At 7 am on the fourth of December in 2024, the CEO of UnitedHealthcare was gunned down outside his hotel on his way to a pharma meeting in Manhattan. Upon the capture of suspect Luigi Mangione, a secondary conversation regarding chronic pain and mental health crept into the news cycle. The public was stunned by the assumed fall from grace of the ivy-league-student-turned-hitman. Looking for a reason behind this fall, people begin to suspect that the major motive of the assumed attack by Mangione was the suspect’s chronic back pain, which had recently worsened.  In response to public confusion, psychologists came out of the woodwork to discuss the extreme effects of long-term chronic pain.

Having lived with chronic pain for the last five years myself, I will say it’s never crossed my mind to kill someone. But I know well the weight of chronic pain on the mind and body – a weight that, like so many disabilities, is invisible to others and often dismissed. This conversation around chronic pain and mental health may be newly discovered in the mainstream media, but it has been a constant conversation in my life and the lives of those close to me since my initial injury in 2019.   

The tricky thing about pain is that you can’t see or measure it. It’s completely subjective which complicates and minimizes medical research on pain, making the pain more isolating for the person experiencing it. To complicate things even further, it’s also all-consuming: “When you live with chronic pain, it often becomes central to who you are. Every decision you make; every experience you have is framed by your pain,” Elizabeth Arbour of The Walrus  writes.  

When I think of the mental ordeal of pain, I return to a paragraph from  Maggie Nelson’s Bluets, which reads: “It often happens that we treat pain as if it were the only real thing, or at least the most real thing: when it comes round, everything before it, around it, and perhaps in front of it, tends to seem fleeting, delusional.” That is, it is impossible to ignore pain once feeling it. With chronic pain, many times a simple Paracetamol won’t have any effect, and the effective pain medication is too strong to be taken every day. But pain is the biggest distractor there is, it is impossible to ignore. Thus, an Adderall prescription is not uncommon for those dealing with intense chronic pain, myself included. 

According to a recent  New York Times editorial article, an estimated two billion people live with chronic pain globally. Despite this statistic, what really sparked any real research on chronic pain was the explosion of the U.S.’s opioid epidemic. There was no visible evidence of pain until it gained a visible, measurable, addictive element. Though opioids and pain are already attached, pain and addiction go hand-in-hand because pain has a hugely detrimental effect on mental health. Jennifer Kahn of The New York Times writes, “A cruel Catch-22 around chronic pain is that it often leads to anxiety and depression, both of which can make pain worse.”  

Furthermore, the isolating experience of chronic pain can aggravate this depression spiral. Arbour opens up about her struggle to inform people of her own pain: “Chronic pain changes your identity – what you believe yourself to be capable and worth of – as well as your relationships and how other people see you”. This candour is something I struggle with too; she recounts explaining her pain for the first time to her now-husband, reminding me of a fight I had with an old boyfriend. I’d neglected to tell him about my pain, and thus disability, for fear he would see me differently. This worked until I had an operation done and had to explain, three months into our relationship, why I was so casual about spending the day in the hospital. He was hurt that I hadn’t told him about something so central to my life for so long, while I was grappling with the shame of being eternally dependent in a world that prizes independence. 

Since then, I’ve become more forward about my pain and physical limitations, but because my pain isn’t visible this is still challenging. Arbour relates: “Pain is mostly invisible to others, which means that there is often the assumption that we are ‘able-bodied’ and do not require accommodation.” 

However, there’s been somewhat of a “revolution” regarding chronic pain in the last couple of years. In 2018, the  US National Institutes of Health  began researching pain measured through the opioid epidemic in an attempt to better treat chronic pain. In 2019, the Federal Accessible Canada Act was passed, aiming to make life for people with disabilities more accessible on a social level. In 2024, Britain announced their plan to begin further research on chronic pain. The European Pain Federation did not fall behind and has published a plan to tackle the way chronic pain is managed throughout Europe, kicking into action in April of this year. 

As governments and medical offices around the world attempt to solve the problem of chronic pain, they’ve all come to realize that the limitations and negative attitudes accompanying it are based on societal issues. Thus, it is increasingly important that those able to operate without pain understand how an estimated two billion people are limited, visible or invisible.