University of Exeter: Metaphor and images should be used alongside traditional medical scales for patients to describe pain, study says

Pain cards with pictures to describe feelings and poetry can all help people portray chronic pain more meaningfully, according to the research.

Doctors will get a better understanding of the impact of pain – and patients will be better able to express how they feel.

Giving patients other ways of expressing the impact of pain could help to reveal important information which will aid diagnosis or allow doctors to give better support.

Pain charts and visual-linguistic scales were developed during the twentieth century to help doctors and patients measure pain. But asking people to report pain in this way can be challenging for some.

Researchers have said only using scales “displaces the patient’s own story, sidesteps the issue of pain’s private meaning, and disrupts the potential for humane communication between patient and doctor”.

The research, by Nicole Migliofrom the University of Milan and the University of Haifa and Jessica Stanier from the University of Exeter, is published in the journal Frontiers in Pain Research.

Ms Stanier said: “Feeling supported rather than stigmatised can help people cope with pain. We need better ways to express and describe pain other than a scale of one to ten. Numbers are useful, but often there is too much riding on picking the right number. We need to give patients better resources to describe pain in a different way.

“A far more radical understanding of the role of imagination in the expression of pain can take us beyond the use of pain scales and toward a transformation of social and material conditions.

“Imagination plays a crucial role in determining how the self makes sense of experiences of pain figuratively. Pain is not a thing, a state, or a condition, but rather a process that involves the whole person and whose complexity lies in the way it implicates all kinds of different biological structures and layers of meaning.”

The study explores creative ways people in pain have found to express sensations, bodily feelings, and their psychical impact through metaphor to clinicians and communities. Metaphors make it possible to express and understand a given experience in terms of another, increasingly the potential for others to understand and relate to the experience.

Pain cards — a set of laminated images representing aspects of pain — can encourage patients to volunteer descriptions of their experience without solicitation by the practitioner. They rely less on language and more on visual imagination and could help patients from different backgrounds to feel more in control of their time with doctors and better express how they feel.

Creating pain portraits – a visual description of pain – could help patients relay information to doctors and help them make sense of their pain.

Pain cards and portraits in the clinic can be complemented with poetry, zines, and other community-based schemes, so that people in pain can explore their experience beyond the medical setting.



Ms Stanier said: “These types of interventions give people back the sense of control that long-term conditions can very often take away. These approaches do not treat participants as anonymous patients but instead respect the differences between people in pain and their individual situations.”

Pain cards with pictures to describe feelings and poetry can all help people portray chronic pain more meaningfully, according to the research

Doctors will get a better understanding of the impact of pain – and patients will be better able to express how they feel.

Giving patients other ways of expressing the impact of pain could help to reveal important information which will aid diagnosis or allow doctors to give better support.

Pain charts and visual-linguistic scales were developed during the twentieth century to help doctors and patients measure pain. But asking people to report pain in this way can be challenging for some.

Researchers have said only using scales “displaces the patient’s own story, sidesteps the issue of pain’s private meaning, and disrupts the potential for humane communication between patient and doctor”.

The research, by Nicole Miglio from the University of Milan and the University of Haifa and Jessica Stanier from the University of Exeter, is published in the journal Frontiers in Pain Research.

Ms Stanier said: “Feeling supported rather than stigmatised can help people cope with pain. We need better ways to express and describe pain other than a scale of one to ten. Numbers are useful, but often there is too much riding on picking the right number. We need to give patients better resources to describe pain in a different way.

“A far more radical understanding of the role of imagination in the expression of pain can take us beyond the use of pain scales and toward a transformation of social and material conditions.

“Imagination plays a crucial role in determining how the self makes sense of experiences of pain figuratively. Pain is not a thing, a state, or a condition, but rather a process that involves the whole person and whose complexity lies in the way it implicates all kinds of different biological structures and layers of meaning.”

The study explores creative ways people in pain have found to express sensations, bodily feelings, and their psychical impact through metaphor to clinicians and communities. Metaphors make it possible to express and understand a given experience in terms of another, increasingly the potential for others to understand and relate to the experience.

Pain cards — a set of laminated images representing aspects of pain — can encourage patients to volunteer descriptions of their experience without solicitation by the practitioner. They rely less on language and more on visual imagination and could help patients from different backgrounds to feel more in control of their time with doctors and better express how they feel.

Creating pain portraits – a visual description of pain – could help patients relay information to doctors and help them make sense of their pain.

Pain cards and portraits in the clinic can be complemented with poetry, zines, and other community-based schemes, so that people in pain can explore their experience beyond the medical setting.

Ms Stanier said: “These types of interventions give people back the sense of control that long-term conditions can very often take away. These approaches do not treat participants as anonymous patients but instead respect the differences between people in pain and their individual situations.”

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