The language of chronic pain

Chronic pain is a serious health and socio-economic issue and, unfortunately, it’s likely to get worse according to Imogene Munday, PhD candidate at UTS Graduate School of Health (GSH).

“About one in five Australians currently suffer from chronic pain – sometimes due to an identifiable physical cause, sometimes not – but as our population ages, the prevalence is likely to increase,” she says.

“It isn’t just the physical suffering that’s the problem either, chronic pain has many co-morbidities. It’s linked to depression, anxiety, substance abuse and increased suicidality, and people with chronic pain are much more likely to be unemployed, on a disability pension and have reduced social contact. This makes it a costly socio-economic issue too.”

Despite being such a serious issue, it is confounding that chronic pain is so ethereal a problem to test. “Unlike many other health problems, there is currently no objective assessment for chronic pain,” continues Imogene.

“Aside from non-verbal communication, such as grimacing or guarding, the only way a physician can gauge the severity of pain is through a patient self-reporting. This obviously makes it subjective and quite nebulous.”

The inextricable nature of pain and language solidified for Imogene during her Master of Clinical Psychology studies at UTS when she undertook a placement at a chronic pain clinic. “I looked into it and discovered that, historically, it’s a really understudied area, although this is changing now,” she says.

“The little research that has been done points to the fact that when describing pain people frequently use metaphor. This captured my interest and I decided to pursue it further through my PhD.”

With a view to cataloguing and creating a starting taxonomy of the language of pain, Imogene’s research has involved a large study looking at the types of metaphors people with chronic pain use. A secondary aim will be to see whether metaphor types can be linked to diagnosis, level of anxiety, depression, stress, pain intensity and/or pain interference levels.

The metaphors she gathered during the research ranged from simple one-word descriptors, such as: ‘It felt like a burning pain,’ to very elaborate: ‘It was like mercury and molasses had been injected into parts of my body and set like concrete.’

“Several types of metaphor stood out when it came to analysing the data. One was the novel use of common illness or injury descriptors such as the pain feeling like: ‘A toothache in my shoulder,’” Imogene explains.

“Another interesting category was the personification of pain as an embodied attacker. For example, one person reported their pain feeling like, ‘Somebody driving a knife into my bones and muscles and twisting it.’” 

Having completed two studies on the patient experience of chronic pain, Imogene’s final study will focus on the clinicians’ experience of metaphor when working with patients with chronic pain.

“I’m hoping my PhD will result in more successful communication, aid diagnoses, and make a significant contribution to the overall body of knowledge about the language of pain,” she says.

Learn more about Clinical Psychology at the Graduate School of Health