Living with pain that persists

Epigraph

“all men love life”

The Dhammapada, 130, a complete clause in F. Max Müller's translation. Verses 129–133 connect recognition of another's vulnerability with refraining from harm. This is a religious and ethical address, not an empirical claim about every person or a treatment for pain.

What this article is about

In an imagined situation, Nikolai laughs during a short conversation. That evening pain makes it difficult to concentrate on music he loves. An acquaintance saw only the laughter and now doubts how serious things are. Nikolai starts proving his suffering in detail, although he wanted something simple: to postpone a long conversation and receive help with one household task.

This article considers how to describe the impact of persistent pain while retaining a voice and a place for ordinary life. A report of pain, investigation of its cause, evaluation of treatment and help with a particular task have different purposes. We consider why psychological dimensions do not make pain imaginary, and where Stoic thought can support dignity or become a cruel demand. The practical outcome is a clearer account of one interfering change and one needed support, without individual prescriptions or promises of relief.

I. Pain need not look the same every minute

One visible episode cannot describe a whole day. Being able to smile does not cancel an experience; silence does not show that pain is absent. Someone may want company and conversation while also struggling. A pleasant moment should not become evidence against their account.

IASP's 2020 definition stresses that pain is personal and a person's report deserves respect. Speech is only one means of expression; being unable to communicate verbally does not exclude experiencing pain. This professional definition is not a household truthfulness test.

Nikolai need not stop laughing to deserve attention. A supportive person can ask what is interfering now, instead of comparing a facial expression with an imagined correct appearance of suffering. The purpose of the conversation changes when it becomes assistance rather than a judgment of whether someone looks ill enough.

II. Reporting pain and explaining its cause are different tasks

A person knows more about the experience than an observer, but need not know its mechanism. Reporting pain and establishing its cause are different things. An unclear explanation after investigations does not make the experience invented. Equally, acknowledging pain does not automatically validate every proposed cause.

NICE NG193, section 1.1, considers pain's impact on life and warns against invalidating experience when communicating normal test results. Diagnostic categories and further investigation require clinical assessment rather than informal comparison.

Nikolai can therefore say that he does not know why today is worse, while describing what has changed. A professional receives information for assessment. A friend can hear a need without appointing themselves to determine the cause. An unknown should remain an unknown, rather than becoming an accusation or a convenient final explanation.

III. Impact is more than capacity to work

Pain may interfere with sleep, attention, conversation or enjoyment of an ordinary activity. A useful description need not begin with paid employment. Wanting to listen comfortably to music is as human as wanting to finish a task.

NG193 includes relationships, sleep, daily activities and actual social circumstances in assessment. Discussing a desired outcome helps when it does not become a demand to prove usefulness. Relief is not a reward for promising to become productive again.

One concrete contrast might help: previously two songs were manageable, while now finishing one is difficult. This is an imagined description of impact, not an instrument or a required experiment. If comparison is tiring, a short statement that pain is disrupting the conversation and a pause is needed may suffice. Communication should help rather than create another job.

IV. A person is more than pain, but pain need not obey the will

In the Enchiridion, section 9, Epictetus distinguishes bodily impediment from the capacity to choose. In Stoicism a person's value concerns the moral use of choice. This perspective challenges the idea that a bodily limitation destroys dignity.

It cannot responsibly become a promise that pain never limits attention or choice if someone tries hard enough. Thinking itself can be difficult; needing support does not establish moral failure. An ancient text is not modern research into functioning with pain.

The useful borrowing has a boundary: Nikolai is not reducible to one symptom. An unacceptable extension would require him to prove this through endurance or refusal of assistance. Dignity can include speaking directly about pain and wanting relief, without performing impassivity.

V. Recognising vulnerability is not knowing another's sensation

Dhammapada 129–133 invites recognition of one's own vulnerability and restraint from harming others, including through harsh speech. This is an ethical movement from oneself towards another. It does not say everyone experiences identical pain or can use their own experience to determine someone else's intensity.

Nikolai's acquaintance need not feel the same sensation to stop contesting the report. Acknowledging that one cannot feel exactly the same but can hear what is interfering leaves room for both uncertainty and support. Religious membership is not necessary for this conversation.

Unlike the Stoic emphasis on choice, this emphasis concerns limiting the harm one causes. The two approaches can meet in respect for a person without forming a shared method of pain treatment. Spiritual practice and moral resilience are not conditions for receiving necessary assistance.

VI. Helping means finding out what participation is wanted

An unrestricted offer to help can be too broad. Sometimes a limited choice is easier: end the conversation, help with one task or simply remain nearby. Looking tired does not authorise others to decide for someone. Difficulty speaking calls for an accessible way to answer, rather than automatic exclusion.

