Ten tips for writing believable pain

Occasionally, when I edit or read a book I come across a character who gets injured, and then for whatever reason that injury is basically forgotten within a paragraph. My mind always sort of has to catch up. How is that possible? How is it this sword-weilding orc can lose a leg and basically be fine two sentences later? (Wouldn’t that be nice if that’s how it really worked?) It just doesn’t compute with me. When pain isn’t dealt with in a realistic way, it tends to really throw me from the story.

I’m coming at this from a bit of a different direction, so let me tell you about my pain, and how it shapes everything I write. 

I have a rare genetic degenerative condition called Ehlers-Danlos Syndrome. Basically, this is a collagen disorder, meaning any part of my body that has collagen doesn’t work right. My skin is too stretchy and it cuts and bruises pretty easily. My joints stretch and dislocate. The connective tissue is too flimsy/stretchy, so they don’t hold together well. In any given week, I generally have countless subluxations (partial dislocations) and a handful of severe dislocations a month. (It’s worse when low pressure systems slide through, or cold weather. Don’t ask me why.)

It’s never not painful. Dislocations hurt, no matter how much I have them, and that bone-against-bone crunch I get with a subluxation is absolutely unforgettable.

EDS is degenerative, which means it gets worse, not better (there’s no cure). It also means I’m really prone to injury. I was nearly paralyzed for three years, for example, because I got a towel out of the closet. My lower spine basically caved in on itself, and four extensive, six-hour reconstructive spinal surgeries later, and about two years learning how to use a leg I will never feel again, I’m roughly mobile on my good days. However, the smashed nerve root is still smashed, and it will never heal, so to deal with my screaming agony there, I have eight electrodes imbedded inside my spinal column. When I turn them on, they send bursts of energy up my spine and into the pain center of my brain, which sort of fuzz up the pain signals my brain receives. It’s decreased the pain I process from my spine injury by about 70%. 

So, to summarize, I live my life in constant pain of varying degrees. It impacts just about every move I make, and every day I live in this world. My experience in my body is how I base how I write and understand pain, both emotional and physical.

As with all advice like this, take what you feel is useful and bag the rest. Your mileage may vary. Not everything will be applicable to every character in every book and that’s FINE. Remember, you know your characters best, so stay true to them and their world. I wrote this, basically, based a character who sustains a physical injury in some way, but I’m sure you can manipulate these points to fit just about any situation where a character experiences prolonged pain.  

Here are a few tips to help you make your character’s pain believable: 

1. Injuries don’t just go away. 

One of my authors actually creates a timeline of character injuries, so he knows when they happen and how long into the plot they need to last for them to be believable. If you, for example, cut your finger off, you’re not just going to shrug and get on with it. That’s a serious injury and it will take time to feel it, and then heal. Same goes for something as simple as a bruise. You won’t want someone to go up to your bruise and poke it. Your character might punch someone in the face who does that.

Injuries, no matter the severity of them, take time to heal (if they can heal), and somehow, that time needs to be accounted for in your book. Maybe not the focus of it, but a mention here or there, just to remind readers that your character is injured, and they are aware they hurt, will help the injury/pain your character is experiencing feel real. 

2. Pain will change your mood. 

When I’m hurting really bad, my entire neighborhood probably knows to stay away from me. Pain tends to change moods, and everyone is different. Some people get really quiet and withdrawn. Some people get angry. I seem to become an absolutely intoxicating blend of both of those. Some people try to power through it by being overly happy. Some get depressed. Regardless, if your character hurts, they will have an altered mood, at least during the most intense part of their pain. Depending on who you are writing, they’ll react differently. I don’t know many people who get hurt, and then keep on going with their mood completely unaffected. Even if they act unaffected, inside, they’re probably screaming, and think of the energy it takes to hide that scream.

