Pain writing guide

Different forms of pain

Pain is generally classified as one of three types: nociceptive pain, neuropathic pain and psychogenic pain. Nociceptive pain is caused by tissue damage, neuropathic pain is caused by nerve damage and psychogenic pain is either caused or influenced by psychological factors. Each of these can also be chronic (long lasting) or acute (sudden and temporary).
Now you don't need to remember all these terms and the different types, but it is important to think about pain as more than just a feeling of discomfort. There are many different kinds of pain and each is expressed differently.

A headache feels different from a stomachache, a needle piercing your skin feels different from being punched and so on. Each pain is usually associated with a specific kind of feeling as well. A headache is often described as a throbbing pain for example. While you may not know from personal experience what each kind of pain feels like, especially the more severe ones, plenty of people do and these experiences can often be found online. Reading up on injuries is always a good idea whenever writing about them. Not just to express how your character feels, but also how these injuries heal and affect life throughout the healing process. Some movements might rupture stitches for example and some injuries might cause you to walk with a limp.

Severity of pain

Everybody experiences pain differently. Some might fall over in pain after being punched in the stomach while others might just grimace and shrug it off. How your character deals with pain is an important aspect to consider and it's important to keep it consistent throughout the story. Of course we don't always handle pain the same way every day, there's plenty of factors that could make us unable to cope, like a lack of sleep, but as long as you don't divert too much it'll be realistic.

Doctors often use a scale from 0 to 10 whenever trying to assess what a patient is dealing with in terms of severity of pain. The scale is as follows:
0-1: No pain whatsoever.
1-3: Mild pain, but pain that's usually easy to ignore.
3-5: Moderate pain. This is pain that might interfere with tasks and activities, even activities like simply walking or sitting straight.
5-7: Moderate pain. This is pain that'll affect your concentration as well, pain that can't be ignored.
7-9: Severe pain. This is pain that'll interfere with even the most basic needs, like eating, sleeping and other simple tasks.
9-10: Worst possible pain. Think torture.

This scale says nothing about the type of injury. Some feel nothing whenever a needle pierces their skin, others might express it more as a 1, 2 or even 3 on this scale. It's all about how somebody feels, not about what causes the feeling. This is an important thing to distinguish as it's what your characters feel that matters, since it's usually also how you make your readers feel for your characters.

Also keep in mind that people with high pain tolerances aren't necessarily strong or bulky either. In fact a huge, muscular person could still have a very low pain tolerance as muscles have very little to do with pain tolerance. But it's all about keeping whatever tolerance level a character may have consistent.
At the same time giving them a tolerance that's more toward either extreme (too high or low) can become dull or seem unrealistic if it's not handled well.

Dealing with pain

Not only do we experience pain differently, we also deal with it differently. Some will take things slow and make sure everything heals properly, some may ignore the pain and pretend it's not even there, others might use the pain and draw strength from it. The way a character deals with pain is part of their personality and thus an important part to consider, just as important as things like who they love, what they enjoy and so on.

But we also express our aching to others in different ways. For example, we may pretend we're fine so we don't bother others or don't appear to be weak or we may pretend we're hurting more than we are so others will take pity. This is just one more element to keep in mind when incorporating pain in the lives of your characters. There's more to writing pain than just the feeling, especially when dealing with chronic pains.

On top of that we also deal with pain of others in different ways. Some may take pity, some may feel helpless and some might just feel annoyed by the constant complaining of others. This is especially important when writing a story from a point of view of a character as this will determine whether this character even notices the pain of others and thus whether the reader knows about it or not. Needless to say this can bring a whole lot of tension, surprise and other elements to a story, especially when done well.

Experience is key

Writing about anything is always easier when you have experiences to draw from, but as mentioned our experiences of pain usually aren't remembered well. You've probably heard about how women who have given birth never remember how painful it really was afterwards, the same is true for most types of pain. So drawing on experiences purely from memory isn't always the best way of doing it, but there's a way to make sure they're more usable.

