In Pain? Fight the Stiff Upper Lip

In the early 1970s, Ronald Melzack at McGill University in Montreal developed the watershed McGill Pain Questionnaire (MPQ), a list of descriptive words, such as "itchy," "vicious" and "nauseating," that patients could check off to indicate how much and what kind of pain they were in.

Variations of the MPQ are used in many hospitals to assess pain levels and patients are often glad for the list.

"I do remember going 'oh my god, I can check off a lot of these,'" said Deatherage, after she received a list of pain words at a doctor's office.

Some descriptors have a direct relationship to bodily ailments and can assist doctors who need to make a diagnosis, said Dr. Carol Warfield, a professor of anesthesiology at Harvard Medical School.

Tingling could indicate nerve pain, while cramps and aching might be related to the internal organs and cold sensations could indicate something wrong with the sympathetic nervous system.

Talking It Through

But the pain lexicon is always changing. The University of Texas' Fernandez has done some research to refine the MPQ, omitting some words that could be ambiguous, redundant, or less germane to pain, and could be potential hazards in a clinical setting. For example, Fernandez found that the word "numb" connoted cold sensations to some and a dull feeling to others.

Consolidating the pain vocabulary into 36 descriptors showed Fernandez how economical and precise the language of pain could be. And, particularly for more commonplace types of pain -- bone fractures, dental pain and joint pain -- many people draw from a similar pool of descriptors.

"But as the whole experience of pain departs from the normal domain, words become more unique," Fernandez said, citing patient use of metaphor, literature and art to aid their descriptions. "That's when it stretches the imagination."

A patient once described pain to Fernandez as "someone reaching into your stomach and ripping out your organs." A cancer patient said his pain was "a rotten curse, like a hidden enemy I can't figure out."

Other common metaphors include the feeling of an elephant sitting on your chest (heart attack) or the feeling of a head about to explode (sinus pressure.)

Scarry pointed out that there are few literary representations of pain, partially because of how difficult it can be to portray. Some works that deal accurately with pain include "Philoctetes" by Greek playwright Sophocles about a man with an injured foot and Ingmar Bergman's film "Cries and Whispers" about a cancer patient.

Art may do a better job of depicting pain. Many of the Mexican painter Frida Kahlo's paintings were influenced by the physical pain she lived with throughout her life due to the injuries she suffered in a bus accident when she was 18.

Dr. Joseph Shurman, chairman of the pain committee at Scripps Hospital in La Jolla, Calif., described a successful program at the hospital in which patients are encouraged to represent their pain as a drawing and write what that picture means to them. Patients have depicted knives going through their chests, crying every night and distress that they cannot go skiing with their family.

Pain remains inherently difficult to describe because of its subjective nature. This difficulty can be compounded by a person's verbal ability, as well as language and cultural differences.

For Deatherage, the language barrier is still in place.

"I was trying to think how to explain this," she said. "But I guess I can't."

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