Chronic Pain

Let's face it. Dungeons and Dragons is notorious for being slow when it comes to inclusivity and accessibility. It is often up to us to come up with our own systems in the name of recognition and representation. Here, we will attempt to create a comprehensive system to define rules for characters with chronic pain due to injury or illness.

Living With Chronic Pain

The daily life of someone with chronic pain does mean that they need to adapt in ways that able-boded people never needed to. As such, they gain some advantages with this adaptations. It must be stated that chronic illness is not a "superpower." These bonuses are meant to represent the necessary adjustments that need to be made to carry on with life.

Built Different: Living with chronic pain means that a character has to learn to focus through sometimes intense levels of pain. If the character does not already have it, they gain proficiency in Constitution.

My Own Advocate: Because people with chronic illnesses need to navigate the the world of treatment for the majority of their lives, they tend to pick up a lot of information about the medical field. The character gains proficiency in all Medicine checks.

Superior Focus: Working through the pain is a reality that is faced on a daily basis for people with chronic pain. The character gains advantage on any spell or check that requires Concentration.

Morning Roll

Chronic pain is a condition that is lived with forever. It is also always changing, often many times over the course of a single day. Waking up brings an uncertainty with it. After a long rest, use a d10 to determine where the character is sitting. This will serve as the day's baseline, and can be effected both positively and negatively by a number of factors. Some days are harder than others.

This chart is accumulative, meaning that the negative effects stack as you proceed down the list. However, after a long rest, the day resets, and the character rolls for a new baseline at the start of the day.

Pain and Condition Flares

On occasion, the actions of a day may lead to a flare up. "Borrowing spoons" from the days to come is a reality, and sometimes can have devastating effects on the body. This is not a daily roll, but rather a roll that happens at the beginning of the day when the DM or the player feel like the actions of the character would bring them to this point. The DC is set by the actions, and is agreed upon by the DM and the player. The DC should be determined on a case by case basis.

In the event of a flare: The player rolls a d100. If they score even to or above the DC, then the character is not experiencing a flare. If the character rolls below the DC, then they are experiencing a flare of their chronic conditions. All checks, including Constitution checks, will be rolled at disadvantage. Further more, the character's speed is halved. The only thing that will reverse the effects of a flare is a long rest.

Flare Difficulty Chart (examples)

Pain Management

Chronic pain is lifelong and ongoing, however that does not mean that there are not ways to manage the conditions over time.

Healing Spells

In a world full of easily accessibly magic, spells were one of the first things visited in an attempt to ease the symptoms of chronic conditions. It is important to state: Chronic illnesses cannot be cured. The nature of healing spells is to focus on short term conditions. Since chronic pain is lifelong, "curing" it is not something that can be done with normal healing spells.

Healing magic can, however, aid in the lessening the symptoms of chronic pain. Referring to the Chronic Pain Chart, using one healing spell cast at level 1 or higher will take the baseline down one full level. For example: If the character rolled at the 8-9 level for the day, casting one healing spell will take them down to the 6-7 range.

These effects cannot be stacked. Only one healing spell may be used per long rest to counter the effects of chronic pain.

Note: The effects of a Wish spell can completely and permanently negate chronic pain conditions.

Medications

Outside of healing spells, mundane medicine may offer some relief to chronic health patients. Characters may visit a physician or experiment on their own with herbs and treatments. These medicines can be administered a number of ways, from oral, or topical, even ocular or even injectable (with the right tools.)

Regular medication means that the character will start their day one point lower on the Chronic Pain Chart than they started.

However, medication is only effective if taken regularly. If there is a significant gap in the regime, the character will start their day at one point higher on the Chronic Pain Chart. It may also add to the difficulty for a Flare Check.

Mobility Aids

Mobility aids come in all shapes, sizes, and uses. They can be a brace, a cane, a mobility chair, or any other physical device that is intended to be used long term. Not all mobility aids need to be used every day, however they can help manage pain and other conditions.

Use of a mobility aid will automatically take the level rolled on the daily pain chart down one level. No roll is needed for this.

Appendix

Written by Jackson K (@thecalicojackson on Instagram) To Ciaran D. (@thecalicoqueen on Instagram) for consulting and test-playing