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One thing about the Cage that you should know, was that Lucifer chose when you died, only to bring you back whenever he wanted. He could stab you with his favorite serrated knife and keep you writhing and gasping, but with a snap of fallen, angelic grace he would start all over.
For example, Sam could see his own intestines wriggling like a worm on a hook (that wasn't being impaled into his already torn and frayed body). His stomach was already empty of its contents and dry heaving only made the hooks inside him jerk and prod deeper into him.
While his intestine, still connected to him mind you, did it's best to squirm off its hook, the rest of him tried desperately to not think of the part of his flesh and skull that was missing, leaving the back, left side of his brain exposed. Or that his back was shredded enough for his ribs and bits of vertebrae to be seen. Or that some of said ribs were pulled out in some demented, twisted version of wings. Or that there was a gaping hole where his right eye socket should be. Or that there were spots on his arm and legs that were supposed to have skin and muscle, but instead there were jagged slashes and gouges from Lucifer skinning him with his teeth. He also tried to not think of Lucifer currently kneeling in front of him trying to dig his heart out with blunt fingernails. All while Sam was still awake and able to feel everything being done to him.
He should know by now to stop trying to catalog his torture, even if subconsciously. It never helped to distract him.
It was futile to wish darkness upon himself. The only reprieve he had was when Lucifer let him. Sam was almost thankful when he felt unconsciousness seep into his exhausted body and mind. And wasn't that a disturbing thought.
Sam could hear his heart thumping wildly while the devil dug into his chest cavity, acting like he was searching for the best treasure one could dream of. Fervent in his slashing, hacking away at chunks of flesh.
At one point Lucifer backhanded him, telling Sam he didn't want him spacing out for the best part. Since the best part was apparently him digging his heart out, he would've been perfectly fine within the confines of his own mind, thank you very much.
Sam was just glad that Lucifer wasn't tasting his blood again. He didn't think he could stomach Lucifer licking the blood off his finger and commenting about the taste of it again. How he could taste the demon blood still residing inside him, even in small doses.
There was a time when Sam would have fought Lucifer. Using every fighting instinct he had to postpone his torture. But after 5, 6?, 10? decades, Sam thinks he finally broke. He manages to surprise himself sometimes with a witty remark, but mostly he's silent now minus the screams and bellows of pain.
Just as Lucifer’s finger was prying to grab an artery, a blinding glow surrounded the Cage. When Sam had first jumped in the Cage, Lucifer and Michael's grace blinded him. It wasn't until after the seventh or so try after he was healed that his eyes didn't melt out of their sockets.
Even being used to seeing angel grace, it hurt to look at this one, but a feeling of warmth, safety, and familiarity covered his body and soul. It was familiar in a way and he would only admit to himself that it still scared him after years of angelic abuse.
He felt a tugging and all at once, he didn't feel pain anymore. For the first time in a long time, he felt hope, albeit apprehensively. At least, until he felt another's grace tug him back. It was excruciating. Sam felt like he was being split into halves.
Until he was.
A body and a soul, separate from each other.
His body pulled one way and his soul pulled another.
As soon as it came, the hope drained out of him. Swirling into blood, sweat, and tears.
Sam didn't have time to think before he was plunged back into pain and anguish, with the devil whispering poison and feeding rotten secrets to his soul once more.
Before Lucifer could heal him and start on a clean slate, or rather unmarred flesh, Sam had the sickening thought that whomever that grace belonged to should’ve gone ahead and killed him. Permanently this time.
It was so much worse feeling a sliver of hope and it being torn away then never having it in the first place.