our choice of language for persistent pain persons....

[nari]

While I was bored one day, I wrote out a table of possible nocebos and placebos that we might impart to patients with our use of language.

This has interested me for a while; I won't inflict it on the forum for now, but how well do we consider the effect our choice of words has on our patients?

eg a commonly used phrase is: 'sit up for me/lie down for me..etc'

My reaction to that is: why should I? Who's playing boss around here?

Do others consider choice of words or am I being paranoid again? :wink:



Nari

[Diane]

Nari, please present your list. And please write a book!
Physio language has always been hugely important to me. If we can shed just a bit more of our "command" attitude that is still a meme holdover from having evolved as part of the army world, I'll be happy.

Bossy, patronizing language, however well intentioned it may be, is bad news to the nervous system which will defend itself. What purpose will it serve to get our patients' backs "up" at a verbal level at the same time we are trying to get them "down" at a physiological or functional level?
Here's a link to a page, connected to one of Jon's extensive links:
http://www.learningandteaching.info/learning/authority.htm
It decribes Milgram's shock experiments and says something about the human proclivity to use authoritatrian methods, and the proclivity we have of obeying them and tuning out important cues from our bodies. Also (on another note), in an authoritarian context, critical thinking has a harder time being learned.

I'm on a bit of an evolutionary rampage today: I'm pondering the idea that maybe we humans lost our fur/hair so we could be more deceptive. If we had kept it, and then tried to be animals as socially dependent as we are, our fur would be "up" most of the time. Now only our skin can go up (except for very hairy men) and we keep it pinned down with clothing, neckties, etc. By losing our body hair we also probably cut way back on our own sensory feedback mechanisms that told us when our limbics were in a state. Maybe we opted for rational efficiency rather than emotional existance, as a species are still trying to get there... It must have improved our odds of survival, because here we are, all over the place, mostly less rather than more hirsuite.

Diane

[rolf]

Hi nari!
A very good topic!I think that our body language might be as impotant as what we are saying!
RIN :wink: :wink: :wink:

[nari]

OK, at the risk of offending someone, here are my pet peeves and the inference (in parenthesis) that I would draw from those words if someone said them to me:

Let pain be your guide..........(Your pain has full control over you)

Stop when you feel pain.......(Pain is dangerous, it can harm)

How is your / pain today?......(How's your mother?)

How bad is the pain today?....(It's always bad, is it worse today?)

What does the pain stop you from doing?...(it must prevent you from --)

Does the pain get worse when you.....(Surely it does get worse?)

If I do this does it hurt?.........(I may need to hurt you)

The XR shows you have degeneration in....(You are falling apart)

I want you to do these exercises...(You should do as I say)

Do this for me...lie down, roll over...(You should do as I say)

Don't ever push into pain......(You should be afraid of this pain)

Push into pain, hard, it won't hurt you....(Liar!! How would you know...)

You must not bend over........( Bending/moving normally is dangerous)

You must sit and walk straight...(You must look like a robot/stuffed duck)

You can't expect to get better if you don't do the exercises.............
(I know more than you do, and do as I say if you want to improve)



Bring on the Army?



Nari

[bernard]

Nari,

I will agree with some and don't with some others! The employed words have subtle effects and we have to choose them carefully!

As RIN told us, I'm also listening to their body language, tone voice and clothes...

I'm believing that we can really say all what we want but we have to explain our sayings?

[Diane]

Those are good Nari. :)
You've covered most of them, if I can think of more I'll add. I've met patients who haven't done a movement in years, because some one told them it wasn't 'good for them', like neck extension. So they've tightened up in all the bits that would ordinarily slide if they did neck extension. They've been afraid to go into that range in case they "break a disc" :roll: ... I ask them, how are you supposed to look at stars if you don't bend your head back?, it's a normal human movement. Let's see how much 'normal' we can recover..
Diane

[emad]

Hi All;

Amazing topic .

Those called Verbal & Non_Verbal communication skills.

Nari :
You gave us the experssions which might harm our consumer , on both levels of our thinking /thought (as health care peroviders ) concious and sub .What are the better experssions we can use ??

Of course , For you the issue is very easy as First -English speakers , you can detect very easly the Gentle words / experssions to deal with consumers .

How is your / pain today?......(How's your mother?)

How is your pain today ?
Usually , i use this question .What is the alternative in your view ??

Regards
Emad

[nari]

emad

I do appreciate, as far as I am able to, the difficulty of interpreting English expressions when it is not your native language. It's a devil of a language to learn.

I would prefer the question to be phrased:

How are you today? taking the focus off the Pain and onto the person and his welfare. Often you get more functional answers - eg: Oh I'm not too bad. yesterday I walked for 20 minutes!

