The Language of Pain

There are many languages in the world- so many languages that it would be impossible to learn them all. However, IF you could learn them all, think of how cool it would be to communicate with anyone at any time! That would be an incredible feat! Just as language allows us to communicate feelings, thoughts and ideas with those around us, there are a variety of ways that people express pain, including verbal and non-verbal expression. Pain is a language all to its own, with many cultural and personal nuances. Everyone’s language of pain is unique and specific to them. Many words and phrases are learned throughout the course of our life, creating our own personal language of pain. I remember one of the first patients I ever treated was a recent immigrant from Ghana. I treated him for back pain; each time I asked him if where I was pressing was the “sore spot” he would say “Yes.” After about 5 treatments he asked me what “sore” meant. That word was not part of his pain language. I assumed that “sore” was a universal language. What “sore” meant to me, clearly did not carry the same meaning for my patient.

 

I recently worked with a patient who had been a competitive varsity (University-level) tennis player. Throughout her career, she had seen countless physiotherapists and health care professionals for her back pain. She always experienced temporary relief with the treatment provided to the tissues. Joints were manipulated, muscles massaged and lengthened, core exercises given and stretches assigned; however, she still experienced back pain every day of her lengthy career; the pain persisted up to this point, even though she no longer played tennis competitively. Because of her love of the sport, I decided to use a tennis analogy as part of her pain language when I explained to her why we were going to take a different approach than she had previously experienced. She had exhausted conventional treatment of the tissues, and nothing more was to be gained by repeating the same treatment techniques that had only given her temporary relief in the past. We talked about the pain system and how her nervous system had become part of the problem. Her brain was so “practiced” at producing protection, and therefore pain, that we would have to retrain the brain to decrease the need for protection. I described the need to use body-mapping exercises, which target the sensitive nervous system by using her knowledge of mastering the forehand stroke. Over the years, she had developed so much confidence in her forehand stroke that she didn’t even have to think about it. She had used it so many times, that she had mapped it expertly in her brain. I related this to the way her brain was producing her back pain. Just like her forehand stroke, her brain did not even have to “think” about her back needing protection; she automatically created a pain response every time there was a potential threat. I explained that when any information (pressure, position, proprioception) came from her low back, her brain produced a protective pain response since her belief system was that there were mechanical problems in her spine that could just not be corrected. That is what the years of failed treatment had taught her. Since this continual pattern had been reinforced over the many years of her tennis career, changing this pattern would be like asking her to suddenly change her forehand stroke. Learning to change her stroke, or learning to change the “back map” on her brain requires practice, and an expert’s help to break down the task that needs to change. Sensori-motor retraining through careful observation of the sensation of movement using techniques such as Feldenkrais and Franklin exercises are extremely helpful with the task of re-mapping the brain. I was able to speak her pain language and she understood why body-mapping exercises would be helpful.

 

Learning to speak the patient’s pain language starts with empathetically listening to their story. This allows you to learn some of the words and phrases your patients’ use and has been taught over the years. On the second visit with another one of my patients, she told me that a health practitioner explained to her that her nerves were like “frayed electrical cords shooting sparks into the air.” She stated that this image really helped her to visualize her pain; unfortunately, it was a negative, limiting image not a positive, restoring one. I knew then that I would have to address the “frayed cords” in her treatment when I spoke to her about her sensitive nervous system. A specialist also told her that her brain needed to be “retrained” by injecting the site of her pain with an unknown substance using extremely painful needles. My patient reported that this provided 6 weeks of pain relief after each of these injections initially but then it stopped working. I knew that if I mentioned, “retraining her brain” in my treatment explanations, she would associate it with failed attempts to “retrain” her brain using these injections. So “retraining the brain” did not become part of my pain education language with this particular patient.

 

Learning to speak the language of pain also requires research. We need to learn more about the many pain languages in our world. A great place to start is with a course about pain like Pelvic Health Solution’s course, Treating Pain: A New model of care, or Debbie Patterson’s course, Understand the Brain to Treat Persistent Pain, or NOI’s Explain Pain to truly understand the science behind pain. This allows us to give accurate accounts of what is happening in our patient’s brain and body when they experience pain. There are also many excellent books and websites available to help us with the language of pain. Explain Pain by Lorimer Mosely and David Butler, Lifeisnow.ca by Neil Pearson, and Better Movement by Todd Hargrove are great places to start. The more words, phrases, and descriptions we have to choose from, the more successful our pain language communication will be with our individualized and unique patients. I challenge you to open the doors of communication with your patients in order to improve your success of treating their pain.

 

Written by Michelle Day

Michelle Day
Assistant Instructor