Write down what you feel whenever you're in pain and look for experiences of others who have done the same. There are plenty of experiences available online for all sorts of injuries. Being shot, being stabbed, breaking bones, you name it it's probably there. In other words: do your research. It's always worth it when going for realism, plus you may gain some inspiration along the way.

Having said that some injuries and ailments are not documented and others are just so uncommon the average person wouldn't be able to relate to them anyway. But that doesn't mean these types of pain can't be described in a way people can relate to them. This is where those previously mentioned terms come into play. Terms like 'throbbing pain', 'searing pain' and so on. Most people will know what these pains feel like and if they're used to describe an injury people can generally imagine what that injury might feel like even if they'll never experience that injury in their life. But more on this later.

Now I've seen people tell others to hurt themselves (nothing serious, I hope) to gain experience and use those experiences to write about pain. Don't be an idiot and actually hurt yourself for 'experience'. I shouldn't even need to point this out, but you never know.

Actually writing it

So we've covered the different types of pain and how we deal with it, but how do you actually translate it into good descriptions in a story? Well, first and foremost you should keep it free of pointless details and anything else that adds nothing to the story. This is pretty much the first rule for anything you write and it holds true for writing pain as well.
Some prefer (or are just used to) writing in analogies or more specifically in metaphors, which isn't necessarily a bad thing, but it usually doesn't convey the pain to the reader as well as just keeping it simple and using terms people can identify themselves with.

To illustrate this, here's an example:
- He crumbled to the floor and tried to breathe, but it was as if two fists clamped tightly onto his lungs. He was sweating profusely, as if he had just run a marathon, and he felt as if the world was spinning at a million miles per hour. For a moment the world looked blurry, as if seen from underwater, but it was only a moment later it all turned black.
- He doubled over in pain and gasped for air. Sweat dripped down his forehead and his head felt light and dizzy. His vision blurred and before he knew it everything turned black.

The second example is far easier to relate to and thus it's far easier to imagine what the character is going through. Nobody knows what it's like to have fists clamp onto your lungs as it's pretty much impossible, but most people either know what it's like to gasp for air or now how to fake it.
The differences between the examples 'sweat dripped down his forehead' and 'he was sweating profusely, as if he had just run a marathon' and the examples 'his head felt light and dizzy' and 'he felt as the world was spinning at a million miles per hour' are a little more subtle as the metaphors are a easier to imagine, but the examples with the metaphor add unnecessary details that detract from the pain the character is feeling. Instead of being focused on the pain the focus now shifts to the metaphors for a moment before shifting back to the pain.

Metaphors aren't all bad, but they tend to work best if you use terms that are used to describe pain in the first place. A burning sensation is a common type of pain, so "it felt like her lungs were on fire' isn't a terrible metaphor even though a burning sensation and having lungs that are actually on fire are nowhere near the same amounts of pain. But this doesn't always work. A sharp pain could be described as 'it felt as if a knife was stabbed deep into his chest', but since most people don't know what it feels like to be stabbed it works better to simply use 'a sharp pain' instead.
As a final examples, compare each pair:
- She had done it. She had finally reached the finish line. Exhausted she dropped herself on a soft patch of grass and lied on her back trying to regain her breath. Her heart still raced on, her lungs burned and longed for more air, the muscles of her legs felt weak and limb and she was unsure whether she'd ever be able to get up again. But she had done it. She had finished the race.
- She had done it. She had finally reached the finish line. Exhausted and completely out of breath she dropped onto a soft patch of grass. Her lungs felt like they were burning with hellish fire, her heart was beating so fast it felt as if it could burst out of her chest at any time and her legs felt more like noodles than legs. But she had done it, she had finished the race.
- A sharp pain suddenly struck his chest. He grunted, determined to complete his task he ignored the pain and carried on.
- Suddenly it felt as if a knife was stabbed deep into his chest. He grunted, determined to complete his task he ignored the pain and carried on.

Example 1 and 3 are easier to relate to and imagine, but some might still prefer the way 2 and 4 are written and that's fine too. Most people seem to prefer the versions they can relate to over the unnecessarily complex, so do with that information as you please. At the end of the day you'll have to consider who you write for. Other people or for your own entertainment?