Positive language in pain consultations
The way clinicians use language can be stigmatising because patients can feel judged about the validity of their pain. This is a guide on how to use positive phrases that can improve patients’ health outcomes and self-reliance.
What you say matters
Clinicians who use effective and respectful communication to help consumers deal with pain within a biopsychosocial framework avoid contributing to stigmatisation.
Stigma has been described as a sense of shame, disgrace or disapproval that leaves a person feeling rejected, discriminated against, and excluded from participating in different areas of society, including medical and therapeutic relationships.
The effects of stigma affect a person in every area of life such as home, work, social, friends, family, romantic and medical interactions.
John stopped coming to pain appointments because he didn’t feel as though he was believed. He got the keen sense the clinicians thought he was a ‘freeloader’, making it up.
— Triage nurse
Access to pain management for people with chronic pain is a basic human right.1, 2 Chronic pain is a complex health condition. It is also invisible, which means the person needs to be able to describe and explain their experience. Stigma, or fear of stigma, causes consumers to resist seeking help. It is also associated with poorer physical and psychological wellbeing.1
Stigma occurs when a person feels judged because:
- they have chronic pain
- of the way they manage their condition
- they feel disbelieved about their pain experience.
Types of stigma
The experience of being treated differently to other people. It may include being:
- disbelieved by health professionals, loved ones, family members, employers, colleagues and friends
- accused of exaggerating their pain or being told it is “in their head”
- blamed and dismissed.3
When a person believes society’s negative messages about chronic pain or disability and applies those beliefs to themselves. Internal stigma might include:
- feeling a loss of control, confidence and self-worth; the sense that their body fails them
- believing their value as a person is less due to their reduced capacity to contribute at home, work and in the community
- blaming themselves for not getting better, despite the treatments they have received.4
How clinicians, support staff and carers can minimise stigma
- Listen to the patient and show understanding as they describe how pain has impacted their life.
- Empathise and validate so that the person feels believed, heard and understood.
- Summarise what you have heard them say, giving them the opportunity to correct you if required.
- Support and build confidence in their capacity to adopt self-management strategies.
- Work with patients to create a treatment plan. This gives the consumer agency and helps them to feel empowered to contribute to the management of their pain.
- Provide education or educational resources about chronic pain.
- Introduce them to people with chronic pain for peer support and connection.
When a mental health professional is added to their medical team, pain patients often ask, “Is this pain all in my head?” Or, “Are you saying the pain is all in my head?” Before you recommend a mental health professional, ensure that you have:
- developed a trusting relationship and positive rapport
- a thorough understanding of the person’s experience of pain
- explained the reasons for making this suggestion and how it might be helpful
- discussed ideas, thoughts and concerns they may have.
Effective communication to reduce stigma
Here are suggestions on how to respond in a positive manner when you hear a patient make a negative comment about their situation.
| Negative patient comments | Positive responses from clinicians |
|---|---|
My scans show wear and tear. It looks like bone-on-bone. | The body continuously wears and repairs throughout life. Just like wrinkles on the skin, joints also show wrinkles over time. Your cartilage is showing signs of normal ageing. |
My disc is collapsed / busted / blown out / ruined. The disc is out. My bone is out of place and squeezing the nerve. There is no hope. I'm going to end up in a wheelchair. | Spine joints, discs and cartilage are very strong elements, and it takes a lot of force to damage them. The spine is a strong, resilient part of your body. Your body can heal and repair. I want to help you to create the best lifestyle circumstances that will encourage healing and restoration. Healing takes time. The tissue is a bit irritated, but it is repairable. It is ok to move, even if you are feeling some discomfort and pain. |
Exercise makes things worse and will cause more damage. I’m scared to move because it hurts. They think I'm lazy. | Physical activity is important to maintain strength and flexibility, and this helps you with your everyday activities. Let's work together to find safe ways for you to move again. Let’s find something you enjoy doing. Let's learn about how we can make some changes to put you back in control. |
They think I'm taking too many medications. They think I'm a drug addict. They don’t think my pain is real. | Your team of clinicians is ‘on your side’. We're all working together to help you improve and maintain improvements for the long term. International research strongly suggests that chronic pain is best managed in an integrated way. This approach can involve emotional and psychological supports as well as physical and sometimes pharmaceutical supports. It all works together to retrain your pain-sensor system. |
My situation is hopeless and unbearable. I feel embarrassed and ashamed about my pain. | Your situation can be challenging. But you and the pain management team can work together to realise your recovery and healing. There are challenges but there is hope for the future. |
I'm depressed about my pain and life situation. I'm anxious about my future. I'm stressed that I can’t work. I'm frustrated and angry that this pain hasn't gone away. | I've noticed some changes in your mood, and this can make your pain better or worse. Our team includes a psychologist who might be able to help. There are many counselling techniques that help to regulate and improve your mood. In turn, this will help your pain and lifestyle. Let's talk about how we can make things better again. |
Why do they want me to see a psychologist? | The brain has an important part to play when it comes to controlling emotions, movement and pain. Psychology can help with learning strategies for you to take control of your life again. |
Another scan will show what’s wrong. | Scans don't show your level of pain or what you can do. Scans show normal age-related changes. Once assessed, you can still do things safely regardless of what your scan shows. |
Useful links
- Pain Australia
- Chronic Pain Question Planner
- Pain Health
- How to have effective conversations with patients about opioids and chronic non-cancer pain - YouTube
- Effective conversations about psychology referral, opioids and chronic non-cancer pain - YouTube
References
- Cosio D, Demyan A. Behavioral Medicine: How clinicians can reduce the stigma attached to chronic pain. Pract Pain Manag [Internet]. May 2021 [cited May 2023]; 2021;21(1).
- De Ruddere L, Craig KD. (2016). Understanding stigma and chronic pain: A state-of-the-art review. Pain [Internet]. Aug 2016 [cited May 2023]; 57(8), 1607–1610. DOI: org/10.1097/j.pain.0000000000000512
- Chronic Pain Australia. National Pain Survey 2021 [Internet]. Sydney: Chronic Pain Australia; 2021 [cited May 2023]
- Waugh O, Byrne D, Nicholas M. Internalized stigma in people living with chronic pain. J Pain [Internet]. May 2014 [cited May 2023]; 15(5):550.e1-10. DOI: 10.1016/j.jpain.2014.02.001