The thing to remember is, pain is going to take up part of your headspace. If you had your whole mind focused on defeating the emperor, and then you take an arrow to the shoulder, now 40% of your thoughts are going to be on defeating the emperor, and 60% are going to be focused on the pain you are feeling (Or something. You get the point.). Pain takes up space. It just does. Don’t think of it as something you feel. Think of pain as an uninvited guest, and now you have to make room for it because, depending on the injury and the timeline to healing (if there is a “healing”), that guest isn’t going anywhere. You have to feed your guest. Pain feeds on energy, and energy impacts mood. So keep that in mind when you write your injured character.

3. Pain changes how you think. 

If someone is in a lot of pain, their thoughts will likely be dominated by it. Every motion, twinge, move, gasp will first go toward that pain (remember, you have to feed your guest), and after that it will move on to whatever else you’re thinking about. I call it “pain fog” and it’s a very real thing. I’m currently dealing with some extremely severe hip issues, and as an added bonus, the big toe on my left foot has randomly decided to stay in a permanently subluxated position, and it does impact all of my thoughts. Every time I move, that motion is first dominated by my pain, and then, after I feel that initial stab, I can kind of burrow deeper to whatever it is I’m supposed to be concentrating on. It’s hard, and it’s exhausting, and a lot of times this pain-dominated brain space causes forgetfulness and flaky tendencies. I forget what I’m supposed to be doing. I forget what I’m supposed to be saying. I start talking and trail off halfway through a sentence because the pain is just blocking out everything else. I get exhausted so much faster.

Again, this doesn’t need to be a huge thread in your injured character’s storyline, but a moment here or there of something like this showing up would go a long way toward making your reader not only understand your character is experiencing pain, but believe it as well.

4. Pain takes up a lot of energy. 

I feel like I’m really hammering this point home, but it’s a big one.

This is a lot of the reason for what happens in point three. Pain takes up so much energy. Think of it like this: You get injured. Let’s say you dislocate your hip. That dislocated hip suddenly erects this brick wall in your brain. Every time you need to do, think, or say anything, you have to punch through that pain wall to get to the other side where all your regular stuff lurks. And that takes energy and effort. You can’t just punch through a brick wall in real life any more than you can punch through the pain wall. Everything you do and think will be divided. Part of your energy goes toward pain, and part of it toward everything else. The spoon theory is how some people think of it, and I think that’s a good description. For me, it feels a lot more like I’m punching through a wall, and it’s exhausting. 

Furthermore, there’s a HUGE cost when you hurt, and you try to act like you aren’t hurting. Chronic pain sufferers have amazing poker faces. My doctors can’t tell if I’m hurting or not, and I have an absolutely awful time trying to pinpoint my pain on a scale of 1-10 because I hurt all the time, so I have no idea how to quantify that. Usually, if I’m screaming, my pain level is so far off the 1-10 chart, it’s practically in a different solar system. A lot of people want to hide how much they hurt, and so they will spend a whole lot of energy hiding their pain behind a poker face of normality and the energy cost for that is just… unreal.

That exhaustion will lead your character to the other things I’ve mentioned so far: the mood changes, the distraction, the low energy in general, and basically everything else I’ll talk about here. 

Remember, pain is an uninvited guest. It’s not going anywhere, and it needs to eat. The food it likes is your energy, your mood, your comfort. Every bit of what you lose, is what pain gains. 

5. There are different kinds of pain. 

When you go to a doctor, they’ll often ask if you’re experiencing pain, and what kind of pain you’re feeling. There’s a reason for that. There are different kinds of pain. Right now, my hip is sort of burning and throbbing. My toe is feeling sharp. When I was in the hospital after my spine injury I literally felt like someone was stabbing me in my spine and twisting the knife. 

Pain isn’t a one size fits all thing. I tend to be a lot less pleasant when I’m experiencing the burning/throbbing pain, for example. That kind seems to last longer, and it’s like having a migraine lodged in whatever part of me is hurting. The stabbing pain gets me to swear a lot more, but I’m past it quicker. It’s that low throb that really sends me into mental orbit. It depresses me. It makes me angry. It makes me feel trapped in my own skin. I hate it.

