What’s in a name? A rose is a rose is a rose by any other name…but those thorns still hurt.
Sticks and stones may break my bones, but words will never harm me… except at night when I’m lying awake and worrying…
Well as we all know, words do hurt, and often unwittingly especially in the area of pain management.
As health professionals, we use specialised language that sometimes can be misinterpreted by the people we are trying to help – a good example is the term ‘disc prolapse‘. To many people this means ‘disc collapse‘ which means ‘there is nothing between my vertebrae, I have bone rubbing on bone…’ Or disc degeneration, meaning a similar thing instead of merely being grey hair of the back!
While we use words to mean specific things, so do the people experiencing pain – but who knows whether we are in fact speaking the same language? It’s impossible to REALLY tell whether someone’s experience of ‘sharp’ pain is the same as the ‘sharp’ pain that we feel — just the same as we can’t tell whether the colour blue WE see is the same as the colour blue YOU see.
Coincidentally today I was thinking about the difference between calling an assessment a ‘psychosocial’ assessment, and calling an assessment a ‘psychological’ assessment. Even apart from the professional boundary issues, the concept of a psychosocial assessment, to me refers to ‘the interaction between the person and their social environment, and the influences on their behaviour’
A psychological assessment which implies assessment of psychological processes. The process of psychological assessment involves ‘a process that involves the integration of information from multiple sources, such as psychological tests, and other information such as personal and medical history, description of current symptoms and problems by either self or others, and collateral information (interviews with other persons about the person being assessed).’
I see the definition above as being pathology- or diagnosis-focused, looking at the individual and the problems they have. Now I know this isn’t necessarily always so – but by definition, a psychosocial assessment, to me, means using a similar process of collecting information from a variety of sources – but not only about the individual’s experience, but also those factors that could be contributing to disability, and especially social or community interactions that may be contextual to the individual’s presentation. A psychological assessment doesn’t have this flavour.
And of course, a critical component is that a lot of health professionals are skilled, competent and capable of carrying out a psychosocial assessment, while a psychological assessment is carried out by a psychologist.
In pain management, understanding the individual’s experience of pain, and then developing possible explanations for the interaction between various factors – both initiating the experience, and then maintaining the experience (particularly when disability or functional restriction is the key feature) – is critical to developing an individualised plan to help the person manage. This means including contextual factors like the employment situation, family roles, cultural factors, and needs to incorporate resources as well as deficits.
In the end, assessing the pain experience of the individual will require some level of mutual communication – without it, YOU will never know MY experience. This means some sort of language be it verbal or nonverbal will need to be transmitted. And we will need to include not just information from one or two domains, but from many, and from multiple sources including the social context, or we risk missing really important aspects of the individual’s experience that will impact on his or her disability.
So, in preparing this blog I did a wee search on lo! and behold! someone I really respect in the pain field, Professor Jenny Strong, Occupational therapy background, is chairing Pain Lang in Brisbane on Friday, March 28 2008, 12 – 5pm. This is a forum that aims to:
- to present an overview of the current state of play in research on pain language
- to investigate specific topics in pain language, especially in relation to the McGill Pain Questionnaire
- to explore current studies at the cutting edge of pain language research
- to explore social suffering associated with chronic pain, especially in the relation between the language of pain and other pain indicators and symptoms
- to explore avenues for future research, both on pain language itself, and in its relation to non-language issues in pain diagnosis, treatment and management
Judging by the quality of the speakers listed (Professor Harold MERSKEY, Professor Roland Sussex (The Linguistic Perspective on the Language of Pain: Meaning, Metaphor and Discourse), PhD Candidate Amanda Neilsen (Social Suffering Experienced by People with Chronic Pain)), this is going to be a GREAT forum, with plenty to learn – and an opportunity to mix and mingle.
BTW I am NOT getting any commission on people who attend as a result of this post! I just think it’s a great opportunity to learn, and it’s really relevant to what I’m looking at in this post.
All the best to the organisers and speakers – it sounds like a great forum.
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