Nobody talks about how tiring pain is

People understand pain. Say your knee hurts and they picture a sharp thing in a joint, they wince in sympathy, and the conversation moves on.

What they do not picture is Tuesday afternoon, when you have done nothing much and you are wrung out anyway. You cannot point at that. There is no part of it you can rub.

Where the tiredness comes from

Some of it is sleep. A knee that throbs at two in the morning wakes you without ever fully waking you, and you surface in the morning having been asleep for seven hours without having rested for any of them. You are not tired because you did too much. You are tired because the night was not a night.

Some of it is the low hum. Pain that never quite stops is a background process running all day, taking a share of everything. It is why the shopping feels harder than the shopping should, and why you have no patience left by four o'clock for something that would not have bothered you at all five years ago.

And some of it is the vigilance. You are watching the ground. Every kerb, every wet tile, every step down from a bus, assessed in advance. Nobody who has not done it understands how much that costs by the end of a day out.

Why it goes unmentioned

Because tired sounds like a complaint about nothing. Everyone is tired. Say you are exhausted and somebody will tell you they are too, and they will mean it, and you will be talking about two entirely different things.

So it stays unsaid, and it gets folded into a story you tell yourself about getting older and slowing down. Some of it is that. A lot of it is not.

What tends to help

• Deal with the nights. Broken sleep is the biggest single contributor, and it is the thing most worth raising with your GP. It is a specific problem with specific options, and it is more likely to get you a useful conversation than saying your knee hurts.
• Warm the joint before it has to work, rather than after it has already seized. Stiff mornings cost more energy than they look like they should.
• Stop rationing rest as a reward. A sit down is not something you earn by having done enough. It is maintenance.
• Give the vigilance somewhere to go. A stick on bad days is not surrender. It is one less thing your brain has to do on every kerb.

It is not weakness and it is not age

The tiredness that comes with long-standing pain is well recognised by people who work in this area, and it is not a character flaw or a sign you have given up. It is what happens to anyone whose body has been running a background process for years.

You would not tell somebody else in your position that they were being feeble. Extend yourself the same courtesy.