Writing About Pain: Invisible Injuries and Conditions

In this series on pain, we’ve covered everything from minor injuries to major and mortal injuries. But there’s another source of pain that can push our characters to the edge of coping: invisible injuries and conditions.

When readers see a bruise, cut, or gunshot wound, it’s easier for them to fill in the blanks about what happened, and imagine the pain that goes with it. But when the source is internal, writers have to work harder to connect the dots for readers, especially if the character themselves is unaware of what’s causing their distress, or they choose to mask their pain.

So what are some examples of internal conditions or injuries?

A concussion, brain injury, stroke, or another condition affecting the brain. Maybe your character fell on the ice and seemed to have escaped with only a few bruises, until a headache or migraine shows up. There are changes in vision and nausea. Or they’re having trouble forming thoughts, words, or remembering things.

Internal organ damage, bleeding, or ruptures. Physical trauma, being poisoned or exposed to toxic elements, a surgical complication, bone fractures, or even an ectopic pregnancy can all be sources of internal bleeding and damage. While initially a character may not realize they are in distress, it doesn’t take long to know something is off as internal bleeds can cause significant pain, and manifest in different ways depending on where they are located. Organ damage can cause a rapid or irregular heartbeat, make the character feel nauseous, lead to confusion and lethargy and fever and chills. Untreated, organ damage can lead to organ failure.

Chronic Pain. Your character may have fibromyalgia, chronic fatigue syndrome, or recurring pain from an old injury or condition without visible markers. Because the pain is chronic, it may impair their ability to enjoy everyday things, cause mood swings and irritability.

Neck injuries (like whiplash) can be caused by things like car accidents, pinched nerves, contact sports, or being shaken, and don’t necessarily have visible signs of swelling. Characters can experience stiffness and debilitating pain in the neck, shoulders, and head.

Hearing conditions that lead to sensitivity. Some characters may feel pain when exposed to certain noises, due to hearing loss or other conditions. They could even have Misophonia (an aversion to specific sounds that causes panic attacks and causes one to feel as though they are losing their sanity).

Neurologic disorders, diseases or lesions. A character with a condition like Multiple Sclerosis, Parkinson’s disease, Long Covid or even a spinal injury may experience neurological pain, paresthesia, tingling or numbness that is difficult to manage and impacts their quality of life.

Autoimmune Disorders. A character who has a condition like lupus, rheumatoid arthritis, IBD, or Crohn’s disease will experience internal inflammation and invisible symptoms that can range from fatigue, joint pain, fevers, and uncomfortable digestive issues.

Cardiovascular Conditions: Heart conditions, such as arrhythmias, certain types of heart disease, and attacks can cause pain in the chest, upper back, and neck, lead to discomfort from experiencing indigestion and nausea, and even cause dizziness. Some arrhythmias have no signs, others can be quick and fatal.

Digestive issues. Irritable bowel syndrome (IBS), gastric ulcers, food poisoning, gallstones and a variety of other gastrointestinal conditions create discomfort in the form of cramps, diarrhea, nausea, and bloating.

Other forms of disease like cancer. Tumors pressing against an organ, bone or tissue can be painful, and the radiation or chemotherapy the character may have to undergo no less so.

Depression, post-traumatic stress disorder (PTSD), borderline personality disorder (BPD) and other mental conditions and struggles. Not all invisible conditions cause physical pain; many cause emotional distress, anxiety, panic attacks, etc. as well. The psychological battles being fought may not be visible to others, but this doesn’t make the emotional pain your character feels any less real or debilitating.

The little things. Pulled muscles. Toothaches. Infections. Minor nerve pain. Even small hurts can cause your character to feel irritable, spoil events, or ruin their day.

Tips for showing internal injuries

Regardless if a character doesn’t know what the invisible injury is, or they are purposefully hiding it, we still need to help readers realize something’s off. Here are a few ideas on how to do that.

Seed some hints. Is there something a character is avoiding, like bending down, getting out of bed, or cleaning the house? This can plant a clue that pain is a factor.

Give the character a few tells. Is your character consistently rubbing at their neck rolling their wrist, or they’re extremely irritable for no reason?

Know the signs of internal conditions. This one is one of the most important. Each non-visible condition or injury will have specific symptoms for pain. Do your research to make the character’s behavior authentic.

Show their struggle to manage or hide pain. Is your character overcompensating, breathing in a strained way, or struggling to form words?

Have the character talk it out. If the character is around someone they feel comfortable sharing with, they can talk about what they feel, but only if it makes sense for your character to be open like this.

Have a character make an observation. Characters can be very observant. A pointed question, “Is there something wrong with your knee? You keep rubbing it.”

Reveal something they can’t do. There’s nothing worse than discovering something you used to do is no longer possible: tying a shoe. Being sociable at a family barbecue. Talking about anything without becoming emotionally upset.

Add urgency. Internal injuries get worse when not treated. This can happen slowly, or quickly. Raise the stakes by showing your character’s condition worsening, making it crucial to find an answer to what’s hurting the character.

Invisible injuries and conditions have a superpower: they create tension.

Visible signs give readers a good idea about what’s wrong and how bad the pain will be, but when it’s something invisible, the reader wonders, what’s wrong? How bad is it? And because they’ve experienced that feeling of ‘not knowing’ in their personal life, they will feel unease until the story provides answers.

Internal injuries can also be a false front. Readers might believe a character has gotten away unscathed, only to discover a clock inside them is ticking, and if they don’t get help soon, the consequences will be significant…or fatal. So the next time you need to hobble your characters with pain, consider an invisible injury!