Given the notorious resistance of physical pain to textual representation, how does an author write the story of pain? Using Eula Biss’s 2005 essay “The Pain Scale” as its touchstone, the article considers lyric essay as pain’s most suitable autobiographical genre. A lyric essay, it is argued, can perform the kind of conceptual shift that many theorists of pain have called for, situating pain along the pathways not just of nerves but of subjectivity, of relationships between self and other, imagination and words. By turns elusive, imagistic, ecstatic, associative, and melodic, more often circling and symbolizing life events than narrating them in linear ways, the lyric essay has a unique capacity to represent the self-in-pain, giving pain a rich experiential dimensionality that it may lack in more conventional, particularly medical, accounts. In “The Pain Scale,” Biss does not render pain as an adjunct to other physical experiences, such as addiction or disease, but rather capitalizes on the distinctive fragmentation and emotional intensity of the lyrical essay to capture the movement of pain. In a form where pain becomes affirming rather than negating, an avowal of the self’s aliveness and of its impact on the world, new articulations can occur— of how we conceive of, and therefore live, with pain.