Making sense of pain

Humans have an incredible desire for things to make sense. We want things to fit a story or what’s expected – and we get right discombobulated (it’s a word) if we encounter a situation where things don’t make sense. To a certain extent we can blame our use of language for this, because it’s the way we’ve learned to pair words with concepts, and to associate multiple concepts together. For example, we learn “ouch” is associated with that unpleasant sensory and emotional experience that we’ve learned goes along with scrapes or bumps or cuts. We’ve also learned that “ouch” goes along with “it will go soon” and “don’t use that bit too much or it will hurt for longer” as well as “big boys don’t cry” and “you’re just being lazy if you don’t suck it up” and “whiners talk about their back pain all the time” and other similar notions. This is how humans connect visible objects (nouns) with words and other invisible concepts to create a network of meaning that, among others who share similar language and culture, means we can communicate with one another and go beyond the here and now and into the future and recall the past.

Even when events don’t make sense, we struggle to create a sense from it – we even say things like “this doesn’t make sense” as a way to classify the event along with a bunch of other “events that don’t make sense”. 

Why does this matter?

Well, because we want life to make sense, and to understand what we and others are up to, we create meaning and sense (coherence) even where there is no sense. Sometimes we grasp at straws (otherwise known as explanations from people who may not actually know what’s going on, but can spin a good tale). And at times, grasping at these straws means we ignore our own experience just so we can  hold on to what we think ought to be there. Here’s an example: some of us have back pain. We don’t know why it started, but we try to make sense of why we experience it by drawing on things we’ve been told by others – we might blame age, lifting “incorrectly”, weak “core” muscles, or differences in how long our legs are. Now the explanation itself doesn’t need to even be accurate – what’s important is that by accepting an explanation we become less sensitive to alternative explanations, and even more importantly, we begin to ignore what our own body feels like because we think we should believe what an expert tells us.

The problem with trying to make an explanation work for us, when it’s not necessarily so, is that in adopting that explanation we may find it a lot more difficult to respond flexibly to different situations. For example, if we’ve learned that back pain happens because of poor posture (where “poor posture” means not holding the spine a certain way), then we have more difficulty doing things when we’re in situations where being hunched over is the only way to get into an awkward situation, like when we have to lift a child into the back seat of a car, or put the pots back into the back of the bottom shelf of the cupboard.

Explanations for pain

Because pain is so common, and critical for human survival, we hold deep and powerful beliefs about what pain should mean, and how we should handle it. We probably all learned that pain is temporary and generally settles down once tissues have healed. We might have learned to hide our tears and not to ask for help when we’re sore. We probably grew up knowing that if tissues are really mangled, then it really hurts, and if it’s a paper cut it shouldn’t bother us. And we learned all the myriad concepts associated with pain – like being too withdrawn or tearful means we’re not really very brave, that if we get angry and hit out at someone who’s helping us with our pain, it’s very bad. We learned that it doesn’t hurt as much when someone “kisses it better”, and we learned that we should find out what’s wrong, get it fixed, and get over it.

But what happens when pain violates our past experience and all the explanations we’ve been given before?

What if we have pain that doesn’t disappear? What if the explanations we get given don’t fit with our own experience? What if the very things we’ve been told to do to “help” our pain actually make our lives worse? What if we’re clinicians who find that all the things we’ve been told should work – just don’t.

If we’ve been good learners, most of us will be unsettled by these inconsistencies. Things don’t add up. We probably keep on looking for “the answer” that will fix the problem. We’ll probably feel guilty and perhaps even a bit embarrassed that this pain is different. We might doubt our own experience and worry that we’re being just a bit pathetic or a really don’t want to get better. Or if we’re clinicians, we may wonder if the person wants to get better, or if they’re really doing the exercises the way they should…

And this isn’t helped by well-meaning people who might suggest that we should keep on looking for “the answer” – even when doing this gets in the way of important things we want to be able to do! So we might take the pills that make us feel groggy and constipated. We keep on doing the exercises that are boring and don’t seem to change anything. We do these things not because they work – but because we think they should work. And so we all get frustrated and irritated and just don’t live lives of richness and fulfillment. Perhaps we forget what we want our lives to stand for anyway.

