The Language of Chronic Pain

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Background and Aims: Pain is a universal phenomenon, but it is also inherently private and subjective – there is no objective test for its existence. Sufferers rely primarily on language to render their pain public, to describe and qualify their pain experience. It has been suggested that pain language may thus provide the best tool to assess and measure pain (1). The McGill Pain Questionnaire (MPQ; 2) paved the way for incorporating language into pain research. However, more recent research has gone further and explored aspects of pain language such as metaphors (3) and linguistic and grammatical patterns (4). The objective of this study was to explore the ways in which those with chronic pain use language to speak about and describe their pain experience. Methods: Three focus groups were conducted with a total of 16 participants (age range = 22 – 74 years, mean age = 46.6 years) who were attending an outpatient chronic pain management program (average pain duration = 6.6 years). Participants were asked to describe aspects of their pain experience such as how their pain feels and how pain affects their lives. These focus groups were audiotaped, transcribed verbatim, and analysed via thematic analysis. Results: The key themes and subthemes identified were: Isolation (Invisibility of Pain, Difficulty of Pain Expression, Suffering Alone, Separation from Others, Shame), Physical Sensations of Pain (Size and Weight, Strange Sensations, Temperature, Piercing, Aching, Making Pain Relatable), Pain Personified (As an Adversary, As External to Self), Pain as Overwhelming (Unrelenting Nature of Pain, Loss and Ruin), and Coping with Pain (Holding on and Moving Forward, Finding Positives). Across themes, participants utilised metaphorical language and spoke of their pain in an externalizing fashion, personifying it as an adversary and as outside of their self. The physical, sensory aspects of pain were subsumed by a personal narrative of pain and its effect on the sufferer’s life, particularly in terms of social isolation. Conclusions: The dependence on metaphor may suggest something of the nebulous, subjective nature of pain, but also of the desire to communicate it to others. The externalisation of pain, as well as the personification of pain as enemy, may render it tractable, able to be treated, fought against, and expelled from the body. This linguistic separation from pain may engender hope and resilience. Further, it seems important for participants to be able to situate their pain within a whole person narrative context of personal meaning. This study shows that pain language is complex, suggesting that single word adjectival measures such as the MPQ may be inadequate to capture its nuances. (1) Melzack R, Torgerson WS. On the language of pain. Anaesthesiology 1971;34(1):50-59. (2) Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1975;1(3):277-299. (3) Semino E. Descriptions of pain, metaphor, and embodied simulation. Metaphor and Symbol 2010;25(4):205-226. (4) Lascaratou C. The Language of Pain: Expression Or Description?, Vol. 9: John Benjamins Publishing, 2007.
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