It is no coincidence that we describe the “pain” of loneliness or the “agony” of rejected romantic feelings. Paper cuts can be “excruciatingly painful”, but so can watching the social mishaps of Basil Fawlty or David Brent. Personal criticism can be “stinging”.
The book The Patient’s Brain outlines the evidence that later evolutionary traits such as social cognition and language appear to have grafted themselves onto the ancient brain functions that alerted us to external threats or bodily damage.
Words are neurological events. They are meaning-laden puffs of air that our brain transforms into knowledge, opinions, emotions or danger signals.
Shakespeare, perhaps the greatest wordsmith of all time, frequently used bodily sensations including sensitivity to pain as metaphors. If you’ve ever complained about the “bitter cold”, called an ugly sight an “eyesore” or felt it “sharper than a serpent’s tooth … to have a thankless child” you might know what I mean.
Words affect pain
The “right” words in a medical context can activate both the pain-busting endogenous opioid networks in the brain and the feel-good dopamine-driven reward centres. One of the most widely relied-upon pain assessment questionnaires, the McGill Pain Questionnaire, relies entirely on verbal descriptions of pain to diagnose the severity of someone’s pain.
I have a patient with complex regional pain syndrome (a severe, uncommon type of nerve pain), who has little pain in her affected foot as long as she doesn’t think or talk about it. Mention the foot and her symptoms burst into life, causing a severe burning and prickling sensation. Even listening to me discussing it with her husband can set it off.
Given how important language can be to pain sufferers, well-trained clinicians go to some lengths to use appropriate terms. We can spot patients at higher risk of disability by carefully listening to how they tell us about their pain predicament. I forbid any of my trainees in pain medicine to use the following phrases in consultations because of their poisonous effect on patients:
That’s the worst I’ve ever seen
It looks like bone-on-bone
Your disc is collapsed/busted/blown out/ruined
You will end up in a wheelchair
Just learn to live with it.
No doubt readers could expand this ghastly collection of backhanded reassurances with some from their own experience. The reason such phrases are unhelpful is that they come to define all subsequent attempts at therapeutic interaction. If you have any doubt about the power of medical words to influence perceived pain, I can quote a recent study that provides a good example.
This study compared “real” acupuncture to “sham” acupuncture where both were delivered with either a neutral or highly positive endorsement from the practitioner. Both the groups who received acupuncture showed an equal improvement compared to a group left on the waiting list.