Embracing Metaphor in Pain Medicine

There is a widespread assumption that medicine should be objective, using standardized terminology and plain speech to relay raw facts about disease and health. Within this paradigm, figurative language - such as metaphor - is viewed as unnecessary and to be avoided. Yet medicine, science, and human languages are built on a foundation of metaphor. The focus of this chapter on metaphor in clinical practice is pain management. Drawing from theoretical and empirical work, we argue that use of metaphor is essential and unavoidable. Rather than attempting to sanitize clinical practice by containing metaphor use, we will argue that there is a need to intentionally and carefully co-construct metaphors with patients to facilitate mutual understandings and enhance health-related outcomes. Metaphor is often used unknowingly by clinicians and can shape patients’ experiences and behaviours, for better or worse. Metaphors will be examined with clinically relevant examples related to pain, accompanied by original images to help readers to think poetically. Greater attention to use of metaphor in medical education and clinical practice is desperately needed to improve person-centred communication about the idiosyncratic complexities of pain and to avoid overly simplistic messages that may do more harm than good.