Difficult conversations

It isn’t easy to talk about pain that doesn’t do what it ought to. Our very human nature makes the situation difficult. I’m hoping that by beginning to think more contextually, more about what works in the here and now, about having a range of options to try so we don’t get backed into an unworkable corner just because that’s what someone has suggested should work, that we the people (those living with chronic pain and those working with those who live with chronic pain) might gently and creatively develop some flexibility around what can be such a sticky  concept. Maybe that’s what resilience is?


Musings on new learning

Over the past week I’ve been reading a book on embodied cognition, Intelligence in the Flesh: Why your mind needs your body, written by Guy Claxton. In this book, Claxton argues that we place far too much emphasis on abstract ideas of language and intelligence, and fail to recognise how intertwined our body and brain systems really are. It’s fascinating and raises many ideas and questions for me when I think of our pain experience.

To add to my musing, I had the great pleasure of attending the Australia and New Zealand Association for Contextual Behavioural Science conference in Wellington where I had the opportunity to have my mind blown by Steven Hayes and colleagues talking about a way of viewing language and behaviour from a functional contextual perspective (lots of links in this post because I can’t hope to do justice to the topics and I hope you’ll take the opportunity to click through to read more).

The truly weird thing is the links between these two aspects of being human: the one in which language is viewed in the context of whole body systems, and the one in which language (and thought) is viewed as a behaviour that develops as we grow and make connections between what is “out there” and what is “in here” – and all the abstract things in between.

I have no idea where this post will lead to, but here goes!

Let’s begin by thinking about how a baby experiences pain. Not that long ago it was believed that because babies can’t remember early life experiences and don’t have language to represent their experience, they didn’t feel pain. This, despite all of us knowing that when a baby is surprised by something external to them, when they want or need something, and times when they respond dramatically to an injection or being bumped, they react! And they react loud and clear.

Babies grow up into toddlers, and as they do we notice they develop associations between symbols and objects and experiences they interact with. Kids without hearing, in an environment where they’re surrounded by people using sign language, quickly develop the capability to represent experiences and objects with movements that mean something both to them and to those around them. Embodied cognition approach argues that the network of physiological responses flows in cycles between body and multiple parts of the brain to stamp “expected” patterns that begin to represent the world around us, and inside us. And we develop associations between internal and external objects that ultimately loop around many bits of the brain to ultimately be represented by symbols – words either spoken or gestured. Actually, according to Guy Claxton, these initial representations unfurl like ferns as a welling-up of associations and actions with multiple potential associations and actions that are either dampened down by past experience or allowed to develop dependent on intentions.

So, for example, a baby has a bunch of signals from his or her belly that flow and cycle around to various parts of the brain and endocrine system that represent what we know as “hunger”. Maybe initially it’s an urge to recapture that warm, safe, satisfied experience of having a full belly, but over time these signals develop more complex associations, with some representing “hunger”, others “milk”, “food”, “mummy”, “give me”, “want” and so on. As the baby develops, the associations between experiences and representations become far more complex and largely out of our “conscious” awareness, and these representations begin to develop a life of their own, so that as a two-year old, around dinner time, all those associations of “hungry”, “milk”, “food”, “mummy”, “give me”, “want” clamour for attention and the toddler has a melt-down! Seriously, perhaps for a toddler, being given a carrot which doesn’t fit with all those associations of  “hungry”, “milk”, “food”, “mummy”, “give me”, “want” actually doesn’t fit with the representations the toddler is trying to achieve at dinner time.

Let’s think about pain then. When a baby experiences the “yukkiness” of an empty belly – or the absence of “warm”, “mummy”, “food”, “safety” – he or she responds by crying. A baby’s whole body gets in on the act (you go watch one cry!) – and we respond. We use a bunch of words to talk to a baby when they fall down or get hurt – and they quickly learn that falling down or getting hurt isn’t nice – and that someone will come get them when they cry. Over time these experiences accumulate and the words we use for pain become associated with lots of unpleasant experiences like – cold, hungry, sad, tired, afraid, ouch, scratch, sore, comfort, abandonment, worry and so on. Soon enough any time we hear the word “ouch” or “pain”, or see a scratch or someone falling or ourselves falling, this constellation of associations are all activated, some more than others! Given how long we’ve been pairing all these associations together, it’s no wonder that pain, any pain, holds a whole bunch of meaning for us, many of which are deeply physical but also psychosocial.