It’s also not a one size fits all thing. People will react to these kinds of pain differently, and that’s fine. Take your character’s personality into account when you write their pain. How do YOU think they’d react to a burning but constant pain? And how do YOU think they’d react to a sharp, stabbing pain? Would they get over it fast? Would a stabbing pain make them in a worse mood than a burning pain? And how would this impact their relationship to the people around them while they are in the heat of it?

So, keep that in mind. If your character gets injured, likely the pain they will feel from that injury will vary, depending on what has happened. An arrow wound is not going to feel the same as a broken leg, and each will impact your character differently.

6. Pain changes what you can do. 

This might seem obvious, but I run into this problem quite a bit in the books I edit. Let’s say your character cuts off a finger. He wouldn’t then be able to Indiana Jones his way through a jungle after, leaping from one tree to another without issue. He wouldn’t pick up a sword with that hand and start swinging. Chances are, he wouldn’t want to use that hand at all, not for a little while, at least. He’d be concerned about infection. He’d need to clean it and wrap it. He could power through some things, but likely the pain would be so intense he could probably see his vision wavering along with his heartbeat. There’d be a lot of blood, and likely a touch of shock as well. His entire hand would hurt, and the last thing he’d want to do is use it. 

My leg, hips, and spine absolutely impact how much/if I can walk, for example. When I am in extreme pain, I can’t even get out of bed. So consider how injury and pain would work together to impact what your character is capable of.

This is where the timeline comes in handy. If you know your character gets a finger cut off, then you can write down how long you think that severe, shocking part of his injury would last, and you can write it accordingly. You can also plan what kind of character he is. Does he try to power through it? And if so, how does this impact his mood, judgment, and actions, because it WILL impact those things. If you think he’d start healing after 2-3 weeks, then you know about how long that presents itself in your book. You can write his plot line in that section, accordingly, altering his actions to account for his injury at any given time in that span. And keep your mind on how living with one less finger on that hand will impact him from that point forward. Maybe it won’t matter much, but there are moments it will matter. Think of Logen Ninefingers in Joe Abercrombie’s series. The loss of one finger doesn’t physically impact him overly much, but it’s accounted for in his name.

Another thing to consider is treatment. Often times, the treatment of an injury can be just as altering as the pain and injury itself. If your character gets put on opioids, for example, think of how opioids make people feel. Some people get a bit loopy, a bit high, a lot of people get nauseous from them, there’s a risk of addiction and moods tend to change as well. Driving a car and etc. will be ill advised. If there’s a magic system in your world that heals injuries, consider the cost of said magic.

Basically, consider how the treatment could change things as well.

7. Be aware of risks. 

People have died due to a cut on their foot. Back in the day, if you injured yourself on the farm, you had a very good chance of losing a limb, or dying, no matter how small the wound. So, the injury might be straightforward, but often times, especially in books that are set in secondary worlds that aren’t so advanced with medicine and technology, it’s not really the injury that’s the real risk, but everything that comes after, from infection, to long-haul symptoms, to learning how to live with this new body of yours. 

8. Be aware of what happens after.

Be aware of longer ranging issues that might be impacted from this injury. My husband broke his knee a few years ago, and ever since then, he feels cold weather in that knee really, really acutely and sometimes it impacts how much he can do. If it’s a physical wound, your character might be a bit shy about being touched there for a while even after it goes away. It’s human nature to protect our vulnerable parts. If your character flinches at the wrong moment, say, during a sword fight, that could change the tide of the engagement. If your character was sick, think of the people with long-haul COVID symptoms and how it’s impacted them. Long range symptoms aren’t beyond the realm of believability, and a lot of times they’ll add a rich layer of realism in your character’s arc if they are subtly woven in their narrative.

