Pain is designed to scare us.

It’s a warning that we’ve been hurt -- a red flag that something isn’t right.

Though it’s a universal human experience, it's also so individualized that we can never really know how someone else feels in it. Most of us desperately want to avoid it.

I’ve been thinking a lot about acute and chronic pain since my mom broke her arm last month. After a complicated surgery to repair her fractures, the surgeon prescribed opioids to deal with the pain. This is standard medical protocol.

But anyone who has paid attention to the country’s opioid crisis may wonder about the safety of taking these painkillers. In a Morbidity and Mortality Weekly Report published last spring, the Centers for Disease Control and Prevention estimated that more than 51 million people -- more than 20% of U.S. adults -- have chronic pain, and that 17 million -- almost 7% of adults -- have high-impact chronic pain (pain that limits their activities most days, if not every day).

Chronic pain is more common among older adults than any other age group. And yet their treatment options come with significant risks, including addiction to pain medication.

The billionaires sitting atop America’s empire of pain are the Sackler family, owners of Purdue Pharma and the highly addictive and wildly profitable drug OxyContin.

The hyperaggressive marketing of Oxy contributed to a devastating and worsening national epidemic. From 1999 to 2021, nearly 645,000 people died from an overdose involving opioids, including prescription and illicit opioids, according to the CDC.

In December, the Supreme Court listened to the government’s objection to a multibillion-dollar bankruptcy settlement with Purdue Pharma, in which the company would be restructured as a nonprofit to address the public health crises created by the epidemic.

Members of the Sackler family agreed to contribute up to $6 billion to the plan in exchange for immunity from future civil liability for opioid-related claims. The Sacklers want to protect the $10 billion moved to offshore accounts in the years leading up to Purdue Pharma’s bankruptcy. (Sackler lawyers say more than 40% of that went to pay Purdue’s taxes.)

The Supreme Court will decide later this year whether the Sacklers get this shield of immunity and remain one of the wealthiest families in the world.

In a sane society, a high court would be deciding if the Sacklers ought to rot in prison.

In a 2021 story for The Bulwark, writer Saul Lelchuk asked if the Sacklers were "the most evil family in American history." He argued that the Sacklers caused more widespread harm to America’s social fabric -- and correspondingly, more American deaths -- than any other single American family in history.

That ought to win them the title.

I asked an older reader who lives with chronic pain to describe what it’s like trying to manage it with opioids. Until recently, he had been functioning while taking a painkiller called tramadol. But he thinks he may have fractured his back, which caused his pain to spike, and now his doctor has prescribed oxycodone -- a much stronger opioid.

“Taking sufficient painkillers to reduce (not eliminate) the pain means I do not think clearly unless I make a special effort, on even the simplest of chores, to ensure I am doing it correctly,” he wrote. Every act of basic living, such as balancing a checkbook or putting the groceries away, requires extra attention.

It’s more mental stress on top of the physical stress.

"And being spaced out or snarling in pain really doesn’t help my relationship with my wife,” he added.

The most disturbing part of his account described how little the medication was helping him improve.

"Unfortunately, the pain keeps increasing, and as it does, my dosage amount gets higher," he said. "The worst part is it is not a pleasant 'high.' It just makes me drowsy, and I sleep for two or three hours until the pain wakes me up again. The cycle is somewhat vicious -- pain, increasing pain, drugs, sleep, wake up to pain, increasing pain.”

The last thing I want to do is scare my mother about the risks of pain medication while she’s still reeling from post-surgery pain. She’s well aware.

All the doctors can offer her is this double-edged sword.

Meanwhile, the Sacklers await their shield of protection.

As my mom walked to her car parked in the driveway earlier this month, the toe of her Ugg slipper got caught in a crack.

She fell on the concrete. She tried to break her fall using her left arm. Her forearm snapped in two. She sat on the driveway in excruciating pain until my sister arrived to take her to the emergency room.

I’ve often heard about the risks of falling for elderly folks. But the statistics from the CDC still surprised me: Falls are the leading cause of injury and injury death for adults over 65. About 36 million falls are reported among older adults each year, resulting in more than 3 million visits to the ER and more than 32,000 preventable deaths.

Until my mom broke her arm, I didn’t realize how life-altering a fall can be for an older person. I certainly hadn’t given much thought to what we could have said or done to try to prevent it. In fact, even though my mom will be 74 in a couple of months, I didn’t think of her as “old.” She’s not the parent who I worry about falling.

She’s been taking care of my dad, who has Parkinson’s and is a cancer survivor, since the pandemic. She teaches Arabic virtually to a group of adult students multiple times a week. She’s social and runs their errands and can cook amazing meals. My mom has a penchant for moving quickly from one task to the next.

She’s older -- but not old, I thought. These days, people in their 70s remain active and engaged, and I expected no different for her.

It would have seemed strange to warn my mom, of all people, to always wear proper shoes when she steps outside. Or to teach her exercises that help with balance and encourage her to do them daily. But now I wish I had said something. Balance tends to worsen as we get older, bones become more brittle, and the winter is the most dangerous time for falls. Women fall more often than men and account for three-quarters of all hip fractures.

