The Meaning of Pain Expressions and Pain Communication

  • Emma BorgEmail author
  • Nathaniel Hansen
  • Tim Salomons


Both patients and clinicians frequently report problems around communicating and assessing pain. Patients express dissatisfaction with their doctors and doctors often find exchanges with chronic pain patients difficult and frustrating. This chapter thus asks how we could improve pain communication and thereby enhance outcomes for chronic pain patients. We argue that improving matters will require a better appreciation of the complex meaning of pain terms and of the variability and flexibility in how individuals think about pain.

We start by examining the various accounts of the meaning of pain terms that have been suggested within philosophy and suggest that, while each of the accounts captures something important about our use of pain terms, none is completely satisfactory. We propose that pain terms should be viewed as communicating complex meanings, which may change across different communicative contexts, and this in turn suggests that we should view our ordinary thought about pain as similarly complex. We then sketch what a view taking seriously this variability in meaning and thought might look like, which we call the “polyeidic” view. According to this view, individuals tacitly occupy divergent stances across a range of different dimensions of pain, with one agent, for instance, thinking of pain in a much more “body-centric” kind of way, while another thinks of pain in a much more “mind-centric” way. The polyeidic view attempts to expand the multidimensionality recognised in, e.g., biopsychosocial models in two directions: first, it holds that the standard triumvirate—dividing sensory/cognitive/affective factors—needs to be enriched in order to capture important distinctions within the social and psychological dimensions. Second, the polyeidic view attempts to explain (at least in part) why modulation of experience by these social and psychological factors is possible in the first place. It does so by arguing that because the folk concept of pain is complex, different weightings of the different parts of the concept can modulate pain experience in a variety of ways. Finally, we argue that adopting a polyeidic approach to the meaning of pain would have a range of measurable clinical outcomes.

Clinical Implications: First, by making a subject’s tacit beliefs about pain explicit it will be possible to create a more open, shared space for pain communication (particularly between clinicians and patients) and support a move away from purely quantitative measures of pain towards more discursive pain narratives. Secondly, the polyeidic view might provide a mechanism for predicting who will do well or badly from cognitive interventions for pain management, allowing more efficient use of healthcare resources. Finally, the polyeidic approach might also contribute to the creation of more nuanced cognitive interventions by elucidating the pre-conscious beliefs that influence a subject’s experience of pain.


