfort sometimes and fashion other times. Let them navigate the trade-off and make different choices on different days. Let their pain not steal their relationship with their own appearance.
Let them be angry about something else. Let them rage about politics or injustice or a book ending they hated. Let their emotional life be about more than pain. Let them have opinions and passions and causes they care about. Let them protest, advocate, argue, fight for things that matter. Let their pain not consume their entire identity.
Let them forgive themselves. Let them have days where they accept their limitations without shame. Let them say "I can't do that today" without spiraling into self-hatred. Let them be gentle with themselves sometimes. Let it be a hard-won skill they're still learning. Let them get better at it slowly.
Let them grieve and let them live. Let both be true at the same time. Let them miss their old body and also appreciate what their current body can still do. Let them mourn what they've lost and celebrate what they've kept. Let them contain multitudes.
Let them be whole people. Complicated people. People who hurt and also people who laugh, achieve, love, create, connect, matter.
Let their pain be part of their story, not the whole story.
Let them succeed and hurt.
