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Pain is Like an Onion

 “It’s all very well telling me to ‘walk through the pain,’ to stay positive, but there are layers and layers of pain.”

hareinthemoon, The Chronic Pain Files


Pain does have layers. In fact, it’s just like an onion. While those of us who cope with chronic pain are told to “just walk”—or work—through it, it’s a lot easier said than done.

Maybe that’s because the people who say this in such a blithe and sincere way only understand—and can empathize or sympathize with—the kinds of pain one experiences during exercise, or perhaps some types of acute pain, like stubbing a toe or skinning a knee. I can, myself, easily understand that exhortation in those contexts. Who hasn’t “walked through” or “worked through” stiff, painful muscles? It can hurt like a you-know-what until the offended muscles warm and loosen up, or until that magical “runner’s high” kicks in. And a stubbed toe? Hurts like the blazes—until it suddenly doesn’t.

But I sort of doubt they’d be so thoughtless as to tell you to walk through the pain of a badly sprained ankle or a broken leg. Nor would they expect you to “work through” the deep, gut-twisting pain of appendicitis or the urgent, lancing throb of an abscessed tooth. That kind of pain is different.

Pain’s First Layer

This, like the thin, papery skin of an onion, is the one I live with every single day. I don’t even think of it as pain, per se; I’ve had it for so long, it’s part of my being. My hands are always tender. I utter my first “ow” under my breath when I push the blankets off when I get up in the morning. I whisper it again when I fill the coffee pot, and again when I dry off after a shower.

This first layer of pain is the easiest for me to “work through,” since it barely breaks into my conscious thought. When it does, it usually surprises me. “Well, ow!” I think, and I remember, suddenly, when wringing out a washcloth didn’t hurt. Oh, well. Nothing for it.  Carry on.

The Second Layer

This one is thicker. (An aside, here: I never know which layer I’m going to get, or when. RD is capricious and more than a little cruel). This layer is harder to ignore, though it depends on what I’m doing, and I can almost always “work through it.” The “ow’s” go from whispers to soft yelps. This pain affects my mood—I might get a little quiet, or even grumpy—unless I’m involved in something that can help keep my mind off it. This second layer of the pain onion always comes with a sneaky little mist of fear, too: will it get worse?

These first two layers usually respond, at least temporarily, to gentle alternative pain therapies, like ice or heat packs, paraffin baths, or over-the-counter pain relievers and salves. Meditation sometimes helps. Distraction does, too.

Layer Three

Once I hit the third layer of the pain onion, though, things are getting more serious. Now, using my hands for almost anything takes grim determination. All movement hurts; pressure hurts bad. The therapies I mentioned above are soothing, but that’s about all (and soothing is something, at least, when you don’t have any other options). The fear juice is dripping from the pain onion now. It’s making my eyes tear up. It’s hard not to worry about whether it will get worse.

This is when I go for serious distraction: an absorbing book, a good movie, etc. Because my work requires typing, this layer of pain can put a wrench in the works, though often I do “work through it,” as those nice, clueless people suggest. OTC pain relievers aren’t much use, here. Gritted-teeth-type courage is.

The Inner Layers

When it gets to the fourth, fifth, and even deeper inner layers, nothing but prescription opioid pain relievers really help. But because of the so-called “opioid epidemic,” many doctors are afraid to prescribe them these days, leaving chronic pain patients to suffer terribly.

I’m fortunate to have a pain specialist who does prescribe low-dose opioids for me. When these deeper layers of pain hit, I take them. No apologies. They don’t make me high. They simply drop the pain back a layer or two, and usually, I can get on with my work and my day. I’m grateful to have access to these miracle drugs. Fingers crossed (ow!) they’ll keep working.

I’ve lived with my RD pain without the benefit of narcotic pain killers in the past. It was excruciating. Just as living with the pain of a crushed hand or a broken leg would be, there’s no “working through it.” It’s all-encompassing. It’s disabling. For as long as it lasts—two hours or two weeks or two months—it becomes the only thing in my life.

Ignorance is Bliss

People who don’t live with RD and other forms of chronic pain are ignorant of its layers. They have no idea how much pain each of us “works through” all the time. They don’t know that we may live with it every single day of our lives, and no clue as to the kind of courage this takes, or why we sometimes get a little cranky when they suggest that we just treat our pain with some exercise or meditation or, maybe, some aspirin.

Pain really does have layers, just like an onion. And its vaporous juice is fear—not of the unknown, but of the deeper layers of pain we know. This takes a special kind of strength and courage. People who don’t have chronic pain can never really understand.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • MMuehlberg
    1 year ago

    That’s it exactly. The pain some days is just horrible. Unfeeling clueless people just make it worse.

  • barbara1776
    2 years ago

    Beautifully descriptive with what we all deal with every day

  • KarenG.
    2 years ago

    This article is so spot on…. Comparing RA/RD to an onion is the best description yet! Thanks for sharing….

  • Wren moderator author
    2 years ago

    Hi, KarenG!
    I’m glad you liked the onion analogy. The concept of layered pain certainly got my attention when I first read about it. I’m always looking for good ways to explain to friends, family, and others who ask how this disease affects those of us who have it, so I was glad to pass it along to my friends here.
    Thanks for stopping by and taking a moment to comment! 🙂

  • Kersey
    2 years ago

    I absolutely love this article. It describes the pain perfectly. From the first ow’s in the a.m., throughout the day and coping until the only relief is to turn to outside help which is prescription pain killers. Kill rhe pain it does NOT. IT takes it back a couple of layers. I am so very thankful for pain management. No pain means “functionality” and getting through the day. Ì miss the old me without pain. With the help of pain meds, the old me can show herself in a new way a little bit.