Otherwise, the answer to a pain question might be:
'Not good, it kept me awake most of the night and I had to take more painkillers..'

Do you see the difference in focus?

To some patients, pain is like a very close relative, it's part of them, it occupies their life in a big way. Sometimes it's good not to encourage that perception.

Nari

[bernard]

Emad,

I agree with Nari. You may focus on the person and her life not on a single symptom that reduces your possible action.

[Diane]

It is possible to inquire about pain without referring to it directly, or naming it as such.
1. How have you been doing since your last visit?
2. What percent better do you feel?
3. What can you do now that you couldn't do before? How does your leg (or what ever bit of body) feel when you do that?
4. Are you getting more sleep? Longer? Are you able to sleep on both sides now?
5. Have you worked your movement therapy into your day?
6. Does your ankle (or whatever bit of body) still draw your attention like it did last time, or are you finding yourself forgetting about it more?
7. Have you noticed yourself sitting with that one leg crossed, and changed to the other leg?
8. Have you found a new place to carry your wallet besides in that back pocket?
9. Have you taught yourself to sit on both bumbones at the same time?
10. Have you taught yourself to notice when you slip over onto one side (there's always a preferred side), and to deliberately shift to the other side for part of the time?

When I have to inquire about pain itself in some bit of body, I usually use a different word, like "cranky", or "does that feel tender anymore?", etc.

And when I do manual treatment, I let people know that there are several (other) sensations to be on the lookout for: A feeling of space opening, a feeling like fizzy bubbles spreading, sensations of temperature change, or that they might feel "twings" or "twangs" in some remote bit that isn't being handled, that these are all desireable, that it means the brain is working, the mirror neurons are working, that the sympathetics are re-routing blood flow patterns, that some people see colors, that if they do, it's fine, it's normal.. that the brain is busy taking the new input and making new output, dismantling it's "pain" movie.

When they get up, I ask them to feel their bodies again: Do they sense anything different? Any changes? Any feeling like they are taller or lighter? Easier to hold head up? Does the head feel less like a bowling ball and more like a helium baloon? When they walk can they sense an easy lengthening then telescoping of the legs? Internal bungee cords that are resilient, as if they have gotten new shock absorbers? Do they feel their body is more of an antigravity suit? Does it take less effort, less concentration to do a movement? Does there feel like there's any inner resistance anymore? Or does the movement feel more easy, more automatic like it should feel when the "crankiness" is gone? (All these similies came from patients at one time or another. I keep the ones I like, in order to pass on new memes.)

When they are told the sorts of possibilities that exist, that these sensations are common and ordinary ones that are enjoyable, that they can tune in on instead of looking for just "pain/no pain", their brain will start to seek out the new possibilities and disengage from the old patterns more easily; when it has a vague idea that something else can possibly exist, it won't be so likely to default to feeling the "familiar". I consider this a fair offering of novel stimulation, teaching people to find pleasurable ways of tuning into the body. They usually need a cognitive basket to put sensations into, especially given that most people have no language at all for sensations. They usually can only talk about pain or no pain, but not all the multitudinous delicious ways there are to feel one's physicality and enjoy it.

I think this is analogous to the North American way of eating to just get full or to stop being hungry, as opposed to the French way of taking time, enjoying each bite and savoring tastes, the plethora of contrasts and subtleties.
Diane

[emad]

Diane :

How do you write and read those long posts ??



Emad :wink:

[bernard]

Emad,

Word by word and phrase by phrase! :lol:
They are not long but you need to enhance your reading about English.

Just experience! :wink:

[nari]

I also use the word 'cranky' with respect to CNS.
Patients can understand the expression, and do all sorts of things with it - one person might come in and say: ...'my nerves are cranky today but I'm not, fortunately,' and laugh a bit.

The degree of pain that is needed to be experienced for useful movement is tricky.
Language needs to be very relevant...when promoting a movement.

Fishing pain analogy:
When you begin to move, slowly, you might feel a drag (that's the line through the water) and you might feel a nibble or two...hang in there, move further..if you get a bite, don't stop. Change the slack a little, but keep going. When the big bite strikes, hold a second or two, ease off and continue, playing the line calmly...and so on.

Reverse parking pain: Learning to drive is something almost everyone understands. Reverse parking requires careful but steady movement - if you nudge the car behind, OK, no harm. If you rush and slam into it - you will regret it. Nudge..move forward, etc etc.

Colours: If RED is pain overload and BLUE is painless and ineffective - go for the purple.

One wonderful Chilean lady said to me: "When I feel the pain increasing during an activity, I tell it to b----r off, and sleep n a corner. It is starting to do exactly as I say!!" (She is extremely responsive to pain education - it took only 20 minutes and she got it.)


Nari