When I ask patients about pain, I’m always intrigued by the amazing variability in terminology or often the complete lack thereof. Maybe it’s because of growing up in a multilingual environment that I have a personal fascination with words and language in general. What’s particularly interesting to me is how inadequate words can be for all of us when trying to fully convey pain and sensation.
Not only is there an endless variety of quality and severity, people who make a habit of “toughing it out” in the face of pain, actually lose their language for pain. Depending on modeled pain behavior in your childhood home, it’s also possible that this language was never even allowed to develop . Based on what I see, I believe firmly that it’s only through the re-learning (or learning anew) of how to speak about our physical pain that allows healing to begin.
First of all, on a simply practical level, if you cannot describe your pain with any convincing accuracy, someone like myself who is interested in learning about your pain in order to help you troubleshoot it and get rid of it, is working with hands tied. It’s not until I spend time with someone who has no language for their pain that I am reminded of how important it is to the successful outcome of any bodywork treatment.
Secondly for yourself, how can you forge ahead successfully towards a cause – in this case eliminating your pain, if you don’t even have a name for it? For many people pain conjures up fear. The first rule of thumb about conquering fear is to name it and face it. If you say to yourself you’re unhappy, don’t you need to know what it is that you’re unhappy about before you have any hope of being happy again? Same thing with pain. Get specific. Dig deeper.
I notice that the people who are the most conflicted about using the word “pain” tend to be the chronic pain sufferers – the people with high pain tolerance. (A topic for a separate blog post: people with a high tolerance for pain often are the ones who end up in chronic pain because of their inability to register the early warning signs – and yet they seem to be the ones who worry the most about being pain-“wimps”). These are the people who hesitate and insist instead on using a different, less loaded word because “pain” sounds too serious compared to their perceived discomfort.
It’s okay if you don’t want to refer to your discomfort as “pain”, but you should know that by repeatedly dismissing the idea of pain you lose the ability to describe any aspect of it. For example, “pins and needles” is an important sensation that leads to very different approach in treatment than “stabbing” sensation. An “ache” can be very different than “stiffness” and both are significant to me but will change how I treat it. Sometimes the sequence and timing of sensation is meaningful and sometimes it’s the combination of sensations that points to the cause. Everything and anything that you notice is significant – even if you don’t want to give it any weight.
I believe this widespread issue of inadequate command of and connection with our language for pain, is what causes some physicians to quickly dismiss complaints as fabricated or baseless. If you are someone who is unable to describe your pain as anything other than “it hurts”, your concern will most likely be dismissed and you’ll be urged to medicate it away because no one has the words to understand it.
If you’re like any reasonable person, after years – or even just weeks – of pain, certainly you would like nothing more than to distance yourself from it. Why would you choose to dive deeper into your awareness of it? Well this is exactly what I’m asking a lot of my patients to do and yes it can be a frustrating process. But it is an important step to solving the puzzle and taking control of what is within your reach.
Start with basics like: “sharp”, “dull”, “burning”, “throbbing”, “grabbing”, or “stabbing”. If you’re still having trouble coming up with words that seem right, try thinking of how you can compare your pain or discomfort to other sensations you’ve had in your life like: a tooth ache, a stomach pain, stubbing your toe, catching your finger in a door or a drawer and other things like that. Those are all good starts and you will probably find that once you start the conversation the words will come to you more and more easily.
I would venture to guess that at least half of the failed outcomes in physical medicine with any given practitioner has to do with how accurately the practitioner was able to interpret the patient’s pain language. I certainly have failed my share of patients in the past when there’s pain that I don’t know about or fully appreciate, which is why I’ve learned to ask so many questions about the “pain”. I will probably never seem alarmed by a sensation you’re describing but that is because most pain and discomfort makes sense to me. What doesn’t make sense and worries me more is when something I know should be hurting, is instead shrugged off or does not even seem to register.
Start talking about your pain. Be creative and daring; find your pain-language. It’s personal, unique and valid. There’s a good reason for your pain and it’s not out of your reach to figure it out and with some help to put an end to it.
Above all, be patient with yourself. Pain is your ally not your enemy. It’s an important message to you about something that needs your help and attention.
Practitioners: How does pain language affect your practice?
Patients: Have you encountered this language barrier with your practitioners?
Don’t be afraid to share your thoughts below…
Image Credit: Wikimedia Commons: By JD Fletcher (http://arowmaker.tripod.com/AROWMAKER/id6.html) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/)%5D, via Wikimedia Commons