The English word ‘Pain’ has its roots in the Latin poena meaning ‘punishment, penalty or retribution’. No surprise then that we have created a rich vocabulary based on the metaphor PAIN AS ENEMY. At NOI we believe that optimal linguistic expression of a pain state is as important as optimal movement expression. To achieve this we, amateur linguists, have turned to the world of metaphor research for guidance, in particular Lakoff and Johnson’s work “Metaphors We Live By”(1980). To understand how to use this, we must first understand the notions of primary and secondary metaphors.
IDEAS ARE FOOD, LOVE IS A JOURNEY AND PAIN IS ENEMY
These are primary metaphors (we have adopted the convention of writing PRIMARY METAPHORS in all caps – we’re not yelling at you!). Primary metaphors are concepts that we are not usually aware of, but they powerfully influence our language as the basis for secondary metaphors. For example, from the primary metaphor IDEAS ARE FOOD we have the language (secondary metaphors) my brain is fried, or I’ll stew on that or you pea-brain!
See if you can find some secondary metaphors arising from the primary metaphor LOVE IS A JOURNEY? You don’t think of the primary metaphor LOVE IS A JOURNEY when you may say we are at a crossroad darling, or we have hit a brick wall, but the primary metaphor has certainly influenced your language.
So, from PAIN IS ENEMY we get the secondary metaphors of fight pain, attack of back pain, burning, stabbing, shooting, pain killers, anti-inflammatories, the pain is killing me and so on.
But PAIN IS ENEMY is ever so wrong!
Homo Sapiens got this one wrong. Pain is not enemy; pain protects us. It’s part of what makes us who we are, and tragically we may die an early death if we can’t experience pain. A little bit of pain can even be nice – think of the gratifying ache after a day spent undertaking enjoyable and productive physical activity.
PAIN IS PROTECTOR is better
Pain is protector is a more apt and biologically correct primary metaphor. But the secondary metaphors which run off it are nowhere near as developed and as numerous as those emerging from PAIN IS ENEMY. We do have ‘you can be sore but safe’, ‘your hurts won’t harm you’ and ‘know pain, know gain’ to begin with though. I’ve also suggested ‘pain softener’ instead of ‘painkiller (why kill the thing that protects you?) and a colleague has suggested ‘movement enhancing medicines’ rather than ‘anti-inflammatories’. Nice and much more functional!
PAIN AS INVADER
As a side step from PAIN IS ENEMY, reflect on PAIN AS INVADER with secondary metaphors of like a knife in me, burning inside, deep in there, red-hot poker in my back, and so on. These secondary metaphors need to be heard and acknowledged, and warrant some analysis. A simple, but powerful first step is always to ask ‘what do you mean by…?’. The very nature of metaphors is that they can have different meaning to different people – how you as a therapist interpret like a knife in there might be different to how the patient does. There’s also likely to be benefit to exploring the use of a metaphor with the patient. Again, it’s like a knife in there will have been uttered by the patient many times, and ‘said’ it internally even more. The work of Lakoff and Johnson (1980) would suggest that we can ‘become’ the metaphors we use over and over – is there a more accurate, less threatening, linguistic expression that you could offer a patient to replace the invasive knife? Often just the awareness of their use of the metaphorical knife (remember, primary metaphors can shape our perceptions and actions without us ever being aware of them) might be enough to create some change and reconceptualisation – if the patient updates their own words then so much the better.
But… what a challenge to shift a primary metaphor!
So much of the health industry runs off, and profits from PAIN IS ENEMY. And while promises of quick fixes for acute pain abound, persistent pain states struggle to find resolution. The underlying ENEMY primary metaphor does nothing to help these complex pain states such as persistent post-surgical pain, pain in neurological disease, child or adolescent pain and male and female pelvic pain.
We’ve introduced the idea of primary and secondary metaphors at many talks, presentations and courses, to doctors, surgeons and therapists of all stripes. We’ve also frequently heard from these front line pain clinicians that ‘my patients don’t use language like that’! But, in nearly every case, we’ve received calls or emails from these same clinicians after they return to the clinic and start listening to patients again, often along the lines of ‘all of a sudden, I realised that when a patient is talking about their pain, nearly everything they say is a metaphor … and … I never stop to think about what they might actually mean!’
Reconceptualising pain and changing primary metaphors isn’t easy. But if we start to carefully listen for the secondary metaphors we hear in the clinic, and think about the primary metaphors that might be influencing them, then respectfully offer to explore – with the person – new language, we are making a start.
– David Butler
Thank you for this post. I’m a patiënt of a Belgian manual therapist who uses neurodynamic techniques. As a psychotherapist training in Solution Focus Brief Therapy (solution Focused Cognitive and Systemic therapy – Bruges Model) the post makes me think of what I try to do in close collaboration with clients: expand their semantic and pragmatic options in order to promote freedom of choice in how they wish to create new ideosyncratic Habits. Finding out what they mean by what they Say is crucial. With admiration for your work, Véronique (Brussels, Belgium)
Couldn’t agree more! I have been a student of Neuro Linguistic Programming as an adjunct to Neuro Physio for many years (just qualified as a trainer in it too) so I’m very used to noticing people’s language and metaphors. I’m very pleased that you are flagging this up in the Comfort and Movement Management Community! I’m sick of “Pain Clinics” and “Pain Consultants”
That’s exactly right. I learned from David long time ago that “No Pain, no Life”
I often tell my patients that pain is our Blessing, and it is our alarm system. As a part of education about pain I explain CIP and/or HSAN syndrome and mortality percentage associated with lack of pain sensation. It helps to create a better picture and that makes a huge difference.