When my mom got home from the ER, she reminded me that her mother had broken her hip in her late 80s and died less than a year later. Studies show that a hip fracture dramatically increases an older person’s risk of death. Even a lesser fracture can lead to a loss of mobility and functioning.

As you age, mobility equals independence.

Here are some of the risk factors that increase one’s chances of suffering a fall, according to the CDC:

-- Lower body weakness

-- Vitamin D deficiency

-- Difficulties with walking and balance

-- Use of medicines, such as tranquilizers, sedatives or antidepressants. Even some over-the-counter medicines can affect balance.

-- Vision problems

-- Foot pain or poor footwear

-- Home hazards or dangers such as broken or uneven stairs, and throw rugs or clutter that can be tripped over.

My mom underwent a three-hour surgery to repair her arm. When I saw the X-rays of her bionic arm, it looked like surgeons had installed an entire Home Depot shelf in there. She will need to be in a cast for a couple of months. It will likely take months of physical therapy to restore her upper body strength. In the meantime, my siblings are helping out and looking for home health workers who can come assist my parents. I hate that my mom has suffered so much needless pain and that her life will be upended until she’s completely healed.

We can be slow to change habits until an injury forces our hand.

I’ve learned to slow down when rushing down the stairs, to use hiking sticks when attempting a steep trail, to incorporate more balance exercises in my workouts and to pay more attention to the sidewalks when walking our dog. I regret not surveying my parents’ home and habits more carefully when I visited them last.

We’ve learned the hard way -- a fall can change everything.

Ron Sanford reads the daily newspaper every morning -- a habit of more than 40 years. I occasionally hear from him when he’s heated.

Sanford, 65, a retired computer science teacher in St. Charles County, Missouri, has accused me of having an agenda when I’ve written about school boards or book bans in the past. I usually reply to his emails, as I do with local readers whenever possible. The tone of many of his messages led me to believe he’s one of my “hate-readers” -- the ones who only read because they want something to criticize.

In this day and age of dwindling print subscribers, I’ll take it.

Last spring, however, I wrote something that really touched a nerve with Sanford. I was describing a situation in which my husband and I had gotten turned around in an unfamiliar neighborhood in St. Charles at night. It was shortly after two young people, one in Kansas City and one in upstate New York, had been shot by strangers simply for mistakenly knocking on their door or pulling into their driveway. At the time, I told my husband to be careful since we were in a “shoot-first” part of Missouri.

This description did not sit well with Sanford. He wrote to say that St. Charles County had lower rates of people getting shot than the city of St. Louis. He said it revealed my bias that I would describe the county that way, but not the city. (He used more emphatic language, but you get the idea.)

At first, I tried to describe what I had meant. The column was about where individuals feel safe, and a few weeks prior to writing it, I had read about signs from a white nationalist group popping up in St. Charles County. In such a deep red county, it’s also reasonable to expect a higher rate of gun ownership.

Perhaps an unknown person of color pulling into a stranger’s driveway in such an area would be viewed suspiciously. That was the context of my feeling unsafe in that situation.

Sanford insisted that my feelings did not justify the "shoot-first" descriptor. He pointed out there was scant evidence to suggest that I would be shot, and said I needed to publicly apologize. I considered his point of view and realized it was, indeed, a glib and unfair remark about St. Charles County.

I asked if I could call him and possibly write about our exchange. He reluctantly agreed.

I was curious about a few things. First of all, what was driving his dogged persistence in writing to me about this phrase? We had exchanged emails over several months by this point.

He admitted that being retired gave him ample time to send emails.

“I like getting emails because it’s something for me to do,” he said. That’s the opposite of how I feel about my overrun inbox, which I’m constantly triaging.

We did discover some unexpected common ground. He described himself as a moderate, politically speaking.

“I don’t like Trump or Biden, if that matters,” he said. Judging by the polls and approval ratings, the majority of the country feels the same way. When I asked about his top three issues going into this election, he said the economy, border security and, surprisingly, abortion.

“I have daughters,” he said. “Some of these laws being passed are insane.”

I didn’t expect to hear that.

Even more surprising, he said that he probably agrees with more of what I write than he disagrees with. You could have knocked me over with a feather.

We’ve become accustomed to making assumptions about people based on tweets, social media posts or brief interactions. Those who disagree on the most divisive issues tend to see each other as one-dimensional. But most people are more complicated. We just hear the loudest, least-nuanced voices most frequently.

Another reason I wanted to talk to Sanford is because I’ve been grappling with how our discourse around political disagreement in this country has devolved. I’ve talked to my children about how to disagree without being disagreeable, but maybe it’s better to model that behavior. In an election year that’s bound to be highly contentious and polarizing, I wanted to show them another way to talk about our differences.

“In general, I wish people who disagree with each other would talk more, like we are doing right now,” Sanford said during our phone call.

Maybe our conversation felt productive because I was willing to engage and admit that I was wrong on a point Sanford deeply cared about. It probably helped that his tone was much friendlier over the phone than in his emails. We got to know a little more about each other’s backgrounds and perspectives, and discovered areas of agreement. He trusted me enough to talk to me, even knowing I would be writing about it.

Before we ended the call, he said that his previous demands for a public apology had been “crossing the line.”

I recognized it as an olive branch, and I appreciated it.

For the record, I publicly apologize.