Our words can really HURT…

Have you ever thought about the language you use in the clinic?  Have you ever listened to your colleagues or other medical practitioners talk with patients?
Well, one of my research interests is to study the effects of our language, as well as our patients language, on pain.   I believe that language can invoke a nocebo response due to it providing an input to our defensive neuromatrix.  Here are some examples:
“That must really hurt”
“Your images show some pretty bad degeneration of ______”
“Your discs are bulging as multiple levels”
“You have a large heel spur that you’re walking on with every step”
“Your posture is horrible”
“Your knee cap is slipping off of its track”
Ok, you guys get the picture.   I hope that the readers of this site can appreciate that the above statements, in and of themselves, can result or heighten an experience of pain.  So maybe, we should consider rephrasing our wording and focusing on the positive aspects of our patients health. I mean how medically accurate are these statements anyway?  Could we ethically practice without giving these OPINIONs?
What do you think???

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  • It still amazes me that anyone says these things whether or not they have a knowledge of current pain science. It hurts me when I hear other clinicians say this to patients in the clinic (I have some old school practitioners working with occasionally). I think this is perpetuated in PT school as well as every other allied health profession schooling. I am unaware of the adoption rate of including pain science in allied health professions, are you aware of this Joe?

    Erson Religioso October 18, 2012 9:30 am Reply
    • I am aware Erson and actually studying the knowledge of pain science in healthcare practitioners as we speak (w/ Cory Blickenstaff, Jo Nijs, & Jason Silvernail). We are in the pilot phase of validating an instrument which asks pertinant, accurate questions. We have sent the instrument to “experts” and still awaiting some responses. After looking at the results of this and making any necessary modifications, it will be going out to MDs, PTs, and DCs. It won’t be testing “adoption of including pain science” but instead basic “knowledge of pain science”.

      josephbrence October 18, 2012 10:29 am
    • Great study Joe, I imagine from what my patients come in telling me about what various healthcare professionals tell them, being all doom and gloom that the basic knowledge will be lacking. I think a good follow up would be looking at pain science implementation in other profession’s curriculums.

      Erson Religioso October 18, 2012 10:32 am
  • “You are in great shape! Now if we can just improve on a few of your limitations.”

    Tim Richardson, PT October 18, 2012 9:55 am Reply
  • “Your x-ray findings are indistinguishable from normal aging and shouldn’t prevent you from enjoying life, doing what you want and picking up your grandkids.”

    timrichpt October 18, 2012 9:58 am Reply
  • “Walk as much as you are able to walk.”

    timrichpt October 18, 2012 9:59 am Reply
  • “Bending, lifting and twisting are safe and appropriate for your spine. Do it.”

    timrichpt October 18, 2012 10:00 am Reply
  • “It might hurt a little but you’re not doing any damage.”

    timrichpt October 18, 2012 10:05 am Reply
    • While the other statements are positive and promote overall health, this one is not at the same level. You really don’t know that this is true. “It might hurt a little but chances are slim that you’re doing any actual damage.” – this is likely to be a more accurate statement.

      fbpt October 29, 2012 2:34 am
    • You’re equivocating – patients need strongly positive language with emphatic delivery to overcome social and media messages that equate pathology with disability. Anatomy is NOT destiny. If you’ve ruled out pathology in your evaluation then you need to deliver the message to promote activity. Gordon Waddell said that “Fear of pain may be more disabling than the pain itself.”

      Tim Richardson, PT October 29, 2012 10:02 am
  • “Your doctor may say you have arthritis but you can still do certain sports safely.”

    timrichpt October 18, 2012 10:07 am Reply
  • I always have students training with me assess knee effusions in patients following knee surgery especially when they are noted to be at a 3+ per the modified stroke test as written up by Sturgill et al in JOSPT 2009. The student will routinely remark to the patient, “Wow your knee is swollen.” Rather than backhand the student (jk), I have to remedy the situation and go over to the patient and say, “looks like you have a little bit of swelling in your knee. Im always shocked when I don’t see some swelling after surgery. Im glad you are here because I will be in a good position to help you and you strike me as a motivated and mindful patient.” You can just see the patient relax at that point. Every word that comes out of our mouths as clinicians is critical and must be strategically used and express genuine care and concern while being assertive. Great post Joe. Onward or shall I say “Forward”

    Chris Johnson October 18, 2012 12:47 pm Reply
  • We are constantly working on this topic in the clinic and changing the words we use. I am glad to see some research on the topic. Awesome comments by Timrichpt.

    valeopt October 19, 2012 11:26 am Reply
  • Years ago I obtained the results of my exercise stress test prior to reviewing them with the cardiologist (big mistake). I had developed an arrhythmia after taking some medication though didn’t connect the dots at the time; perhaps because they were OTC which I thought I had taken before. Anyway, I was troubled to read what appeared to be an entire paragraph of various pathologies affecting my heart. This caused a lot of anxiety which seemed to elevate my symptoms. A few days later I had the follow-up with the cardiologist who stated that I had very healthy heart for my age and that absolutely no treatment was indicated. In fact, his only recommendations were for me to avoid taking Claritin in the future and “keep exercising”.
    Being on the other side of the fence with this experience was a real eye-opener for me. It forever changed the way I speak to patients about the signs and symptoms associated with their problem.
    As with all of your posts, I enjoyed this one very much as well. Thanks, Joe.

    deebbecke October 19, 2012 1:35 pm Reply
  • Great post, always a good reminder to be careful with our words. We all can get careless at times. Thanks!

    Jennifer October 24, 2012 9:37 pm Reply
  • Good discussion. words that we use in clinic are extremily important but what do you think about words that we have to use when we treat patients who are spinal injuried like C5 or Th3? How to reply to their questions they ask every day and those questions are same every day? I think that in the orthopaedic clinic it is easier because rate of success is big during treatment but that phylosophy is going to be changed when you treat the patients with spinal cord. As it would be good to start discussion about words we have to use when we treat SCI patients, i want to point out that there should be multidisplinary approuch when we talk about disability and pain (especially together with psychologists)…..this approuch should also be evidence based as it differs from country to country, through different mentalities and ethnographies.

    Haris October 25, 2012 9:00 am Reply

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