How to talk to people about

their painThe Metaphoric language of persistent pain

by Mike StewartClinical Specialist Physiotherapist

www.knowpain.co.uk michaeladrianstewart@hotmail.com

What is pain?

“Pain is that sensory experience evoked by stimuli that injure or threaten to destroy tissue”

(Mountcastle, 1980).

“A multiple system output activated by the brain based

on perceived threat” (Moseley, 2003).

Historical assumptions about

painLatin ‘poena’ meaning

punishment.

The Cartesian model of pain (Descartes, 1664) is responsible for many misconceptions about pain.

Assumes all pain is caused by injury & direct relationship between damage & harm.

Results in incorrect & overly simplistic treatment options.

Descarte’s model continues to be the driving force in the delivery of Medicine today. (Goldberg, 2008; Linton, 2005; Wade, 2006).

The present day reality

Remove foot from the fire & avoid any fires from now on. Sensible in acute situations but massive repercussions in persistent pain (fear avoidance).

Douse the fire with water. USA in last 5 years has seen a 629%^ in epidural injections & a 423%^ in overall LBP expenditure, yet pain rates keep escalating.

Cut the wire to remove the pain.20% lumbar discectomy patients have the same or worse outcome. Lumbar fusions only reduce pain in 50% of

cases.

Louw & Puentedura (2013)

Explaining pain as a perception

Which part of your body is enabling you to hear my voice?

The ear contains ‘vibration’ & ‘sound receptors’. Messages from these receptors are turned into ‘hearing’ by the brain.

‘Hearing’ is a perceptual brain construct.

Consider this…Do you hear things differently following a horror movie?

So what happens when you sprain your ankle?

PAIN…“A multiple system output activated by the brain

based on perceived threat”(Moseley, 2003).

Nociceptors = ‘danger’ receptors that are interpreted by the brain.

Communication & education reduces the

threat output

VAS: 0-10?