Use of Metaphor, Images May Play Help Providers Better Understand Patients’ Pain for Diagnosis, Treatment


A far more radical understanding of how humans express their experiences of pain moves into embracing the role of the imagination in that process.

Through the use of metaphors and images alongside traditional medical scales, patients may be better able to identify and express their experience of pain and its personal toll to their health care providers, according to research published in the journal Frontiers in Pain Research. Due to the complicated ways patients make sense of their experience of pain, poetry and images may help to reveal important details that can aid in diagnosis and treatment, according to the study.

Developed in the 20th century, pain charts and visual-linguistic scales help to measure pain, but patients’ endeavors to self-report pain may pose challenges for some due to the subjective nature of pain and difficulties with externalizing it on an objective scale.

"Feeling supported rather than stigmatized can help people cope with pain. We need better ways to express and describe pain other than a scale of 1 to 10. Numbers are useful, but often there is too much riding on picking the right number. We need to give patients better resources to describe pain in a different way,” said study co-author Jessica Stanier, a doctoral student from the University of Exeter, in a press release.

Stanier noted that due to the nature of how we process our experiences, a far more radical understanding of the expression of pain involves embracing the role of the imagination in that process, which would require moving beyond the use of pain scales and toward a transformation of social and material conditions.

"Imagination plays a crucial role in determining how the self makes sense of experiences of pain figuratively,” Stanier said in the press release. “Pain is not a thing, a state, or a condition, but rather a process that involves the whole person and whose complexity lies in the way it implicates all kinds of different biological structures and layers of meaning."

Stanier explained that during her team’s research, they explored ways people in pain can creatively express sensations, bodily feelings, and their psychical impact through metaphor to health care providers. Specifically, they investigated the use of metaphors, which can help patients express a given experience in terms of another, and the use of images in the form of pain cards, which are a set of laminated images representing aspects of pain.

The investigators found that pain cards can help patients to more readily volunteer details of their experience without solicitation by the provider. Pain cards also provide the added benefit of relying less on language, which aids patients who are not English first-language speakers, allows greater support of visual imagination in thinking about a patient’s experience of pain, and could help patients from different cultural backgrounds better express how they feel.

Stanier explained that pain cards in the clinic setting can be complemented with the availability of free publications containing pain-related poetry, zines, and other community-based schemes, so that people experiencing pain can continue to understand that experience beyond the medical setting.

"These types of interventions give people back the sense of control that long-term conditions can very often take away," Steiner said in the press release. “These approaches do not treat participants as anonymous patients but instead respect the differences between people in pain and their individual situations.”


Metaphor and images should be used alongside traditional medical scales for patients to describe pain. University of Exeter; July 27, 2022. Accessed August 1, 2022.

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