The language of back pain

The language we use when we talk about back pain is revealing and worthy of noting. This is both the language of the back pain sufferer and the clinician or therapist. Why? Because it highlights the beliefs held about back pain. Why is this important? Because the beliefs underpin the thoughts and action taken in response to the back pain.

Common descriptions that patients use when I ask them to narrate include the ‘slipped disc’, ‘wear and tear’, ‘disc bulge’, ‘worn out joints’, ‘weak spine’, ‘weak muscles’, ‘weak core’, ‘worn out spine’ and let’s not forget the range of expletives that can be attached the the above as well, ‘my ****** spine’, ‘it’s ********’, ‘when he looked at my x-ray, he told me I was ******’ — and I am not joking when I state these are just a few of the things I hear. Do bear in mind that I spend my days listening to people’s stories, making sense of their experience so that we can create a way to move forward.

And where do people obtain such language? They have been told that this is the case, they have read it on the net or heard from well-meaning significant and not so significant others. Sadly, these terms are not useful in any shape or form and in most cases create the wrong image, construct the wrong beliefs, leading to the wrong action and on-going threat and hence protection and pain (pain is about protection as regular readers appreciate).

Clinicians need to watch their language as they are in a position to deliver the right messages at key moments. This creates understanding, which emerges as behaviours and actions that are healthy and groove a way forward to overcome pain. The clinician will have a set of beliefs about pain, and perhaps suffers chronic pain himself/herself. Sticking to the facts about pain, being honest about what we don’t know, avoiding extrapolating a research finding to the populous when it has only been validated in a small number of people and focusing on the ‘cans’ rather than the limitations are just a few notable strategies. I am not going to tell you how to treat or deal with back pain here, merely highlight some observations that I have made over the years.

Back pain is a huge problem the world over and we need to think about it in a different way; a whole-person way, just like any other pain. Considering what we say, how we say it and when we say it is vital. The potency of language and communication should not be underestimated. The words we use will form an internal dialogue in the back pain sufferer’s mind, flavouring their pain perception. Let’s get it right.

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