Thursday, July 14, 2011

The Language of Pain Can Make a Big Difference

Language Matters Words do make a difference and the language used to describe pain conditions, treatments, and affected persons can either perpetuate or dispel harmful misconceptions and negative stereotypes. An important reminder of this and helpful suggestions come from the American Pain Foundation.

Previous research has shown that merely hearing certain pain-related words can fire-up the brain's pain centers in persons with pain [see prior UPDATE here]. Equally important is the communication of healthcare providers in their discussions with patients, in conversations with colleagues, in written articles, or during conference presentations. A 2-page handout, “Tips for Using Language to Communicate Effectively, Empower People and Create Change about Pain and its Management” [PDF here], offers excellent advice. Here are some highlights [with our added commentary]:

  • Use appropriate language when describing affected individuals. Terms such as “pain patient” or “arthritis sufferer” are depersonalizing. Rather, use “patient (or person) with pain,” or “patient (or person) living with the disease of arthritis.” Many authors and speakers like to use the shortcut term “pain patient,” but this label can have disparaging connotations and be stigmatizing.

  • Analgesics are “pain relievers”; avoid use of “pain killer.” Also, rather than referring to “drugs,” which can have negative implications, use “medications” or “medicines.”

  • The term “narcotic” should never be used in reference to opioid analgesics. Today, narcotic is used by law enforcement and some government agencies (eg, DEA) pertaining largely to illicit drugs, such as the opioid heroin, but also inclusive of cocaine, methamphetamine, “designer drugs,” and others. Any healthcare provider who uses the term “narcotic” is not only outdated but possibly inciting unjustified fear of danger in patients. [We previously discussed avoiding the term “narcotic” in a Pain-Topics e-Briefing here.]

  • Keep in mind that not all healthcare professionals involved in pain treatment are medical or osteopathic doctors, and “pain practitioner or clinician” can be overly broad designations. Be specific about the particular qualifications of the care provider, whether physician, physician assistant, nurse, pharmacist, physical therapist, or other professional.

  • Terms like “misuse,” “abuse,” “tolerance,” “dependence,” and “addiction” used in conjunction with medications are often poorly defined, misunderstood, and/or used incorrectly. In particular, tolerance to and physical dependence on opioid analgesics are naturally occurring phenomena; they are not the same as addiction. Furthermore, a person who takes more opioid medication than prescribed might be considered as misusing or abusing the medicine; however, use of those pejorative labels is unhelpful for understanding underlying reasons for the behavior. [We have previously discussed confusion over “dependence” vs. “addiction” in a Pain-Topics e-Briefing here.]

The American Pain Foundation suggests that their advice on using appropriate language when discussing pain should be shared with family members, friends, co-workers, and healthcare providers. When you hear someone using language that is inaccurate or inappropriate, tactfully suggest they use accurate terms or appropriate language. If incorrect language appears in local news media, respond with a letter to the editor or in an online comment.

We also have observed that some of the worst offenders when it comes to using stigmatizing language are healthcare providers, who should know better. Also at fault are journal editors, who are in an ideal position to correct manuscripts to reflect more appropriate language. All of this goes beyond mere “political correctness” — language influences attitudes, which ultimately affects behaviors; so, overcoming barriers to more effective pain management could begin with more suitable communication about the issues and persons in need of better care.