At the same time as we make these connections, we’re also beginning to view “me” or “I” as somehow separate from what happens to us, and we’re all familiar with our internal narrative. This narrative contains not only the words we use to describe or narrate what’s happening, but also all those experiences and associations that go along with them. In contextual behavioural science, the representations of words, concepts, and all the associations between where, when, and how we connect these things are viewed as just as important as the words themselves.  This matters when we begin to believe that the representations (words, language) actually ARE what they “stand in for”. So, for example, if the word “pain” links with a whole bunch of experiences body processes, including perhaps not being helped to feel secure, or of fearing the worst, or of bad things happening to others around us (in life or TV even), it’s likely we’ll be experiencing those things as if they were happening in real life now. Pair that word with body experience which brings the whole to life again (in ways we can’t always express in language), and it’s no wonder many people are truly afraid of what’s going on – and act accordingly, perhaps without not really realising that this is happening. It’s like the unfurling of associations and actions occur independently of what we call “conscious thought”.

I know this is a fairly simplistic account of what I’ve been reading and learning about – and I have much more to learn and explore! But it strikes me that if our bodies are so comprehensively intertwined with the “what it is like” to be living in our world, it’s no wonder that only providing education about pain may not always be as powerful as we’d like. It helps me understand why experiencing our bodies doing things in different contexts while feeling safe/secure is so necessary. It also gives me more confidence that using metaphors (which represent our world or situations in symbols that straight words may not elicit) helps draw on these embodied representations and may elicit change more quickly than trying to “convince” or “tell” someone what’s going on.

I’d love to hear your thoughts – join in the conversation and let’s help each other make sense of this very groovy neuroscientific approach that integrates the social into our biopsychosocial framework.

The language of pain
Have you ever wondered about the ways we communicate our pain? Pain behaviour doesn’t just include nonverbal communication – one of the main ways we communicate our pain is through speech. Words are an incredibly powerful aspect of pain behaviour that strikes me as something we haven’t really studied much. When I was searching for the article to refer to in this post, I looked in PsychInfo under the terms “linguistics” and “pain” – and out of the tens of thousands of articles under each term, and total of 16 included both words. Sixteen!

The stimulus for this post comes from someone who said the term “catastrophising” is a misnomer – a way for health professionals to dismiss or minimise the suffering and distress someone who has pain is experiencing. In this person’s words “Now its no longer just a buzzword but a label that pain docs like to attach to everyone in chronic pain who indicates they are suffering. And of course as most pain docs dont particularly care for hearing about suffering of those in pain they then attempt to get them to go for some cbt or psychotropics.”

Now, I preface this next section with the notice that I’m no linguist (although it’s something I’d love to learn about!).  But in a paper by Elena Semino, it’s absolutely fascinating to read about the ways in which people describe pain – she starts by saying “sensations conveyed by the English word pain tend to be described via expressions that refer to potential causes of bodily damage.”  Note the word “causes”.  She gives the example of someone describing their pain as “sharp“, “like a rake over my eyes and head, digging in and scraping away”, noting that “expressions such as “sharp pain” function metonymically when they describe pain that directly results from physical damage, and metaphorically when no such damage is involved”.  (BTW Metonyms are figures of speech that replace a word with a word that is intimately associated with that thing or concept.  For example, in New Zealand “the Beehive” refers to Parliament, because that is the name of the building in which Parliament is housed.)

The reason we use terms like “sharp” or “stabbing”, argues Semino, is that “that these uses of metaphor may facilitate some form of internal embodied simulation of pain experiences on the part of listeners/readers, which may in turn provide the basis for an empathic response.”

Pain behaviour of all types functions in the same way – evolutionary psychologists suggest that they are remnants of early signalling behaviour designed to elicit a response from those around the individual.  It makes sense that if a group of prehistoric people are hunting, someone who has pain can signal to others through crying or groaning that “something’s wrong”, hopefully eliciting some sort of caring behaviour from the rest of the troup, with the withdrawal response later helping the individual remain still and quiet in the back of the cave so as to minimise the potential for sabretooth snacking!

What Semino and others postulate is that the language we use when describing pain draws upon the neurophysiological aspects of shared experience or empathy – the “mirror neurones”.   fMRI studies of the anterior cingulate cortex, the bilateral anterior insula, rostral anterior cingulate cortex and the sensorimotor areas of the neuromatrix (aka “pain” matrix – but this is probably a misnomer) show these are activated when individuals observe another person experiencing a painful procedure or hear words describing these procedures. 

