STICKS AND STONES…
Best selling author Don Miguel Ruiz in his book The Four Agreements reveals what he believes to be the primary sources of self-limiting beliefs. The first and most important of these principles is to be impeccable with your word.
It sounds easy enough, as a professional we are under the agreement to ‘do no harm’. As a colleague, friend, family member or acquaintance we aim to be courteous, thoughtful, and kind. The problem is not so much our intention but our awareness of the words that we use to convey meaning. Some of which may, without our knowing, pass through the filter and hold more weight than what we give them merit.
…Because the fact is, words do ‘hurt’ and not just emotionally.
There have been a number of studies detailing placebo and nocebo patient responses to explanations regarding interventions by a professional within their field of expertise. An example of this is a study by Varelmann et, al. (2010), where one hundred and forty healthy women at term gestation requesting analgesia were randomized to either a placebo (“We are going to give you a local anesthetic that will numb the area and you will be comfortable during the procedure”) or nocebo group (“You are going to feel a big bee sting; this is the worst part of the procedure”). Pain was assessed immediately after the local anaesthetic skin injection using visual analog scale scores of 0 to 10. Median pain scores were significantly lower when reassuring words were used compared with the more intense nocebo words. This study and many others are beginning to show a pattern suggesting that more reassuring words may improve the subjective experience.
Lorimer Moseley has stated that:
‘100% of the time, pain is a construct of the brain’.
Now this is not to say we lie to our patients. We also have an ethical obligation to be truthful and transparent when gaining consent, giving a diagnosis, a prognosis or offering advice. However it is important to recognise that therapists are in a powerful position in their ability to influence a patient’s perception regarding pain and recovery. It is our responsibility to have an awareness of words that we use and whether or not they have a connection to negative suggestions and connotations, as this may feed into a fear generated belief system and adversely affect recovery.
“The human mind is a fertile ground where seeds are continually being planted, the seeds are opinions, ideas and concepts. You plant a seed, a thought, and it grows. The word is like a seed and the human mind is so fertile. The only problem is that too often it is too fertile for the seeds of fear” (Ruiz, 1997).
If a patient comes to you with concerns about an injury, anxieties about returning to sport or a fear of whether their pain will ever resolve it is important for us to recognize the power of the words we use and the long-term impact they may have on a persons wellbeing.
…We do not want to be unconsciously watering the seeds of doubt, fear or despair.
It sounds relatively simple to strip down and remove some of these negative connotations. However, some of these words are more subtle than we realise. They are words we use often without acknowledgement. For example;
- Words such as ‘try’ suggest anticipated failure.
- A statement like ‘don’t worry’ is associated with there being something to worry about (Allen, et al, 2011).
Terms such as ‘chronic’, ‘disc’ ‘damage’ or ‘osteoarthritis’ may be enough to set off a flag for danger and generate a fear or anxiety driven response.
So where to from here?
I invite you to be impeccable with your word.
Below is a list of resources to assist in better understanding this concept, strategies for intervention and some great tools that can be shared with patients. Knowledge is power.
- Why Things Hurt. A great TED talk by Lorimer Moseley.
- Understanding Persistent pain- How to turn down the volume on persistent pain. A great resource booklet for both practitioners and patients.
- Explain Pain, a book by David Butler and Lorimer Moseley.
- Painful yarns, a book by Lorimer Moseley.
- Explain pain supercharged, a book by David Butler and Lorimer Moseley
- Cyna, A.M, Marion, A.I, Tan, S.G.M, & Smith, A.F. (2011).Handbook of
Communication in Anaesthesia & Critical Care: A Practical Guide to
exploring the art. New York, United States: Oxford university press.
- Ingraham, Paul (updated Nov 18, 2016, first published 2010)
Pain is Weird. Retrieved April 26, 2017, from
- Ruiz, D.M & Mills, J. (1997). The Four Agreements: A Practical Guide to
Personal Freedom (A Toltec Wisdom Book). California, USA: Amber-
- Varelmann, D, Pancaro, C, Cappiello, Eric C & Camann, W. R. (2010)
Nocebo-Induced Hyperalgesia During Local Anesthetic Injection
Anesthesia & Analgesia:
March 2010, Volume 110, Issue 3, pp 868-870.
Retrieved from http://journals.lww.com/anesthesia- analgesia/Fulltext/2010/03000/Nocebo_Induced_Hyperalgesia_During_Local.42.aspx
Becs Van de Scheur – Physiotherapist & Pilates Trained [Mat Work Level I]
From the East Coast of Australia, Bec graduated with a Degree in Human Movement Science before going on to complete her studies as a Physiotherapist in which she graduated in 2012 from the University of Newcastle, Australia.
With a background in private practice and aged care Bec enjoys working with individuals of all ages and all sporting backgrounds placing a large emphasis on education, with an aim to empower individuals by providing them with the skills they require to take ownership over their own health.
With a keen interest in holistic management and pain science Bec believes in offering a combination of hands on therapy and individualised exercise prescription. Bec has completed her Level 1 Mat work pilates training and also offers Dry needling and Western acupuncture techniques when indicated.