acute, afflictive, agonizing, atrocious, biting, consuming, cramping, cruel, desolating, distressful, distressing, exquisite, extreme, gnawing, grave, griping, hard, harrowing, harsh, heartbreaking, heartrending, heartsickening, heartwounding, hurtful, hurting, insufferable, intense, keen, painful, paroxysmal, piercing, poignant, pungent, racking, rending, severe, sharp, shooting, spasmatic, spasmic, spasmodic, stabbing, stinging, tearing, tormenting, torturing, torturous, unbearable, unendurable, vivid