Tag Archives: chronic pain

The use of Metaphors in medicine: confusing or an enlightening use of language?

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Let’s start with a definition:

METAPHOR; generally there are two types (an analogy and a simile). A metaphor is a figure of speech usually to imply a comparison between to different things or not dissimilar things. For example;

  • As busy as a bee
  • The curtain of the night
  • life is like a box of chocolates, you never know what you’re gonna get…..

Image result for forrest gump

  • Diagnosis is more like an umbrella term…..
  • Your explanation is as clear as mud. (Simile)
  • A doctor’s diagnostic method is like a detective’s investigation.(analogy)

Sometimes the metaphor is an exaggeration (a hyperbole) and sometimes used to make a point and be precise (an antithesis). An ANALOGY is usually where the comparison is more literal or similar. A SIMILE – usually different things are compared.

The (hopefully) useful thing about metaphors is they can help put complicated medical jargon or descriptions into “layman speak” or ways that seem familiar. So this may be in work terms such as comparing nerves to electrical cable for electricians, or the complexities of the healing process to say road repairs or building an house extension – I’ll use these later in this BLOG mainly in areas of pain and healing.

Medical researchers seem mixed in their agreement about whether metaphors are good or indeed just a different sort of bad and not enlightening at all!! but here goes……………..

“Metaphors may be as necessary to illness as they are to literature, 
as comforting as a bathrobe and slippers.” (Broyard, 1992)

Let’s start with some simple analogies used in medicine to help with discussing pain especially when pain is faulty!! (More BLOGS to follow on this … PAIN FAULTY !!!….. we’ll get to it !)

Pain : An Alarm system

There are several variations on the use of an alarm system as an analogy for persistent pain. The idea is that the original trigger for the pain has ceased, but the pain signals (alarm) continue to be transmitted.

  • Persistent pain is like a doorbell that goes haywire. Usually when you press a doorbell it rings one house one time and that’s all. But, in the case of chronic pain, it’s as if the doorbell on one house actually rings every house on the block. And the doorbell doesn’t just ring once, it rings all day and all night (Tupper, 2012).

  • Chronic pain is like a broken alarm clock. Imagine that your morning alarm clock goes off at 7 am, and you roll over to hit the snooze button, but it doesn’t turn off like it’s supposed to do. You try banging the snooze bar, switching the alarm off, unplugging the clock, taking out the batteries, and even throwing it out the window, but it still keeps ringing. You’re clearly awake at this point, so the ringing alarm clock is not doing any good anymore, but it just won’t turn off. The pain alarm in our body can be just like this broken alarm clock. It can just keep ringing and ringing even though it’s not helping us in any way (R. Coakley).

  • Chronic pain is like a car alarm. Sometimes a car alarm can go off even when there is no sign of danger. For example, sometimes a large truck passing by can accidentally set off a car alarm in a parked car. Or, sometimes a car just needs to be gently bumped in order to activate the car alarm. Some car alarms, it seems, are very sensitive, while others hardly go off at all. The purpose of the car alarm is to alert other people that the car is in danger. However, when the alarm goes off accidentally and there is no sign of danger, it’s really just a false alarm. Cars with sensitive alarms send out more false alarms and people with more sensitive nervous system can have more false alarms (pain sensations) as well (C.T. Chambers, personal communication, 2013).

Let’s look at metaphors for how impulses like pain, touch, temperature & many others travel up and down form the body part to the brain and back (Yep they go both ways!). There are many filters in the system that can be thought of as “like” gates…..

Chemical bridges  (called – neuro transmitters) bridge the space at these filters or gates along the impulses journey up and down the nerve, they are not supposed to be permanent. The bridge or gate should not be constantly open. See below…….. the railway gate analogy…

a synatic gate

Railway crossing gate

The gate control theory is a very popular theory, originated in the early 1960’s by Melzack and Wall. Whilst now it is known that  this not absolutely the way it is, it is still a valuable concept. This theory posits that there is a virtual gate that controls the magnitude of the pain signal that reaches the brain (Melzack & Wall, 1965). It can be helpful to describe the path to people as an actual gate.

You can think about pain signals being like trains passing through a railway crossing gate. When the gate is all the way open, trains pass right through. Similarly, when the gate to your brain is open, pain signals have free access to your brain. Medication might close the gate partway, but for many people, medications may not close the gate completely. The key idea here is that treatment whether it be physical therapy, manipulative therapy, acupuncture  or  talking therapies like CBT or mindfullness can help “shut the gate”. 

HEALING: There are lots of useful metaphors for healing here are a couple of my favourites that seem to make sense to my patients:

Healing is like …

  • a building project. 

Here I discuss that there are stages, you don’t put up a roof without walls ! a good foundation is essential. In healing there are 3 stages: acute phase – lots of mess but hopefully a good foundation, then the sub-acute phase – the building of the structure and finally the  remodelling phase – the painting, decorating making it useful. Now with every building project not everything may go smoothly or may need bits re-doing, maybe the plumber doesn’t turn as expected……hopefully you can see the analogy unfolding into something familiar.

  • repair on a motorway

Similar to above but I use it for a slightly different emphasis: the analogy is used to explain “reflex muscle protection” or spasm in the analogy the miles of bollards used to protect the work force may seem excessive – they aren’t – but are a “pain” to all drivers!

I tend to ask my clients what they understand from the analogy and see if it does indeed prove helpful..!

The debate goes on in the literature are metaphors good or bad. The right ones work in the right hands for the right people !! Get them right and they are so EMPOWERING and HEALING in their own right.

Facilitate the mind to allow the body to heal – It is a two way street!!! 

As ever like the bits you like, maybe see how they might work in your situation. Ignore if you wish… Enjoy.

Thank you for reading.

Alan

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