It’s like a knife in my shoulder! My disc has slipped. My leg is dead. I have pins and needles!
As creatures who like to communicate, we often describe our experiences, whether good or bad, through metaphor and simile. Pain is one experience that is very hard to visualise. Try and describe a painful sensation without using a simile or metaphor — it’s not easy. For most people, the simplest way to describe the feeling of something like nerve pain is through the metaphor of ‘burning’ or ‘stabbing’. However, recent developments in the psychology of pain has revealed that the use of negative or catastrophizing metaphors to describe pain, medical conditions or injury has a detrimental effect on the patient experience. It’s possible the words we use to describe pain can actually increase the amount of pain we feel!
How does pain work?
With this in mind, it’s important to realise thoughts and feelings are as much nerve impulses as the danger message coming from the injured body tissue itself. The imagery created by a pain metaphor or simile can therefore have a big (if not bigger) impact on our pain experience. This is even more likely when pain sticks around longer than it should — often called chronic or persistent pain.
“Our brain is constantly trying to evaluate the balance of danger and safety, and anything that biases it towards a threat, will likely cause or increase pain,” says Dr Anna Devlin, a psychologist in the pain management team at Epworth.
“Pain recovery is about leaning towards the safety side of the equation. Changing our language is one way we can do this and is best done as early as possible.”
How can we change our language around pain?
Identifying some of the negative ways we express our pain is the first step. These expressions can come in many forms, and, while often innocuous, they may contribute to an overall negative view of the body part in question.
Some seemingly innocuous metaphors:
· My joints are wearing away
· Trade you in a new knee
· My neck is out
· Your arthritis in your hip is bone-on-bone.
These examples could be exchanged for:
· My joints are aging normally
· You will have a stronger titanium knee inserted
· My neck needs to move more
· You have arthritis in your hip. It is best managed with exercise and weight loss.
“There are probably more curly and scary-sounding metaphors for pain and injury around the spine than any other condition. These are so pervasive yet incorrect, and have huge ramifications in the way we think, move, feel and behave,” shares Jack Behne, senior physiotherapist in pain management.
“As a result they are often one of the first things we approach when we manage back pain in-clinic,” Jack says. “In many metaphors the fragility of the back is a common theme and in most cases untrue — the back is actually very strong. Discs don’t slip!”
At the end of the day, the metaphor most worth challenging is that pain is our enemy, and that recovery and rehabilitation are a form of battle.
It’s important we regularly reinforce that pain is a protector — it’s a wonderful buffer that keeps us safe. It’s more of an angel looking over us, than the devil we often see it to be.
For more information about the effect and power of metaphors in health, it’s worth having a read of the blog over at http://www.noijam.com
July 24–30 is National Pain Week. For more information visit www.nationalpainweek.org.au or tweet #NPW17.