The Language of Pain: New Understandings
- Publication Type:
- Thesis
- Issue Date:
- 2021
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Chronic pain is a prevalent and costly condition associated with a wide range of comorbidities such as depression, anxiety, substance misuse, and suicidality. Although near universal, pain is an inherently private and subjective experience. In the absence of objective assessment measures, people with chronic pain rely primarily on language to communicate their experience.
The McGill Pain Questionnaire (MPQ) paved the way for incorporating language into pain assessment. However, it has received numerous criticisms because of its focus on adjectival, single-word descriptors that have been taken out of communicative context. An alternative naturalistic form of assessment and communication is that of metaphor, which may be a powerful tool for people with chronic pain.
Previous research has shown that metaphors are widely used by those with chronic pain and may have therapeutic value in this population. However, there is limited research in the area. The present study series addresses this gap in the literature through four empirical studies. The first study explored the language used by those with chronic pain to describe their pain experience. The second study used conceptual metaphor theory to analyse and catalogue the types of metaphors used by people with chronic pain. The third study explored the associations between metaphor use and chronic pain diagnosis and between metaphor use and adjustment to chronic pain. The final study examined health professionals’ experience with their patients’ use of metaphor in chronic pain consultations.
The results showed that people with chronic pain use a wide variety of metaphors in their pain communication, with the most frequently used category pertaining to metaphors of physical damage. Metaphor use was found to be associated with certain pain diagnoses, in particular endometriosis, complex regional pain syndrome, neuropathic pain, and hypermobility syndrome. Metaphor use was also associated with the extent to which pain interfered with daily life. However, its relationships with other aspects of adjustment such as pain intensity, depression, anxiety, or stress were not as strong. It was found that health professionals use metaphor in chronic pain consultations in a variety of interesting ways, for instance to inform their judgments about pain type, psychopathology, and understanding of pain.
Implications for clinical practice include the need for interdisciplinary care, education for health professionals on metaphor in chronic pain, and the integration of metaphor in the treatment of chronic pain. Areas for future research include metaphor and pain catastrophising and exploring metaphor as a treatment target.
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