Semino quotes Avenanti et al., (2005) who suggests that there are “two forms of empathy linked to one another in an evolutionary and developmental perspective.  A comparatively simple form of empathy, based on somatic resonance, may be primarily concerned with mapping external stimuli onto one’s body.  A more complex form of empathy, based on affective resonance, may deal with emotional sharing and with the evaluation of social bonds and interpersonal relations. p.958”.

Semino therefore proposes that metaphorical descriptions of pain that allude to causes of physical damage may trigger embodied simulations of similar experiences – and that both types of empathy are enacted when we use descriptive metaphors when talking about pain.

OK, where does this leave us when thinking about “catastrophising”? Catastrophising is the tendency to “think the worst” in a situation.  An example might be saying “my headache is killing me”.  Catastrophising influences an individuals appraisal of their situation.  Although this way of describing their situation does convey an individuals level of distress, catastrophic interpretations actually impede effective problem solving and active coping.  Catastrophising is associated with increased disability, high distress, low mood and high helplessness.

Is it normal to catastrophise?  At times, yes.  Most of us will do a little catastrophising from time to time, if we’re honest with ourselves.  But even if it’s normal, catastrophising isn’t helpful.  Again, most of us will catastrophise for a short while, then change our thinking and begin to speak differently and approach our situation differently – usually with a view to taking steps to exert some level of control over our situation.

I think it’s important to consider our use of language as health professionals, and it’s one reason for thinking about how we write reports, for example.  While we have our own technical language and use it amongst ourselves (and the term catastrophising is one of them) we need to be aware that people who don’t know the meaning of these terms can misconstrue them.  And in the case of some patients, feel misunderstood and sometimes offended.  We need to think about this and avoid using jargon where practicable.

More importantly, we need to be incredibly careful not to use terms in a pejorative or dismissive way.  We’ve moved a long way from describing a woman with pain as being “hysterical” – but terms like “functional pain” or “supratentorial” or “malingering” can still be found in some reports.

I think the best thing we can do when we’ve been talking with someone who does “catastrophise” is make it clear that we are not dismissing their pain as less than what they say it is, but instead to be sensitive to their language and reflect that their pain is very distressing and difficult to deal with.  Because in the end, that’s what the language used when sone tends to catastrophise is intended to elicit from us. 

Descriptions of Pain, Metaphor, and Embodied Simulation Metaphor and Symbol, 25 (4), 205-226 DOI: 10.1080/10926488.2010.510926

Avenanti, A., Bueti, D., Galati, G., & Aglioti, S. (2005). Transcranial magnetic stimulation highlights the sensorimotor side of empathy for pain. Nature Neuroscience, 8, 955-960.

April already!

It’s April and time for a change of season, sadly.  For us in the southern hemisphere it means we’re moving swiftly into autumn, with the leaves outside my house becoming yellow and fluttering to the ground, and the hint of chill in the air at night and early morning.  After a weekend away, it’s a bit hard to sit down and write!

And what a weekend it was – I had an absolutely wonderful time at PainLang in Brisbane.  A four-hour forum of discussion and dialogue between a couple of really wonderful people including Professor Harold Merskey, originator of the now internationally-adopted definition of ‘pain’, Professor Jenny Strong from Queensland University, Professor Roland Sussex also from Queensland University, and a range of other researchers and clinicians who all were able to contribute to a wide-ranging discussion about the language of pain.

For me, a highlight had to be hearing Professor Merksey talking about how the definition of pain was first adopted, and his ongoing work in the medicolegal field of defining pain and disability, and establishing that there is a widespread but probably false impression that musculoskeletal pain such as whiplash is short-lived.  Some of his research and particularly his re-analysis of several studies, demonstrated that due to inadequate outcome measures and methodological limitations, there is an impression that all but a small percentage of people completely recover within three months – but in fact, somewhat closer to the truth is that around 10% of people take longer than 12 months to completely recover.  What confounds the assessment of outcome is lack of a consistent measure, and indeed it’s common for measures of:

  • pain intensity
  • disability
  • return to work
  • case closure based on ‘end of rehabilitation’
  • cessation of compensation

all to be used at different times to establish an  ‘outcome’ that is then used to determine how long it takes to recover from a musculoskeletal injury.   This creates problems when respected organisations quote figures drawn from studies without rigorous methodology and use the results from these studies to dictate policy such as duration figures for rehabilitation, types of treatments funded, or to establish whether compensation will be continued.

