Obvious flash .... more "ambient" lighting would have been better.
I can't discern what she is doing. Don't be offended. I love the idea I wonder what these hands trying to hold a teacup would have looked like. (weird thought...good picture though going with the title, depicting pain associated with the simplest of tasks.)
This would be a very good photo if it were not so dark. Just a little bit of editing could have done wonder for this photo and no doubt given it a much higher score.