An agreement about household help does not authorise changing medicines or testing honesty through a home challenge. This article selects no treatment, activity level or transfer technique. Those depend on the person's situation and appropriate assessment.

Helpers also have limits. One feasible step is better than an unavailable promise of constant support. If relatives are absent, they should not appear in the plan by default. An inaccessible service remains a real problem to name, not a failure of determination by the person in pain.

VII. A small description may be enough

A detailed diary does not suit everyone. One known change, its impact on one activity and one question about support may be sufficient to communicate. A chosen helper can record information with the person's agreement. There is no requirement to prove the entire history again each day.

A report also differs from an agreed plan. After an explanation of a possible approach, feasibility still matters: how to obtain it, what to expect and whom to contact when something is unclear. An understandable recommendation and help actually obtained are different outcomes.

Without money or convenient communication, a short spoken request may be a first step, but this article cannot promise that it resolves every barrier. An honestly named obstacle is more useful than a fictional claim that support has been organised. A limited outcome does not make asking pointless.

VIII. Familiar pain does not automatically explain a new change

Persistent pain is no reason to classify every change as familiar and safe. NG193 provides for reassessment when symptoms change. Urgency depends on the actual situation; immediate danger calls for urgent medical help before completing an exercise.

An ordinary discussion should not end with a general command to endure either. A person can report what changed and what is difficult about current help, then clarify the appropriate contact. This article provides no basis for independently stopping, replacing or increasing medication.

Nikolai began by trying to make suffering convincing. Another possible outcome is that his account is heard, needed support is identified and a new question is not swallowed by an old diagnosis. Pain is not promised to disappear. Ordinary joy and a need for help can occupy the same life without disproving each other.

What this means in practice

When an ordinary conversation is appropriate, identify one known change and one impact: pain is interfering with this, and today something is different. Knowing the cause is not required. Ask for one suitable form of support or professional clarification, without staging an intensity test or giving up pleasure to appear credible.

Speak, use accessible communication or involve a chosen helper. No app, diary or family resource is mandatory. Clarify who can answer the remaining question and how help can actually be obtained.

A new or changed situation may need medical reassessment; immediate danger does not wait for this practice. This article prescribes no medicines, exercises or withdrawal of pain relief. The gain is clearer communication and an agreement, not a diagnosis, proven treatment effect or duty to bear pain stoically.

Key quotation

“Do not speak harshly to anybody”

The Dhammapada, 133, the first complete clause in F. Max Müller's translation. The verse continues with consequences of harsh speech. Here the address is to the listener; it does not forbid a person in pain from expressing anger or difficulty.

Connections between traditions

Foundations	Connection and boundary
Epictetus 9 / Dhammapada 129–133	Dignity and restraint from harm have different foundations. Stoic choice and Buddhist moral discipline do not form a clinical therapy.
Epictetus 9 / pain's impact	A person exceeds a bodily limitation. This does not mean choice is fully available during every pain experience or justify blame for weak will.
Dhammapada 133 / supportive conversation	Care with speech can change an interaction. Religious teaching does not require suppressing a patient's emotions or claiming identical sensations.
IASP / NG193 section 1.1	Respecting reports and assessing impact complement each other. A definition does not select treatment; guidance calls for clinical assessment.
Ethics / everyday support	Help need not be earned by proving productivity. This is the authors' argument about dignity, not a new doctrine shared by all traditions.

Primary sources

1. IASP, revised definition of pain, 16 July 2020: definition and six notes, read 24 October 2026.
2. NICE NG193, section 1.1: assessment, impact, communication, planning and reassessment. Read through the browser; treatment regimens in section 1.2 are not transferred here.
3. Epictetus, Enchiridion 9, Elizabeth Carter; read with sections 1–10. Primary philosophy used with an explicit limit.
4. Dhammapada 129–133, F. Max Müller; contextual reading. Short RU/TH quotations are translated from English, not Pali.

Tags

persistent pain, chronic pain, personal experience, reporting pain, impact, sleep, attention, relationships, enjoyment, dignity, pain relief, support, accessible communication, limited energy, unknown cause, assessment, symptom changes, next contact, feasibility, absent family, Epictetus, Dhammapada, moral choice, vulnerability, harsh speech, boundaries of help

About the authors

Andrey Zarinsh is the author and founder of United Wisdom. He explores inner transformation, unity across traditions, intercultural dialogue, and contemporary spiritual discipline. Instagram: @andrey.zarinsh.

Maria Evilkut is a co-author of United Wisdom. Alongside her research, she seeks to test these ideas in practice and observe how principles of unity and mutual understanding work in real life between people and cultures. Instagram: @ilkutki.