Scaling pain to damage wouldn’t work very well without overhauling how bandages and medkits work. As it stands, they directly and immediately repair damage, meaning damage-scaled pain would vanish the moment you healed things. That would render painkillers far less valuable if you could just apply a bandaid instead, unless you made pain time out slowly after hp was restored to a bodypart. It would time out at the same speed regardless of injury type though, and that’s not modelling things much more realistically than we currently have. Unless you really want to start tracking injury types, which seems… much harder.
I like the idea of certain attacks applying effects though. The immediate injury and hp loss could have its temporary addition of pain, and you’d treat those as we currently do - bandages etc would remain the hp-fixers. However, the ‘disease’ applied would have its own effect until it wears off or is treated. For instance, a spitter hits you with acid. It hurts and you take some damage, and you get an Acid Burn disease/effect which adds its own further pain. You could apply water or baking soda to an Acid Burn ‘disease’ to neutralize the condition immediately, or you could take your aspirin and wait it out if you’d prefer to save your water. It’s potentially doable.
I like the thought of making acid attacks from spitters cause a condition to the player, since …last I heard, melting everything dropped on acid tiles has been nerfed? I dunno, depends if you want spitter zombies to be gear-wreckers or player-cripplers, I guess.
I had a complaint elsewhere about how food intolerances cause a morale penalty rather than pain or nausea as some of their descriptions imply. If the morale system gets tweaked, new diseases modifying the player’s pain could take the place of those morale penalties. Plus then you couldn’t stuff yourself with potato chips and cola to offset uncomfortable dairy consumption, which makes zero sense. Heck, you could use that barf-on-command function from the nausea mutation to remove the new intolerance ‘disease’ instead. It’d suck, but it’d also make way more sense as a solution.
The nice side effect of this would be that I could look at my character stats and instead of seeing PAIN: 85, I’d see that, and under effects: Bee Sting, Acid Burn, Food poisoning, Broken Arm. It wouldn’t show me how much pain each is contributing, but it’d be a hell of a lot more informative as to why the hell my pain is so high so as to ruin my movement speed, as not all of that could possibly be pinned on food poisoning alone. I can always surmise that a limb with 0hp is causing me a lot of pain, but the less digging around to understand why everything hurts, the better.