Basically, if your character is recovering from an illness, they aren’t going to go run a marathon a day after their fever breaks. If your character takes an injury that lays them up a while, their endurance will be lower when they start resuming normal activity after. People don’t just bounce back. It takes time to get to where we used to be, IF we can get there. Remember that, as well. Often times, people can heal, but they won’t be the same after the injury as they were before it.

More than that, be aware of emotional impacts of injuries and pain in general. It’s exhausting, it’s depressing. It really grinds a person down. If your character is coping with disability, maybe talk to some people who are coping with disability and see how it feels because there’s a whole lot of messy emotions that get tied up in that journey. If your character can just heal and move on, great, but deep pain leaves deep emotional scars and touching on those at one or two points in your character’s journey wouldn’t be amiss.

9. Susceptibility 

If you hurt yourself, especially if it’s an injury in a joint or something similar, you’ll be more susceptible to injuries there after that, and they’ll come easier and faster and harder. (I just got this lecture from my doctor about my high ankle sprain.) If you’ve had an illness that’s impacted your lungs, you might have a hard time taking a deep breath. Maybe you get sick easier.

Don’t forget to include that in your protagonist’s story. I often feel like this particular point is a missed opportunity for a lot of authors. You can use it to increase tension, and vulnerability often makes things more interesting at important points in the story. 

10. It doesn’t need to dominate your character’s storyline for it to be present. 

Seraphina, in Seraphina’s Lament was, in a lot of ways, me dealing with my disability and coming to terms with life in a disabled body. I wanted her to represent my story, so I gave her my spine and leg injury. I gave her my chronic pain and mobility issues. It was my first time trying to write my pain experience in a way people could understand and hopefully connect with, and it was extremely cathartic. 

However, while Seraphina’s pain is always present, it is not the focus of her story. There are a lot of other things going on.

It was interesting to write her because I had to spend a lot of time asking myself, “If I was in this situation, how would I cope with it?” and then writing based on my answer. So, a lot of small things that people don’t tend to think of had to be present in her narrative. How would Seraphina deal with stairs? How would she cope with walking a substantial distance? How would she deal with tense situations when she’s already mentally fogged up from pain? 

It wasn’t her whole story, though. It was just part of her story. It was an added flavor that made her experience in the world stand out. Seraphina lives her life looking through the lens of pain, but it doesn’t define her. It isn’t who she is though it does impact nearly all of her actions, and her thoughts do filter through the pain wall I mention above. It’s present. It’s always there. It’s her uninvited guest that must be accounted for at all times but she is more than her pain. It isn’t her whole story, and it doesn’t need to be her whole story to be an important part of it.

I’ll give you a bit of advice for writing pain that I give when writing asked about writing disabilities: write the character first, and then weave the pain/disability in after. Focus on the CHARACTER, not the pain/disability. Being disabled is only part of who I am. Being in pain is just a fraction of my lived experience. Your character might feel any/all/some of these ten points after their injury. That doesn’t mean it needs to subsume them. They don’t need to become the pain they feel. I advise subtle uses of moments sprinkled here and there throughout their narrative. Show them compensating for an injury during a fight. Show them rubbing their wounded leg in the firelight at night. Show them snapping at someone they care about when they otherwise wouldn’t. Show them forgetting something, or feeling depressed.

Pain doesn’t have to be big to be present.

Honorable mention: 

Remember, especially in secondary worlds, you don’t have to have things in them that are problematic. For example, castles do not have to have stairs. Wheelchairs can exist if you want them to. 

And finally, mercy killing should never be a thing. (“Oh, Bob wouldn’t want to live like this so let’s put him out of his misery.”) Think of what that’s telling to every reader who relates to Bob. Just don’t do it.

So, that’s about all I’ve got for you today. Again, take what you want and forget the rest. Go forth, dear writer, and make your characters hurt.

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