Intolerable pain: what happens when chronic pain becomes unbearable

Intolerable pain: what happens when chronic pain becomes unbearable

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When a patient says to a doctor “my chronic pain is killing me,” who should decide that living with severe chronic pain is preferable to the risks of opiates? Who gets to make that decision for patients?

Photo manipulation of a woman in a white shirt and long hair. Her face is distorted like shattered glass to convey that she is in severe chronic pain.
Credit: ©Flora Borsi / Behance Creative Commons

Intolerable pain: what happens when chronic pain becomes unbearable

When a patient says “my chronic pain is killing me,” who should decide that living with chronic intolerable pain is preferable to opiates?


What do you do when you are in constant pain?


Now, what do you do?


But what if the condition is incurable chronic intolerable pain and the treatment is opiates?

It’s not a perfect analogy. It’s not supposed to be. But the reason most people recoil instantly at that comparison is that most people don’t see incurable intolerable pain as an illness in the same way that cancer is. Sure, everyone needs ibuprofen at some point in their lives, and sometimes if you have a serious surgery you may need Percocet or codeine, but to most people, intolerable pain is not in and of itself a medical condition that merits treatment. But what to do when severe chronic pain becomes unbearable? What are doctors supposed to do when a patient says “my chronic pain is killing me?”


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However, none of this negates these facts: 1) many people suffer from severe incurable intolerable pain, and 2) opiates are the only drugs that allow some of these patients to achieve anything resembling a livable situation.

Opiates are sometimes the only drug that reduces intolerable chronic pain




In both cases, the “guidelines” and “restrictions” and “regulations” may seem like they’re there to prevent “abuses of the system” or people getting the medical care they don’t really want/will regret later. But really, the goal is pretty clear—sharply reduce the frequency with which this type of medical care is being provided. [1]




This is being presented as a successful outcome. Why? How do we know how exactly these doctors decided whom they were going to deny opiates to? What if some, or most, of the patients who made up that 10% statistic were patients who really needed these medications? Patients in severe chronic pain. Patients with intolerable pain. How many of those patients might go on to overdose on street drugs that they sought out because of unmanaged pain?




Here’s the problem, though. “Not all pain is intolerable” means acknowledging the fact that some pain is intolerable, and anyway you slice it, you have people other than the patient determining if they have intolerable pain or not. And not only that, but this decision-maker is essentially serving as a gatekeeper to effective pain-relieving medication, placing them in opposition to the patient who has intolerable pain, who wants access to that medication.


This page is from a 2014 nursing textbook titled Nursing: A Concept-Based Approach to Learning. After this photo went viral on social media in 2017, the publisher, Pearson, apologized and released an updated edition of the textbook with this section removed. Article highlighted the incorrect notion different ethnic groups reacted differently to severe incurable chronic pain.




Can chronic pain kill you?

“But wait!” you may say. “Cancer kills, but chronic pain doesn’t!” You got me there. Except not really, because first of all, not everyone agrees that a lifetime of excruciating intolerable pain is better than death. For instance, I don’t. Second, severe and untreated intolerable chronic pain absolutely does kill. It can increase the risk of suicide and actual opiate abuse and overdose, as well as alcoholism and complications thereof. More than one patient has exclaimed, “my chronic pain is killing me! ”

People who become sedentary due to pain have a higher risk of dying of heart disease, diabetes, and literally any other disease for which being sedentary puts you at risk. People with untreated intolerable pain may be unable to work, and their ambiguous medical status can make them ineligible for Social Security. Poverty is itself a risk factor for just about everything.

This brings me back to my opening analogy. When chronic pain becomes unbearable who decided that the risks of living are preferable to the risks of taking opiates? Why do they get to make that decision for patients? What the fuck happened to informed consent?


Photo manipulation of a woman in a gray shirt against a black backround. Her hand runs across her face distorting the skin to reveal blackness underneath, to convey that she is in severe incurable chronic pain.

"Most people think they know pain. Everyone's done something: broken a limb, been stung by a wasp, recovered from an operation or rammed a baby through their birth canal. But chronic pain is different. It isn't just pain that lingers; it's pain that dominates. It swaddles you in its gloom and slips blinkers on you until everything you see, and everything you experience, is filtered through that pea soup of pain." Julia Buckley


©Flora Borsi / Behance Creative Commons

My chronic pain is killing me: when does chronic pain become unbearable?








  • Who is the best authority to determine a patient’s pain severity—their doctor, a state government, or the patient?
  • What are the long-term risks and costs of unmanaged intolerable pain?
  • Can severe chronic pain kill someone?


Article by
Miri Mogilevsky

Miri Mogilevsky is a writer, teacher, and practicing therapist in Columbus, Ohio. They hold a BA in psychology from Northwestern University and a master’s in social work from Columbia University.


While pain usually has physiological causes, its perception is subjective. That pain is subjective means there’s no way to know if someone else’s pain is “that bad.” Every method that’s been created to try to objectively rate someone else’s pain is a dismal failure, because you simply can’t.

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