Learn Spanish (Latin America): ¡Cuánto duele la espina!

In English, we say "How much...!" or sometimes just "How it hurts!". In Spanish, when you want to express the degree or intensity of an action, you use ¡Cuánto! with the verb. ¡Cómo! is usually used to exclaim about the way or manner something happens. Since we are talking about the intensity of the pain, ¡Cuánto! is the right choice.

Does cuánto need to match the feminine noun la espina and become cuánta?

No, because cuánto is describing the verb duele ("how much it hurts"), not the noun la espina. When cuánto modifies a verb, it acts as an adverb and stays in its default masculine singular form. It only changes to cuánta, cuántos, or cuántas when it directly describes a noun (like ¡Cuántas espinas! - "How many thorns!").

Why is it duele la espina instead of la espina duele?

In Spanish exclamations, it is very common to invert the word order and put the verb right after the exclamatory word. So, right after ¡Cuánto!, we place the verb (duele) and then the subject (la espina). You will hear this same flexible word order in questions, too.

I usually see the verb for "hurts" written as me duele. Why is there no here?