Dealing with persistent pain is not easy!! There are no quick fixes. This much we all seem to agree on. There are so many different approaches, so many different tools and so many different explanations of pain and its causes, that in their journey of trying out the variety of interventions that patients do, they can become confused and maybe left with greater anxiety as to what is the cause for their pain.
Then there is the language of catastrophisation..
‘your spine is crumbling’
‘your knees are worn out’
Over a period of time, patients come up with their own explanations and analogies. They can develop their own conceptions and notions which can be very difficult to deal with once these become entrenched.
One of the tools that has been shown to be effective in reconceptualisation of pain is provision of pain neuroscience education (PNE). It gives them the knowledge and skill to be able to identify and manage their own pain better. Because as we know, pain is not just due to a physical injury.
But rather than just talking to them about nerves, brain and nervous system, there is ample research to indicate that stories and metaphors are a much better way to impart pain neuroscience education which helps facilitate reframe and reconceptualise chronic pain.
Recently I came across this video by Prof. Tamar Pincus which talks about acceptance of pain as a means of progression and enhancement of quality of life for patients with persistent pain. It was important to note that acceptance doesn’t mean giving up, but rather finding a way to persist despite the pain.
One of the challenges with metaphors is the cultural context of language. Something which may be apt in one culture may be completed abhorrent and insensitive in others. So it is really important to adapt the metaphors to the cultural sensitivities of your location.
It is also important to acknowledge patient’s own metaphors and analogies they use to describe pain and use those as the bridge on which to develop metaphoric co-construction.
As I read more about metaphors and pain, I felt it apt to share some of the best works in pain metaphors.
Explain Pain By Prof. Moseley and David Butler: A ground-breaking concept in its content and presentation, Explain Pain aims to demystify the process of understanding and managing pain. It brings the body to life in a way that makes an interesting read for therapists and pain sufferers alike. All pain is real, and for many people it is a debilitating part of everyday life. It is now known that understanding more about why things hurt can actually help someone understand their pain and go about their daily life. Recent advances in fields such as neurophysiology, brain imaging, immunology, psychology and cellular biology have provided an explanatory platform from which to explore pain. In everyday language accompanied by quirky illustrations, Explain Pain discusses how pain responses are produced by the brain: how responses to injury from the autonomic motor and immune systems in your body contribute to pain, and why pain can persist after tissues have had plenty of time to heal. Explain Pain aims to give clinicians and people in pain the power to challenge pain and to consider new models for viewing what happens during pain. Once they have learnt about the processes involved they can follow a scientific route to recovery.
Explain Pain Protectometer Workbook : Further to the Explain Pain book, this workbook introduces the concept of Protectometer which is an interactive device that allows patients and therapists to gain a deeper understanding of the experience and establish an individualized treatment and education plan. Dr David Butler & Prof Lorrimer Moseley have translated the complex science into bite-sized digestible pieces that we can all understand.
Pain is really strange: Answering questions such as ‘how can I change my pain experience?’, ‘what is pain?’, and ‘how do nerves work?’, this short research-based graphic book reveals just how strange pain is and explains how understanding it is often the key to relieving its effects. Studies show that understanding how pain is created and maintained by the nervous system can significantly lessen the pain you experience. The narrator in this original, gently humorous book explains pain in an easy-to-understand, engaging graphic format and reveals how to change the mind’s habits to transform pain.
Painful yarns: Metaphors and Stories to Help Understand the Biology of Pain This book by Prof. Moseley provides an entertaining and informative way to understand modern pain biology. Described by critics as ‘a gem’ and by clinicians as ‘entertaining and educative’, Painful Yarns is a unique book. The stories, some of his travels in outback Australia, some of experiences growing up, are great yarns. At the end of each story, there is a section “so what has this got to do with pain?” in which Lorimer uses the story as a metaphor for some aspect of pain biology. The level of the pain education is appropriate for patients and health professionals. The entertainment is good for everyone. You don’t have to be interested in pain to get something from this book and a laugh or two!
Why do I hurt? Workbook by Dr Adriaan Louw: This neuroscience pain workbook created by Adriaan Louw, PT, PhD, allows patients to not only better understand their pain and how it works in the body, but also track and record it through active participation. Patients write in the workbook to monitor their pain experiences and learn how to treat their condition. The interactive exercises help them understand how pain works in the body, why they hurt and how they can lessen their pain