The Fourth Pain by Kellie Coff

I never knew there were four different kinds of pain until I felt them all. 

Medically speaking, there are only three different types of pain:  

nociceptive,  

nociplastic,  

and neuropathic.  

But I know another kind of pain.  

A pain that nobody sees… and nobody talks about.  

I call it the fourth pain.  

We need to talk about the fourth pain.  

To begin with, let’s talk about the first kind of pain. This is just regular, nociceptive pain. This post-surgical injury pain lingers like a fly at a barbecue. I know nociceptive pain when it grips me by my Achilles tendon and refuses to let go. It stretches its cruel fingers across my shoulder and claws at it like a buzzard ripping at carrion. 

I can usually scare away nociceptive pain with a heat pack, an apothecary of ointments, or even a tiny pill. The chemist is filled with little boxes of bliss that help defend against nociceptive pain. I think I’ve tried them all.  

The second kind of pain is nociplastic pain. While nociceptive pain warns of damage done or damage yet to do, nociplastic pain is the false alarm that punches me in the stomach and pounds at my head.  

Nociplastic pain can be soothed with PT, AT, CBT, SNRIs and a whole alphabet of acronyms.  Sometimes, for a magical moment, I can briefly ignore my nociplastic pain, provided the stars align in the right constellation of medications and mediations.   

But then the third pain kicks in. The third kind of pain is impossible to ignore. The third pain is neuropathic pain. This pain radiates from my neck to my nails. It short-circuits my nerves and electrifies my limbs.  

I know neuropathic pain when it transforms my world into a cactus. A thousand tiny needles prick at my fingers and electrify my arms, demanding my full attention.  

Neuropathic pain robs me of my sleep each night, and my patience each day. There is nothing that alleviates this kind of pain that doesn’t also numb who I am. Those boxes of bliss come with a cost and they force me to choose between being without neuropathic pain or using my brain.  It hurts so much to choose my brain.  

Which brings me to the fourth kind of pain. The fourth pain doesn’t have a name. It is an unspoken evil that rolls into my mind like a heavy fog. It clouds my thoughts and casts shadows on my soul. Nobody talks about the fourth pain but there are those, like me, that know it. 

I know the fourth pain intimately. I have come to know it better than I know myself. The fourth pain is always with me. Stronger and louder than any of the other kinds of pain. And nothing I do or take can numb it. The fourth pain is the worst of all the pains.  

It is relentless.  

Incorrigible. 

Incurable.  

The fourth pain burdens my every step like a convict’s cannonball.  

It sits heavy in my lap like a barbaric black dog.  

It lays with me each night like a toxic lover.  

It infiltrates my sleep,  

my thoughts,  

my soul.  

This fourth pain is the overwhelming pain of knowing that things will never be the same again. 

We need to talk about the fourth pain.