Oh, there are lots of painful things in this world that are probably of equal or greater intensity. Childbirth. Getting knee-capped with a 9mm. Having white-hot pokers used to put out your eyes. Being kicked in the balls repeatedly.
But as far as pain with no obvious source of external stimuli? Back pain is right up there at the top. At least with other illnesses and injuries, you can pass-out and sleep for awhile. I've been unable to sleep for two days as there is no position I can lie in that doesn't cause intense, shooting pain through my upper back and neck...well, at least when I "relax."
A couple years ago, my wife and I did a pilgrimage/hike with my father-in-law in Mexico. We later calculated the distance was about 60+ miles, all of which is walked in a day and night without stopping except for the occasional short meal break. I had thought, no problem, I walk a lot and I have the endurance to go for 20+ hours without sleep. I'll be tired, but I'm in good enough shape to do this.
In retrospect, it was the craziest, most dangerous thing I've probably ever done. There was no trail, no road...no path. People knew the way because they followed other people that did it for years, or who lived indigenously to the area (and didn't own vehicles), or because people from nearby towns/villages would come set up stands along "el camino" to sell snacks and drinks.
We crossed several mountains. In the pitch blackness with fading flashlights (no stars because of the cloud cover...it was rainy season). On sheer, flat rock or loose rolling gravel. Just hoping there would be no rain and no flash floods. And hoping there would be no injuries...because there was no way an ambulance would find you or that any chopper was going to land and airlift you out.
So anyway...I started the trek in heavy duty "blister-proof" hiking socks and boots from REI (these were worn through by the end, by the way). Stupidly, I was favoring my left leg through most of the day due to a slight tenseness/soreness in my right ankle and my problem "trick right knee" (it gets "tired" quickly due to starting the fencing sport a little too late in life - my mid-twenties). By midnight/1am, my left leg was shot to shit...I could not bend it or put weight on it without collapsing in pain, and so I was forced to rely on my right leg...my bad leg.
Around 3am or 4am we finally made it down the last, longest mountain. I don't know if the thing had a name or not; I just called it Goddamn Mountain. Because every time I stepped down on my right leg I would swear and curse the f'ing thing. By the time we finally rolled into the town at the end of the line, both my legs were shot to hell, and it would take more than a week for my right knee to fully recover from the experience.
The thing is, it was the longest and most excruciatingly painful experience I ever had. Normally, when you are "in pain" you stop what you're doing. You take your hand out of the fire and ice it. You walk off the sports field and take a break. You sit down and have a glass of lemonade. You pop an aspirin and try to take a nap.
On the pilgrimage, I couldn't stop...there was no option. The busses that would take us back to our original town was at the end of the trail...and as I said, no team of medics was going to air-lift me out of the jungle. I just had to keep walking, and keep feeling the pain. I wouldn't call it a "character-building" experience. Would you call being a tortured P.O.W. a "character building" experience? No...but it's a testament to the limits of human endurance that people can survive and sustain on-going physical suffering when there is no other option but to do so.
My back pain of the last couple days has been nearly as bad. Despite seeing a chiropractor for the last six weeks (three times this week!). Despite the emu oil and super-strength muscle relaxant ointment and popping Ibuprofin like candy and drinking lots of water and drinking lots of alcohol and acupressure release and...shit it hurts!
So what's the point of all my whining? Well, it seems to me that, in general, RPGs don't model pain very well.
Which to me is well...nearly an unforgivable sin. I mean pain and suffering is so much a part of the "adventuring experience." We stub our toes, or our thumbs, we get blisters and headaches, pull hamstrings and groin muscles, suffer all sorts of pain and injury and illness. Haven't you ever picked up a bit of a sniffle camping outdoors? I have...and it colors everything you do the whole next day.
Real life adventures can be a pain in the ass. And part of the heroism inherent in partaking in an adventure is enduring these aches and pains and inconveniences.
I always think of the early chapters of Tolkien's The Hobbit...how everyone, especially Bilbo (but even Gandalf and the sturdy dwarves), are miserable and complaining once the weather turns foul. As a kid I could totally relate to this, because every single camping trip I went on it poured rain. Cub Scout and Boy Scout outings or family trips, regardless of the time of year, it was always wet and miserable. That's just part of growing up in the Pacific Northwest (at least on the west side of the mountains). And while we could laugh and have fun reminiscing once we were back home, it was always a damn miserable time out in the woods. Especially if you added injury on top of it all (burns, cuts, scrapes, blisters...as well as the occasional concussion or broken limb).
Most players look at their hit points on a character sheet kind of like we look at our gas tank on a car. "Uh-oh...getting close to Empty. Better pull over at the next station and fill up." You don't want to run out of hit points in the dungeon anymore than one wants to be stranded on the highway with an empty tank. But as a simple resource, "hit points" don't do justice to the pain and suffering of the adventure experience.
Likewise, hit points are, in the main, a measure of the combat/fight-worthiness of a character. Once your hit points are depleted, you're no longer able to fight effectively...you're out for the count and probably winging your soul off to its final reward. Things that do hit point damage (falling, traps) reduce a character's ability to put up a fight...but that is ALL they measure. They don't measure fatigue (which is represented, in B/X D&D, with some small penalties for over-exerting oneself). They don't measure one's willpower or ability to withstand toxins/intoxication (these are in part represented by saving throws and sometimes by ability rolls against Con or Wis).
I've seen some RPGs that try to measure pain and suffering, all with mixed (and for me, unsatisfactory) results. Deadlands (1st edition) couples pain with fatigue in its Wind resource. White Wolf's early games (Vampire, etc. al), had pain and movement penalties associated with levels of damage (At "mauled" person loses two dice and can "only hobble." At "crippled" you lose five dice and can "only crawl"). Albedo has both physical damage levels and mental (stress) damage levels caused by firefights and combat. Violence had both life points and pain points (and each weapon in the game had a different dice roll for each).
But none of 'em really capture the debilitating nature of suffering. And certainly my favorite adventure RPG (D&D) has none of these. Which I think is too bad.
I know some readers have no interest in modeling the minor aches and pains of "real life" in an RPG adventure game, just as I have no interest in forcing PCs to "roll to see if you have a full bladder and need to find a bathroom." It's not "important" enough. It's not "dramatic" enough. It's not "heroic" enough.
Damn it...there IS heroism in pushing through the pain. I feel like a goddamn hero just sitting here and typing this meandering post! Aaarghh! My frigging back!
All right. I'll drop the subject for now...especially as I have no idea (at this time) at how I would model pain and suffering in an RPG. But I will be thinking about it, and if I come up with any scratch rules, you better believe I'll be returning to the subject.
Though I'll try to keep the whining to a minimum.