Burning, crushing, stabbing: how words affect pain

Several studies suggest that the words we use when talking about pain can make us feel it more keenly or take the edge off. Prop stylist: Caroline Dorn. (Justin J Wee/The New York Times)
The pain showed up a few years ago — first slowly, then all at once. My right hip burned, my back ached. I went from running with my kids to not being able to walk down the block. I saw doctors, I did tests, I ranked the pain on a scale of 1 to 10, which felt like pulling a number — mine was 7 — out of a hat. No illness or injury appeared, only the physical erosion from multiple pregnancies and age.

Instead of a number, the pain seemed more like a failing dam against the rising flood of pain. Or something like that. It’s hard putting a feeling that’s abstract, yet all encompassing, into words. But, aside from often-ambiguous 1 to 10 pain scales, words are the main tools we have when people ask how we’re feeling. And what we say — to them and to ourselves — matters: Several studies suggest that the words we use when talking about pain can make us feel it more keenly or take the edge off.

Consider cursing. Whether you’ve slammed your finger in the door or stepped on a stray LEGO, a choice profanity can provide a colourful form of pain relief. In a 2020 study, British scientists found that using real swear words was more of an analgesic than fake ones (like “fouch” and “twizpipe”) or a neutral word, though their effects wear off with overuse.

There are no magic words to make pain disappear, but pain experts say that paying attention to the words we use for pain might help shape how we experience it.

Changing languages changes pain.

Swearing seems limited when it comes to fighting long-term pain. But then, so is English. There are so few words — hurt, ache, sore — that describe pain directly. Other languages often have words and ideas that capture something more clearly than our own — like weltschmerz, German for a kind of world-weariness, or wabi-sabi, an acceptance of imperfection in Japanese. Could other languages help with pain, too?

For some, switching languages while in pain could be mildly anaesthetic. A study of Spanish-English bilinguals found that people felt pain less strongly when they spoke the language tied to their less-dominant culture. Those who speak more than one language could consider their pain through their other cultural and linguistic lenses to see if a different perspective helps.

Yet translating pain can leave even polyglots feeling misunderstood. Physiotherapist and neuroscientist Saurab Sharma and his colleagues compared how people in Nepal and in the US described chronic pain. They found that people in the two countries shared few words around pain. Nepali speakers rarely used expressions like “sharp” or “throbbing,” which are common in English.

Likewise, Nepali has several words for pain without direct translations into English, such as “kat-kat,” an achy sensation that can feel deeply cold. Sharma, a researcher at Neuroscience Research Australia in Sydney, knows of one patient who returned to Nepal in search of doctors who could grasp the kat-kat she felt in her knee.

In any language, having trouble communicating can delay diagnosis and prevent people from getting the care they need. And it adds another burden, too: the emotional toll of not feeling understood.

Metaphors are more powerful than you think.

There are other ways we can talk about pain, even without downloading Duolingo. Figurative language allows us to compare abstract feelings — including pain — with things that are more familiar and concrete, said Elena Semino, a linguist at Lancaster University in Britain. This helps us, and those around us, make more sense of our pain — which is a step toward feeling better.

Some pain metaphors — like “burning” or “stabbing” — are so common we might not even notice them. Others are more elaborate. A survey of people with chronic pain found that 85% linked pain with physical damage. Descriptions included “a giant crushing my bones” and “like I’ve been run over, reversed over and run over again.”

Some metaphors compare pain to an outside attacker — which may provide some temporary relief. Seeing pain this way gives some a foe to fight and creates distance between them and pain, said Imogene Munday, a psychologist and chronic pain researcher at the University of Technology Sydney and the study’s lead author.

But she and others note that these metaphors can be — here’s another one — a double-edged sword.

As an outside attack, pain may seem more menacing and out of your control, said Jasmine Hearn, a senior lecturer in psychology at Manchester Metropolitan University in Britain who works with people with spinal cord injuries and chronic pain. These feelings spin into more worry, which can make pain feel even worse.

Put your words to work.

Taking care with metaphors may interrupt this pain spiral. To this end, Semino and her colleagues developed a metaphor menu for cancer — reframing it as a journey, a weedy garden, even a twisting fairground ride — which could also apply to chronic pain.

Months into my pain journey, the cause was still elusive — was it hormones, joint issues, an overtaxed postpartum pelvic floor? Whatever the reason, worrying about pain stalled my progress as I tried to get stronger.

Things started to shift when a new physical therapist described pain not as a threat, but as information I could use. Instead of being overwhelmed, I felt more curious. I worried less about pain and, with time and effort, started doing the things I loved again.

Paying attention to metaphor might help people on a broader scale, too. Stella Bullo, a senior lecturer in linguistics at Manchester Metropolitan University, is compiling a database of endometriosis pain metaphors. Bullo, whose own endometriosis went undiagnosed for nearly two decades, said she hopes making these metaphors available to doctors and patients can aid diagnosis.

Mapping pain metaphors might even provide clues to how the disease works, said Bullo. “The metaphors we use to describe our pain can be indicative of the internal mechanisms of the pain that happens in our bodies.”

Find your voice and find relief.

Sometimes, though, it’s hard to find any words. Turning to other forms of expression may build a bridge to relief.

Bullo and her colleagues ran workshops that provided art supplies, from modelling clay to needles, to those with endometriosis. Participants reported that making art helped them discover new ways of talking about pain.

Being able to talk about pain can still provide some comfort, even when the pain persists. “Sometimes, the sense that you’ve done justice to your experiences can be a kind of relief,” Semino said.

Having someone to listen can be a relief, too. I was lucky: Family and friends waited while I searched for ways to describe my pain. Words for pain often bubble up spontaneously, said Hearn, so it’s often easier for family and friends to notice the type of language that’s being used. If you are that friend or family member, be open to the way someone explains their pain, even if it seems exaggerated or hard to imagine.

“For that person who’s living with their pain,” said Hearn, “that’s the best, most accurate way for them to describe it.”

Keep an ear out for words that suggest someone’s worried or threatened by their pain — if, say, someone is talking about their pain as a devil — and follow up. Being inquisitive about the words someone uses can open up a conversation about pain, and possibly reveal a way to provide more support, even if it’s just continuing to listen.

Thinking about my original metaphor for pain, the rising flood, makes me want to use it more consciously. When pain comes again — my own, or someone else’s — instead of patching the dam, I might try listening to the water flow.

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