Another person that I listened to and think of as a kindred spirit is Professor Roland Sussex.  He is a linguistics professor and he and Professor Jenny Strong are working together to review the very commonly-used and well-known McGill Pain Questionnaire.  This is the instrument that provides a list of words, and asked the person with pain to identify the words that apply to him/her.  It was developed in the mid-1970’s, and reflects both the language and the concepts of pain from that time and the culture of North American middle-class white professionals.  Why do I think of Prof Sussex as a kindred spirit? Well, he’s a magpie for bits and pieces of information which he gleefully collects and notes down, and pulls out in conversation which is erudite, ranges over an enormous range of topics, and is entertaining and thoughtful.  While I can’t profess to achieve the level of knowledge of Prof Sussex, I too have that tendency to collect and pick over a range of tidbits of information that seems to scatter around me – and lo! and behold, it comes out on this blog!!

So, what did he have to say?  Well, the poor McGill, which is an instrument I have never found useful and have rarely used, has some linguistic features that make it a product of its time, and one which needs some thoughtful consideration before deciding to use.  There are several words in the instrument that are rarely found in the conversations of the people I see in my clinical practice: lacinating (which according to a number of on-line dictionaries means characterized by a sensation of cutting, piercing, or stabbing), torturing, gruelling, searing – to name a few.  The instrument also categorises these words, but the categories are not necessarily mutually exclusive, and although each category apparently ranges from less severe to very severe, this isn’t particularly clear.

Some other concerns I’ve had with the McGill also came up – the cultural bias of an instrument developed in the US for english speakers means that people from other cultures are disadvantaged by it.  We simply don’t know whether it’s possible for someone who doesn’t speak english as a first language would think of these words when describing their pain.  There are some words that are very specific to pain (eg lancinating), while there are other words that are used far more generally for many other things (eg hot, cold, burning), and this makes it especially difficult for people from other cultures to translate.

I’m not sure whether the McGill was ever meant to be a substitute for simply talking about pain, but I’ve seen it used for a wide range of things in the pain literature – from ‘diagnosing’ pain sub-types (eg neuropathic pain), to measuring outcomes of treatment, to simply being part of a battery of tests to ‘understand’ someone’s pain.  There are always concerns when we try to understand another’s pain – we can never know the qualia of another’s pain (just as we can never know whether we each see the same ‘blue’, although we use the word about the same/similar wavelength of light).  Constraining someone to a tool like the McGill doesn’t seem especially helpful for me clinically, so I’ve preferred to talk and come to some sense of understanding, albeit filtered through my own language filters, and through the filters of the person I’m talking with.

Any assessment we use will be subject to certain other ‘cultural’ aspects of communication.  This is because in order to understand another’s pain, we rely on communication, and communication is social and cultural.  Communication involves at least two people, some shared communication conventions (folkways or mores), it relies on the ability of each participant  to have a message to communicate, a method to encode it, transmit it, for that message to be received, decoded and comprehended.  Lots of opportunity for error to creep in!

Think about some of the features that are present in any conversation about pain:

  • the person with pain needs to decide whether their pain is something they wish to communicate about
  • once they decided to communicate about it, they consider/process the aspect they wish to project – and we are quite selective about what we communicate.  For example, do we want to demonstrate stoicism? martyrdom? bravery? anxiety?
  • the actual process of determing what to communicate is filtered through often subconscious processes – how many of us from a Judeo-Christian background really think about the way our Judeo-Christian heritage conceptualises pain?  Of heroes, and saints suffering, and pain as punishment, and retribution and how it was visited on Job to ‘test’ him, and removed only with God’s will?
  • And what about our own family’s view on pain? Are we from a family where pain is discussed? or one where we were told to ‘put up or shut up’?  Was one parent very vocal about pain, and what impact does that have on us? Like the child of an alcoholic, who may ‘blame’ the parent for either abstinence or alcoholism, we too may be reacting to situations in our early life…
  • And culturally, we may be from a culture where certain pains are NEVER discussed (vulvodynia, painful periods), or we may be of an age or in a state such as pregnancy where every horror story of childbirth is discussed in intimate detail.
  • Our gender makes an impact on what we will discuss, with whom and in what detail…
  • Our power in a relationship as interrogator, subject or equal makes an impact on what is asked, by whom and when – and what is answered, by whom and when
  • and finally, once a decision is made to communicate about pain, it is moderated by the response of the other person in that conversation to either increase the frequency of ‘pain talk’ or decrease it.

