Associate Professor Tasha Stanton, is a leading researcher in the field of persistent pain, especially in the context of back pain and arthritis. As two of the most common conditions that are seen at clinics like ours, Tasha was invited to speak to our team at the recent Move for Better Health Conference.
She gave a very engaging and thought provoking presentation, explaining why our choice of words matter and how what we say can even affect how someone feels their pain. In this blog we have outlined some of the key messages from the presentation.
For example, take a look at the famous rotating mask illusion:
It’s thought that, essentially, our brains mix visual input with what we expect to see. Consequently, our brains tend to show us a forward-facing mask even when we’re looking at the back of it! The fact that we only ever really see faces from the outside, results in our brain making an assumption that the mask rotates back in the opposite direction, when in fact it spins continuously the same way.
For example, in a study by Sinke et al. (2016), participants were asked to perform a categorization task while being exposed to a painful stimulus (heat on their skin). One group was told that pain causes worse cognitive performance (the negative group), while the other group was informed that pain improves performance (the positive group). Interestingly, the people who were in the negative group performed worse, in line with their expectations, while the positive group performed without any impairment!
Though it’s important to clarify that at no point are we saying the pain someone experiences is not real. Only that the pain experience itself can be influenced by many factors, including the words that are used. This means that it can be both positively or negatively influenced. Our health care providers, what we read online and all the other supports or sources of information we have around us all play a role influencing what we believe (about our pain) and therefore can help or hinder our outcomes.
Medical imaging is a classic example of this. While some findings can have significance, many can be considered normal parts of ageing (Brinjikji et al., 2015). As radiologists are obliged to write down what they see, reports can often be full of scary words like degeneration or spondylosis… However, neither degeneration nor spondylosis indicate the presence (or absence) of pain. In fact, in the majority of cases, these words could be simply and accurately described as age-related changes. In the same way that our outside appearance changes as we get older, so does our inside appearance.
This is not to say that imaging is unimportant and never relevant. Instead, it’s important to figure out what truly is a problem (and is strongly related to our symptoms) rather than what sounds bad but should actually be considered normal.
Tasha’s enlightening talk served as a reminder for us to consider our words carefully: to give an accurate understanding while avoiding adding unnecessary fear and concern… because we know that can hurt!
References
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
Sinke, C., Schmidt, K., Forkmann, K., & Bingel, U. (2017). Expectation influences the interruptive function of pain: Behavioural and neural findings. European journal of pain (London, England), 21(2), 343–356. https://doi.org/10.1002/ejp.928
