Chiropractic Scholarship 2020

In The Language of Chronic Pain, Imogene Munday, Ian Kneebone, and Toby Newton- John explore the experience of chronic pain sufferers. By conducting focus groups at an outpatient chronic pain management program in Sydney, Australia, the researchers uncover as much information as possible about the participants’ quality of life. Since pain is a subjective experience, historically, health care professionals struggled to understand, diagnosis, and effectively treat pain conditions. By utilizing the help of a Psychology postdoctoral candidate to review the language expressed by the focus group attendees, the researchers identify common themes that reflect the experience of those affected by pain.

The results included five emerging themes consisting of Isolation, Physical Sensations of Pain, Pain Personified, Pain as Overwhelming, and Coping with Pain( I. Munday et al., 3). In short, the participants’ expressed strong feelings of isolation due to the inexpressibility and invisibility of their symptoms. To combat this, sufferers often characterized their pain through evocative language and metaphors to paint a vivid picture to outsiders. Such language ranged from unnerving sensations “like ants in your body” to the image of an adversary, “it was like a dark thing that wanted to suck me out (I. Munday et al., 5-6)”. Nevertheless, the participants unanimously agreed that chronic pain makes there quality of life at best, challenging, but at other times unbearable.

As I studied the article, I could not help but succumb to a variety of emotions (anger, frustration, despair, and grief, to name a few). The language of the program attendees was far from “news” to me. As a victim of chronic pain, this study summarizes every pain-ridden day

and ignorant and dismissive doctor that I experienced over the past six years. Moreover, while the results of the study illustrate a deeply rooted problem within healthcare, these flaws are not irreversible. Instead, this evidences the degree to which our society needs the holistic nature of the chiropractic profession.

One of the most significant problems exemplified by both participants and health care practitioners is the inexpressibility of pain. A participant claimed, “You do not know how to express it … you can’t find a word to express the feeling (I. Munday et al., 4 )”. Because of this difficulty, participants often used analogies and descriptive language to help their audience better understand. Pain descriptions ranged from “a hot, throbbing bruise,” to “I’s like having a contraction in my back (I. Munday et al., 5-6)”.

Furthermore, the researchers noted the vast difference between the participants’ language and the traditional singular adjectives found in the McGill Pain Questionnaire. Because of how widely utilized the MPQ is, the difference in language illuminates a considerable communication barrier (I Munday et al., 7). How can doctors treat symptoms if they do not know what or where
the pain is? For instance, some of my injuries took months to diagnose and years to treat, for no one could pinpoint the exact source of the problem.

Doctors, however, are not the only ones at fault. I, too, struggle to comprehend the complexity of pain. When asking various personal training clients’ to categorize their pain, the descriptive words I suggest typically do not align with their own classification. Forcing victims of pain victims to condense crippling symptoms into tiny one-word adjectives (at best) is simply not cutting it. Improving the way we obtain information on pain simply must change.

As a future Doctor of Chiropractic, I believe I can employ certain practices as a means to minimize these communication barriers. My background in exercise science, as well as my own research, ultimately changed the way I view pain. I learned how to manage different types of pain (joint vs. muscle pain) and different strategies for exercising around an injury. At times, I even rehabbed specific ailments. This experience showed me the potency behind educating those with chronic pain. Therefore, I want to prioritize pain education in my future practice.

For example, the authors reference a study by Gallagher, McAuley, and Moseley, evidencing the efficacy of patient education. In a blinded randomized-controlled partial cross-over trial, participants related to the familiar language of educational pamphlets and were 82% more likely to take one in comparison to typical biopsychosocial advice on pain management (I Munday et al., 6). As hypothesized, the increase in knowledge surrounding pain decreased catastrophic thinking, producing the desired outcome that I, too, hope to accomplish. From social media content to verbal explanations and rehab protocols, this type of instruction puts power into the hand of the patient. It makes them an active participant along their road to healing.

Another crucial element is the psychological effect of pain. The way the mind reacts can drastically increase or decrease one’s pain experience. Every time a patient steps through the door, they encounter an opportunity to celebrate a small victory (more t-spine mobility, better sleep, or reduced pain medicine dependence). Not in an unrealistic manner, but in a way that diminishes catastrophic thinking. Most importantly, helping the patient reframe their mindset hold another added benefit; it shows them that they possess at least one ally in the war against their pain. In a world where chronic pain sufferers often feel like outsiders looking in, this gives them the comfort and support they need to keep on fighting.

My power as an individual might be limited, but I do believe I can help my future patients rewrite their pain stories. This study clearly shows that I am not alone in this battle. Thus, I hope to use my own experience to change the treatment and the perception of chronic pain in my future practice.