Do You Know The Language of Pain?

by Jill Gambaro

A rather heated discussion took place on the American Pain Society's LinkedIn group about the language of pain. I'm not the only patient who is a member of that group, but that isn’t why the discussion was so lively. Just as I found when writing my book, it's the practitioners themselves who can’t agree. Some say we need more specific language to describe the subjective, others say we need more physiology. But, as Dr. A. Breck McKay Research Director of the Fifth Quadrant Research Group in Australia points out, the words used to describe the experience of pain are totally unique to the person using the words. “When they use such words, they are the only person in the world who knows what they're talking about”.

All forms of pain need to be processed in the brain before you can experience them. Part of this processing includes your emotional reaction, whether you’ve had it before, and your ideas about whether you can handle the experience it presents. This makes measuring pain very complicated to a discipline based on scientific rigor. To them, the subjective cannot be measured, at least not yet. As a patient, and a professional writer, I see another gap—patients in pain have lost the very cognitive function necessary to communicate their experience with their practitioners. This vicious cycle has been doused with opioids to disastrous effect.

The solution to this does not come from so much science as from social studies. What the group concluded was that a language of pain needs to be systematized, implemented and communicated. Systematized in order to meet the rigors of scientific inquiry. Implemented in a way that can be delivered to patients. But I believe there's a third aspect of this that must be addressed. This new language of pain must also be communicated to the general public before they become patients. We must teach everyone how to describe pain.

I often run into people who are experiencing at least the symptoms of what they suspect might be carpal tunnel syndrome. When they learn about my book, they always ask me. I, return, ask them to describe their pain. Most of their answers are “it hurts here”. My follow up questions always leave them puzzled: How does it hurt? What does it feel like? When does it hurt? Then I see their wheels turning. They aren’t used to having to describe it in such detail. It gives them a lot of food for thought.

Dr. McKay's solution lies in the pathophysiology of pain where the brain conveys messages related to mechanical, thermal, chemical, finding, and severity. He suggests then that a language of pain include words to describe all four of these types of sensations. Ripping, tearing, grabbing, gnawing, hot, cold, burning, electric, icy, steady, pulsating, throbbing, mild, moderate, severe, unbearable. He came up with this idea after speaking in depth to a linguist, a discipline I'm sure most scientists don't think about consulting. McKay's tenacity stems from his own experience with devastating chronic pain.

From my perspective, as a professional writer, reducing the number of patients suffering from chronic pain cannot occur until the general public is educated about these terms long before they experience pain, while their brains are still able to process it. Given the cost, not only should a linguist be added to the team, but also a writer and marketing professional. All of which, ideally, have also suffered from chronic pain.