I’ve talked before about the words that we use when talking about pain – the importance, to me at least, of the ‘social’ in ‘psychosocial’ assessment, for fear that the interaction between the person and his or her environment (both social and nonhuman environment) will become lost.  I’ve also talked about the language of ‘injury’ being used in some circumstances, but not in others (the head’ache’ is different from the back ‘injury’???).

So, a fruitful weekend, one that I will recall very fondly indeed – a toast to Jenny and colleagues for organising such a rich and enjoyable feast for me and the others who attended!

Words, words, words

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…

Red Rose

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.

If you’ve enjoyed this post, want to see more, or if you haven’t enjoyed this post and want to put your opinion forward – don’t forget to make a comment! And you can subscribe using the RSS feed above, or simply bookmark this page.

Mind your language

Often I hear people with ongoing pain talk about their ‘injury’.  Ouch!  This makes me feel worried – when pain persists, it’s no longer an ‘injury’ it’s pain! Pain itself is enough!!

The power of the language we use when we talk to people with pain is incredible, and often we forget that the words we use might mean something quite technical, but to people on the street the common meaning is the one they remember.

Let me give you some examples…

Injury: “I have a back injury” vs “I have a head injury” – “I have a back ache” vs “I have a head ache” – quite a different implication!

Instability: “You have back instability” vs “You use your muscles inefficiently” – instability means ‘Oh no, my back is going OUT!’   (where is your back going to??)

Desiccation: “You have desiccated discs” vs “Your discs are showing signs of getting older, they’re losing a bit of water” – desiccation means ‘My back is crumbling away like desiccated coconut leaving me with bone grinding on bone!’

Even psychological terms can have considerable impact

Maladaptive thinking: “Your thoughts are maladaptive” vs “Your thoughts are unhelpful”

Catastrophising: “You are catastrophising” vs “You think the worst – which isn’t helpful”

Coping: “It’s time to learn to cope” vs “It’s time to learn how to do things differently”  (surely if I’m still doing things, still alive I’m coping?)

Depressed: “You’ve got depression” vs “You are feeling demoralised and run out of hope”

Psychosomatic: “Your pain is psychosomatic” vs “I don’t know why your pain is carrying on, but it’s related to your whole body including your brain and mind” – ‘Psychosomatic? That means you think I’m imagining it!’

Inviting pain talk: “How are you today? What’s your pain like?” vs “What have you been up to? What have you been doing?”

So – think about what you say to people, use common language phrased in positive ways, and ask the person what they have heard.

Two articles (a little elderly but still interesting)

Schott, G. (2004). Communicating the experience of pain: The role of analogy. Pain Vol 108(3) Apr 2004, 209-212.

Stanford, E. A., Chambers, C. T., & Craig, K. D. (2005). A normative analysis of the development of pain-related vocabulary in children. Pain Vol 114(1-2) Mar 2005, 278-284.

My blog’s readability stats!

cash advance

Hah! I’ve finally managed to dumb down my language to suit undergrads!! Yay!!

I’ve tried to keep my writing relatively simple and understandable – jargon drives me nuts but I know I can be verbose. Thanks to Dr Deb for her pointer to this wee tool – try it out on a website near you!

On a more serious note, it’s amazing how often we use jargon amongst ourselves and even with the people we work with. What exactly are ‘valued activities’, what is a ‘lived experienced’, why do we say ‘cognitions’, and what does a change of two points on an outcome measure actually mean?

I’ve just been writing an application for Ethics Approval, and trying to write out the information sheet and consent form using the wording that has been provided by the Ethics Committee…talk about jargon! I’ve been a fan of ‘plain english’ instead of gobbledygook for years and years – and still I see forms and patient information sheets that reek of long-winded doublespeak.

A plea from the heart – if you want to give information out to ‘the general public’, remember that brevity, being concise, and short, active, snappy sentences are much more likely to be read than pedantic, lengthy and passive tomes. Lots of white space, illustrations to make a point, and good use of bullet points make me want to read on.

And if you want a really great cartoon to make a point – take a look at Randy Glasbergen’s lot – they’re brilliant!