Polyeidic theory Chronic pain Communication of pain Meaning of pain terms 


  1. 1.
    Woolf V. On being ill. The Criterion. 1926;4(1):32–45.Google Scholar
  2. 2.
    Levinson W, Stiles W, Inui T, Engle R. Physician frustration in communicating with patients. Med Care. 1993;31:285–95.PubMedCrossRefGoogle Scholar
  3. 3.
    Matthias M, Parpart A, Nyland K, Huffman M, Stubbs D, Sargent C, et al. The patient-provider relationship in chronic pain case: providers’ perspectives. Pain Med. 2010;11:688–97.Google Scholar
  4. 4.
    Upshur C, Bacigalupe G, Luckmann R. “They don’t want anything to do with you”: patient views of primary care management of chronic pain. Pain Med. 2010;11:1791–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Hadjistavropoulos T, Craig K, Duck S, Cano A, Goubert L, Jackson P, et al. A biopsychosocial formulation of pain communication. Psychol Bull. 2011;137:910–39.PubMedCrossRefGoogle Scholar
  6. 6.
    Dorflinger L, Kerns R, Auerbach S. Providers’ roles in enhancing patients’ adherence to pain self management. Transl Behav Med. 2013;3:39–46.PubMedCrossRefGoogle Scholar
  7. 7.
    Butow P, Sharpe L. The impact of communication on adherence in pain management. Pain. 2013 Dec;154:S101–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Mistiaen P, van Osch M, van Vliet L, Howick J, Bishop FL, Di Blasi Z, et al. The effect of patient–practitioner communication on pain: a systematic review. Eur J Pain. 2016;20(5):675–88.PubMedCrossRefGoogle Scholar
  9. 9.
    Bourke J. How to talk about pain. New York Times. 2014 July 12.Google Scholar
  10. 10.
    Halliday M. On the grammar of pain. Functions Lang. 1998;5:1–32.CrossRefGoogle Scholar
  11. 11.
    Wierzbicka A, Goddard C. Words and meanings. Lexical semantics across domains, languages, and cultures, vol. 336. Oxford: Oxford University Press; 2013. 336 p.Google Scholar
  12. 12.
    Wittgenstein L. Philosophical investigations. 1st edn. Anscombe E, translator. London: Macmillan. 1953. 256 p.Google Scholar
  13. 13.
    Poole GD, Craig KD. Judgments of genuine, suppressed and faked facial expressions of pain. J Pers Soc Psychol. 1992;63:797–805.PubMedCrossRefGoogle Scholar
  14. 14.
    Williams ACC, Craig K. Updating the definition of pain. Pain. 2016;157:2420–3.CrossRefGoogle Scholar
  15. 15.
    Cohen M, Quintner J, van Rysewyk S. Reconsidering the International Association for the study of pain definition of pain. Pain Rep. 2018;3:e634.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Melzack R, Wall PD. The challenge of pain, vol. 368. London: Penguin; 1983. 368 p.Google Scholar
  17. 17.
    Field H. Pain: an unpleasant topic. Pain Supple. 1999;6:S61–9.CrossRefGoogle Scholar
  18. 18.
    Melzack R. The McGill Pain Questionnaire: from description to measurement. Anesthesiology. 2005 July;103:199–202.PubMedCrossRefGoogle Scholar
  19. 19.
    Brogaard B. What do we say when we say how or what we feel? Philosophers’ Imprint. 2012;12:1–22.Google Scholar
  20. 20.
    Merleau-Ponty M. The phenomenology of perception, vol. 696. London: Routledge; 1958. 696 p.Google Scholar
  21. 21.
    Melzack R, Casey K. Sensory, motivational and central control determinants of pain. In: Kenshalo D, editor. The skin senses. Springfield, IL: Charles Thomas; 1968. p. 223–39.Google Scholar
  22. 22.
    Hansen N, Chemla E. Color adjectives, standards, and thresholds: an experimental investigation. Ling Phil. 2017;40:239–78.CrossRefGoogle Scholar
  23. 23.
    Sassoon G. A typology of mutlidimensional adjectives. J Sem. 2013;30:335–80.CrossRefGoogle Scholar
  24. 24.
    Solt S. Multidimensionality, Subjectivity, and Scales: Experimental Evidence. In: Castroviejo E, McNally L, Sassoon GW, editors. The Semantics of Gradability, Vagueness, and Scale Structure. Dordrecht: Springer. 2018. 293 p.Google Scholar
  25. 25.
    Melzack R, Torgerson W. On the language of pain. Anesthesiology. 1971;34:50–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Klein C. What the Body Commands. Cambridge, MA: MIT Press. 2015. 224 p.Google Scholar
  27. 27.
    Bain D. What makes pains unpleasant? Philos Stud. 2013;166:69–89.CrossRefGoogle Scholar
  28. 28.
    Bain D. Why take painkillers? Nous. 2017;53:462–90.CrossRefGoogle Scholar
  29. 29.
    Borg E, Harrison R, Stazicker J, Salomons T. Is the folk concept of pain polyeidic? Mind Lang. 2019.
  30. 30.
    Hawker G, Mian S, Kendzerska T, French M. Measures of adult pain. Athritis Care Res. 2011;63(S11):S240–2.CrossRefGoogle Scholar
  31. 31.
    Jensen T, Karoly P. Self-report scales and procedures for assessing pain in adults. In: Turk DC, Melzack R, editors. The Handbook of Pain Assessment. New York, NY: Guildford Press. 1992; p. 135–51.Google Scholar
  32. 32.
    Stevens S. On the theory of scales of measurement. Science. 1946;103:677–80.PubMedCrossRefGoogle Scholar
  33. 33.
    Katz J, Melzack R. Measurement of pain. Surgical Clinics. 1999;79:231–52.PubMedGoogle Scholar
  34. 34.
    Price D, McGrath P, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17:45–56.PubMedCrossRefGoogle Scholar
  35. 35.
    Williams ACC, Davies HT, Chadury Y. Simple pain rating scales hide complex idiosyncratic meanings. Pain. 2000;85(3):457–63.CrossRefGoogle Scholar
  36. 36.
    Ballantyne JC, Sullivan MD. Intensity of chronic pain — the wrong metric? New Eng J Med. 2015;373:2098–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Werner A, Malterud K. It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors. Soc Sci Med. 2003;57:1409–19.PubMedCrossRefGoogle Scholar
  38. 38.
    Morse JM. Using qualitative methods to access the pain experience. Br J Pain. 2015;9:26–31.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Schiavenato M, Craig KD. Pain assessment as a social transaction: beyond the “gold standard”. Clin J Pain. 2010;26:667–76.PubMedGoogle Scholar
  40. 40.
    Tait R, Chibnall J, Kalauokalani D. Provider judgments of patients in pain: seeking symptom certainty. Pain Med. 2009;10:11–34.PubMedCrossRefGoogle Scholar
  41. 41.
    De Ruddere CKD. Understanding stigma and chronic pain: a state-of-the-art review. Pain. 2016;157:1607–10.PubMedCrossRefGoogle Scholar
  42. 42.
    Woolf CJ, Bennett GJ, Doherty M, Dubner R, Kidd B, Koltzenburg M, et al. Towards a mechanism-based classification of pain? Pain. 1998;77:227–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Turk DC, Meichenbaum D, Genest, M. Pain and behavioral medicine: A cognitive-behavioral perspective (Vol. 1). Guilford Press. 1983. 452 p.Google Scholar
  44. 44.
    Eccleston C, Williams AC, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2009;2:CD007407. Scholar
  45. 45.
    Thorn B. Cognitive therapy for chronic pain: a step-by-step guide. New York: Guilford. 2017. 355 p.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Reading Centre for Cognition Research, Department of PhilosophyUniversity of ReadingReadingUK
  2. 2.Department of PsychologyQueen’s UniversityKingstonCanada

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