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The limits of pain vocabulary

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Reader question:

Knowing what’s really going on — that pain is always an experience generated by the brain — should we change how we talk about pain? Should statements like “my ankle hurts” be rephrased like “I hurt in my ankle” or “my brain claims that my ankle hurts”?

No, I don’t think so — no more than we need to start saying, “My brain claims that I can see a bright, hot object in the sky.” The verb to see is a perfectly good shorthand for the dazzingly complex neurological phenomenon of vision: we don’t need to spell it all out.

There are “unfortunate trivializations” in the way we talk about pain:

The labeling of nociceptors as pain fibers was not an admirable simplification, but an unfortunate trivialization under the guise of simplification.

The relationship of perceived pain to afferent nerve impulses, by Patrick Wall and SB McMahon, 254–255

But simple references to the subjective experience of pain are mostly just fine as they are. Statements like “my ankle hurts” don’t express all the implications of pain science, of course … but no practical statement can. There is no good vocabulary for what’s really going on, but that’s par for the course with science and language. In the last three centuries, knowledge has raced far ahead of the ability of non-technical language to express it, and there’s no good solution to that.

Nevertheless, it’s a good idea — especially for patients with serious chronic pain, and the professionals who help them — to learn to think more literally about how pain works. Make no mistake: it may seem like your ankle hurts, but it doesn’t necessarily have much to do with your ankle, because Pain is Weird.

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