  • Wren moderator author
    2 years ago

    Hi, Kersey,
    I’m so glad that the article resonated with you! I do understand, well, how you miss the “old me,” the Kersey without pain. But I’m glad that careful pain management and prescription meds helps you get her back, if only for a little while at a time. One day, they’ll find a cure for RD–and then we can all celebrate!
    Hoping this finds you feeling well today and wishing you good tomorrows. 🙂

  • MaryB
    2 years ago

    This is a beautiful article, and very helpful. I just cry it out- tears wash the dust from the soul! If I cry it out, the Crohn’s does not get started again.

  • Richard Faust moderator
    2 years ago

    Hi MaryB. I noticed you mentioned Crohn’s disease. I don’t know if you are aware that we have a sister-site for that at They can offer the same excellent level of information and support for Crohn’s as you find here for RA. Wishing you the best. Richard ( Team)

  • Wren moderator author
    2 years ago

    Thank you so much, MaryB! I’m glad you find it helpful as you cope day-to-day with Crohn’s. I love the idea that tears wash the dust from the soul–it’s just beautiful, and I want to thank you for sharing it.
    I hope today finds you feeling well. Please stop by again soon! 🙂

  • Padram
    2 years ago

    Oh, how beautifully you have summed it up !Am sharing this in health forums.

  • Wren moderator author
    2 years ago

    Hi, Padram! I’m delighted that my summing up felt right to you! And thank you for taking the time to comment AND for sharing my post in the health forums you participate in. I hope this finds you well and happy. 🙂

  • Cyd
    2 years ago

    Oh my, YES! You seem to have found a way to describe this pain Wren! Thank you! And like others, I do not wish the pain of this disease on anyone, but do somehow wish my family & friends (those whom have stood by me & remain) could experience, just briefly, RD pain and its other symptoms with which we are forced to endure daily. At least it’s daily for me as the right “cocktail” has not yet been found. Add to the RD pain – felt mostly in my feet & hands – degenerative disc disease w/building discs, and fibromyalgia. Lastly, I thank you for your closing sentences regarding the courage and strength required by one to “work through it” and “walk it off.” I have only thought that I had become weak, maybe even lazy (2 adjectives which would never have been used to describe me in my “past life”), but after reading your article I now believe that I am still, in fact, the strong person I have always been – unfortunately, no one else knows it!
    Keep your insights & articles coming!

  • Wren moderator author
    2 years ago

    Hi, Cyd!
    You’re so welcome! I’m pleased that the post resonated for you. It’s easy, in this hurry-up world of “easy,” fast fixes, to feel like a failure when we can’t “easily” “fix” RD pain and its other symptoms. I really do think we need to stand up for ourselves and point out to others that we’re actually very strong, getting through each day in spite of everything the disease tosses at us.
    Good for you for taking note of your own toughness and resilience! And thank YOU for taking time out of your busy day to comment. I do love hearing from you.
    Wishing you the best and hoping that today is a good one for you. 🙂

  • Lawrence 'rick' Phillips moderator
    2 years ago

    I think whatever layer we get too, we have to face the fact that no other person can really understand. find that when we compare pain we do not communicate well. Be it the 10 step pain scale at the doctor or the various applications that try to chart out symptoms to estimate pain.

    What i like here is that you have outlined six steps with no top end. Yes the dial can go to 11.

  • Wren moderator author
    2 years ago

    Hi, Rick,
    You’re so right–pain is intensely personal. It can be a 10 on the “scale” to me, and a 4 on the same scale to you. Nevertheless, it’s still pain, and it can be overwhelming and disabling.
    As always, thanks for taking a moment to comment. And thanks for the video link–I needed the smile this morning. 🙂

  • Larry Sawyer
    2 years ago

    Dear Wren, You nailed it, I call level five, ” Lighting me up”, In the old days,my doctor would give me one demerol pill for level five. i would take and crawl into bed and sleep it off. this essay should be printed and posted on every RA doc’s desk
    good work

  • skbladt131
    2 years ago

    That’s exactly what I intend to do! This is spot on and I want my RA doc to read this and talk with me. He has the facts in front of him, blood tests, X-rays. All of it shows active severe RA. I don’t want to mess with my meds again, I just want support when I hit those inner layers of pain where I lay in bed and pray for any kind of relief. My job requires endless, detailed documentation for the clients I serve in a waiver home setting. I just need understanding when I’ve hit my limit and I can’t complete anymore. So frustrating and beginning to feel pushed aside by my regular doctor.

  • Wren moderator author
    2 years ago

    Hi, skbladt131!
    I’m glad this post helped you, and I hope it helps when next you speak with your doctor. Sometimes, just having our doctors, family, or friends simply acknowledge that they believe us, that our pain is real, can go a long way toward helping us cope with it more easily. Being disbelieved or shrugged off is painful in its own way and makes us question our own reality.
    I wish you the very best. Thanks for stopping by and for taking the time to comment. I really appreciate hearing from you, and I hope you’ll pipe up again soon! 🙂

  • Wren moderator author
    2 years ago

    Hi, larryswayerk9,
    Thanks very much for your kind words. I’ve often wished there could be some way to “share” my pain–even for just a few moments–with a doctor, family member, or friend who doesn’t seem to understand my reality. I’m sure their attitudes would change instantly. And I remember demerol–it was one I took, rarely, many years ago. Like you, it was a stay-home drug for me, since it mostly put me to sleep.
    Thanks again for your comment. I hope this finds you feeling well. 🙂

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