Thank you David and NOI Group for making us better clinicians.
This is a great article. As a staff psychologist in a multidisciplinary pain management clinic, much of my work is focused on helping my patients understand that while acute pain is a danger signal, chronic pain sensations often no longer signal danger (like a fire alarm that still sounds long after the fire has been put out), and that their nervous systems no longer have to react to those sensations as if there were danger present (e.g., with increased tension, bracing and vigilance).
Your paradigm further shifts the metaphor away from pain as adversary to pain as ally. This shift could allow people with chronic pain to further deepen their sense of embodied comfort and safety while living with their condition, thus enriching the quality of their lives. “I still have pain, but I feel better; I can do more; my life is better.”
Thanks for the work you do.
Pain is not something to live by / live with. There is a difference between the ache of running and feeling free / active and the pain from an automobile accident and I am disgustted by your “everything is beautiful” approach o life when here is real pain in the body not to be dismissed.
Disgust is often a useful emotion to make us avoid things. But when it persists and is unnecessary it creates changes in body chemistry that make you more sensitive. There is no need for disgust here. All pain is real and there are now groups around the world using biopsychosocial frameworks to effectively treat some of the really troublesome pains such as that associated with automobile accidents. Our office may be able to link you up with such groups.
It’s a tough one. it’s so easy for someone to interpret what we are saying means it’s all in their head, or we are implying dismissiveness, which is easily taken anti-personally. Where-as, all we are saying is, we now include what, how and why you feel what you feel, rather than ignore the human. Interesting new find with Marsili Syndrome.
Thanks so much for this informative article. I am not in the medical industry but really appreciate the views and opinions around the use of linguistics, and how we unconsciously or consciously program our world. I’ve been a business and leadership coach for over 17 years and use the context of metaphor on a daily basis to bring awareness to, and help our clients negotiate their growth (business, personal etc). Keep up the great work. Explain Pain changed my life with respect to lower back.
Makes perfect sense, especially after listening to Bruce Lipton’s Biology of Belief lectures. Peace!
Thank you David. As you know I’m Welsh and the Welsh word for pain is poen. However, we also have another word for the pain following exercise. We call it ‘scrwb’ which is often accompanied by a shrug of the shoulders which I believe to be important. We will say ‘It’s just a bit of scrwb.’ The accompanying shrug of the shoulders strengthens the belief that it’s not dangerous or threatening in any way.
Thanks for the blog. I agree with you that “There’s also likely to be benefit to exploring the use of a metaphor with the patient. ” The most effective methods I know of doing use the Clean Language of David Grove.
That’s one for the reading list!
Loved digesting Metaphors We Love By upon a colleagues recommendation. After listening to the audiobook, I advocate for MWLB to be compulsory reading for health practitioners. A powerful insight into the reciprocal influence of language and human behaviour.
Very interesting perspective. I suffer pain (one of my secondary metaphors) quite a lot with migraines and arthritis and would welcome an approach that helped me to embrace it. With migraines I have learnt to listen to the throb in my head and let that hypnotise me to sleep. It doesn’t always work so I do resort to pain reducers to get through the day sometimes.
Thank you for this article. I teach OldPain2Go a method of removing Old unnecessary Pain. Pain usually goes long before all tissues are healed but when we have chronic pain it usually refers to the metaphor that someone has about their pain. When we alter that metaphor the trapped pain can be released. The effects are instant and long lasting as the pain message no longer has a purpose and just goes away (if it is safe to do so). Keep up the good work.
I’d be interested to hear more about OldPain2Go
Hi Lesley, if you click on my name above it takes you to the web page.
That’s the point of metaphors Steven.
You went from, a method of removing pain [definite statement) to; ‘can be’.
The effects aren’t instant (as you claim) but on occasion, can be. And ‘goes away’ gives pain magical mystical metaphors, which can be unhelpful.
I’ve found the above metaphors can be ladened to be the patients fault if the their pain doesn’t go, as they have bought into the wrong metaphors, and if only they would buy into your method, their pain would 2Go.
Wonderful insight. Both of my children were born at home. The Midwives would talk about “pain with a purpose” to focus and support natural childbirth. I still use the metaphor still during periods of psychological stress. It’s very adaptable. Paradoxically, I found acknowledging both the purpose and the effort helped lessen effects of the stress.
Thank you for this post. Like many people, the ‘battle talk’ about pain is something I noticed early on, and something I try to help reframe with patients, as it certainly drives unhelpful activity behaviour. Since reading this article I have been consciously reframing pain as a ‘friend – albeit an over protective one’ something that people seem to relate to.
I have had my own unusual experience with pain metaphor. Some time ago, I had a viral arthritis for a couple of years which was an interesting experience in many ways, but the pain metaphor that came spontaneously to me at the time was ‘bad music’. On average days the pain was like 1970s elevator music, boring and annoying, but I could ‘tune it out’. I could actually here this running around my mind (same genre was used in the Dr Who Episode – The God Complex!). On days when my pain was flared, it was more like punk or screemo, angry noisy music that I would find myself having to ‘switch off the music for a while’ by having a 5 minute sit down. This music annalogy doesn’t extend to other pain I’ve experienced, though interestingly, now I think about it, I have found myself using the expression ‘turning down the volume on pain’ with patients, so perhaps a deeply ingrained analogy I must have picked up from somewhere!