The Nights Pain Won’t Let Go
A couple of years ago, I got into a bike accident.
On a family bike ride, my front tire got stuck in train tracks and I slow-motion toppled off the bike, landing directly on my left arm. My poor forearm and shoulder met the concrete hard, and I went straight to urgent care in as much pain as I’d ever been in.
It turned out to be a very small hairline fracture of my radius. A nothing burger. I was sent home with a sling and some Advil. One of the nurses said, “It seems like when we put ladies your age in a cast, other stuff goes wrong.”
Clearly, she cast the evil eye on me.
Within six months, my radius had healed but I could no longer lift my left arm. My shoulder became so painful that I started wearing my hair curly because I couldn’t hold a hair dryer. Reaching for a coffee cup felt like someone driving an ice pick into my shoulder.
This went on for weeks. And then months. And then it hit a year. And kept going.
Eventually, I couldn’t even sleep on my left side. If I rolled onto it in the night, I would wake up gasping in pain.
Those middle-of-the-night wake-ups were the worst. I would lie there and spiral: How much longer can this go on? Is it possible to die from your shoulder hurting? What if this never gets better? What if I’m just broken forever?
Flat on my back, tears would leak out of the sides of my eyes, soaking the pillow on both sides of my head.
And the irony is if I had just woken my supportive husband, he would have gladly helped. He would’ve gotten the Advil, an ice pack, adjusted the sea of pillows I now needed to sleep, and just held my hand while I cried. But it never even occurred to me. In those moments, I felt completely alone in the pain.
What is pain?
Here’s what I didn’t understand at the time: pain isn’t just one thing. The body actually experiences different kinds of pain, depending on where it comes from:
Nociceptive pain: This is the kind most of us think of—pain from actual injury or damage, like a cut, a bruise, or inflammation. It often feels aching or throbbing.
Neuropathic pain: This is nerve-related pain. It comes from the nervous system itself and can feel like burning, tingling, or electric shocks.
Nociplastic pain: This one’s a bit weirder. It’s pain that sticks around even when there’s no clear injury or nerve damage—more about how the brain and body are processing signals than what’s happening in the tissue.
Mixed pain: And sometimes it’s not just one thing. Pain can be a combination of injury and nerve-related pain, which makes it harder to pin down.
If you want to learn more, here’s a good place to start.
But here’s the part that really kicked my ass: pain is in your brain.
For any of these types of pain to be felt, signals from the body have to reach the brain. Pain is the brain’s way of interpreting those signals and deciding how much danger we’re in. If the brain thinks something is wrong, it turns the volume up. If not, it quiets things down.
If you’re reading this and thinking, “Wait, are you saying my pain is all in my head?” Yes, and also no. All pain is produced by the brain. That doesn’t mean it’s made up. It means your brain is doing its job, interpreting signals and trying to protect you.
This system works well for acute pain, the kind that comes from an injury and resolves as the body heals. But it doesn’t work as well with chronic pain, which is any pain that lasts longer than 3 to 6 months. Over time, the system gets sensitized. The signals keep firing even when the original injury has healed. And that is exhausting. And painful.
Hungry, Angry, Lonely? Double the Pain
Pain isn’t just physical. It’s shaped by three things happening at once: biology, psychology, and social context.
Biology: This is the part we usually think about—the injury itself. But pain is also affected by sleep, stress, illness, and even hunger. When our system is run down, pain hits harder.
Psychological: Our mood matters. A stubbed toe doesn’t feel the same on a good day as it does after a fight with your partner, the cat peeing in the laundry basket, and a kid who just talked back. Stress, anxiety, and worry all amplify pain.
Social: We handle pain better when we feel supported. Being believed, cared for, and not alone increases our pain tolerance. Isolation does the opposite.
With that context, it makes sense why my pain felt so unbearable in the middle of the night: I wasn’t sleeping (biological: check); I was spiraling into “this will never end” and “I’m broken” (psychological: check).; and I was completely alone in those moments (social: check).
Turning the Volume Down
One of the most effective ways to manage chronic pain is to calm the nervous system. A calmer system helps the brain turn the volume down. Things like movement, connection, breathing, distraction, and routine can all help regulate the system and reduce the intensity of pain.
As a therapist, I work with many clients living with chronic pain, from fibromyalgia to migraines. When pain flares, sessions often go virtual: sometimes a client is lying in bed, sometimes we just talk by phone. Many clients are in the same place I was: alone, overwhelmed, and in pain. Our work in those moments is to notice what’s turning the volume up, and see if we can gently turn it down—calling a friend, snuggling a pet, watching a movie, taking a short walk.
I also invite clients to consider who they want to be while pain is present. Even small actions rooted in kindness, care, or compassion can create a sense of alignment with our values—even in the middle of something really hard.
A Different Relationship to Pain
In my case, the diagnosis was frozen shoulder. And just for fun, after my left shoulder healed, my right one froze too. I could do a whole separate blog post about frozen shoulder and perimenopause, but I’ll restrain myself from going off. Between the two shoulders, I spent over 2.5 years with limited mobility, disrupted sleep, and ongoing pain.
The writer Haruki Murakami says, “Pain is inevitable. Suffering is optional.” Honestly, when I was in the thick of my shoulder pain, that did not feel true. At all.
But on the other side of it, I understand what he’s pointing to. Pain is part of being in a human body. It will come and go, especially as we age. But suffering—how alone we feel in it, how much we fight it, how much we believe it means something is wrong with us—that part is more flexible than it seems.
Looking back, what made those nights so unbearable wasn’t just the pain in my shoulder. It was the isolation. The fear. The belief that it would never end.
These days, I think less about how to avoid pain and more about how I want to meet it. Can I let it be there without immediately bracing against it? Can I notice when my mind starts telling me I’m broken? Can I reach for support or self-advocacy instead of going silent?
Because pain might be inevitable. But we have more choice in how we meet it than we think.
