Chronic Pain Language Police …. Look Out!
Simon West (Exercise Physiologist – Burnie)
Language is a powerful influence on how we view ourselves and our situation in relation to pain. It is important to note that, as Pain Neuroscientist Lorimer Moseley would say, “pain is not an input into the brain but rather an output” or ‘the end result”. This output from the brain, called pain, might be based on inputs from the tissue, called nociception (danger signals), as well as contextual elements such as past experiences, memory, other relevant information and emotion.
Words and language are a well-used method of conveying emotion and feelings in relation to pain and, given that the pain experience is reliant on an emotional response to a stimulus, it can therefore influence the amount of pain experienced. So too metaphors that paint an image of what the pain is or potentially doing to you can also influence pain levels up or down.
Examples of pain descriptive words that describe the sensation may include ‘burning’, ‘heavy’ or ‘shooting’ but words that describe the emotional impact might include ‘crippling’, ‘relentless’, ‘miserable’ or ‘killing me’. Examples of common metaphors that might be used to describe pain might include:
“it’s like a nail is being hammered into my heal”
“a red-hot poker is drilling into my back”
Given the purpose of pain is not to tell us how much damage there is at a site, but rather to serve only as a warning system to get us to pay attention and assess the situation (i.e. protection), any words in an alarming context will put the system on higher alert which can potentially increase the pain output.
Similarly, any relevant information, particularly if it is from a credible source (e.g. healthcare worker) may serve to influence the pain network. Pain specialist Michael Vagg discourages student doctors form using statements such as:
“You have the worst Xray I have seen”
“Your back is a mess”
“you have a slipped disc”
“bone on bone”
This may serve to make the recipient of this news think that the area needs even more protection …… protection by way of pain, to ensure that the area is not further damaged and to prevent a further increase in pain. This can occur even with relatively safe activities.
Pain Australia have some suggestions even for when we are talking about people with chronic and persistent pain. Even a label may change the way you think about your pain. These might include some of the following:
What to say | What not to say |
A person/people with chronic or persistent pain | Sufferer |
A person/people living with chronic or persistent pain | Victim |
A person/people with a diagnosis of chronic or persistent pain | Afflicted |
People are not unsuitable for treatments: treatments are unsuitable for them. |
They also provide a list of preferred terms that might help to reframe the real impact in our sense of control, helplessness or hopelessness when describing pain.
If you are looking at preferred terms when talking about the impacts of chronic and persistent pain Pain Australia have a list of preferred terms:
• Disabling
• Challenging
• Life-changing
• Stressful
The following terms should not be used:
• Hopeless
• Unbearable
• Impossible
• Tragic
• Devastating
The amount of tissue damage might not be impacted greatly with language but our nervous system and brain’s response to a perceived threat may serve to turn up or down the volume of the pain output. Your pain language matters ….. A MESSAGE FROM THE PAIN LANGUAGE POLICE!
References
Mosley, Lorimer (2014) https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=3544
Vagg, Michael (2015). ‘The right words matter when talking about Pain’. The Conversation,
access online here: https://theconversation.com/the-right-words-matter-when-talkingabout-pain-50450
https://www.painaustralia.org.au/media/newsletters/issue-84/language-guidelines-for-chronic-pain