Is It Discomfort or Is It Pain?

Discomfort. It’s a word often used in the medical world when referring to procedures or experiences that could involve pain. And it bugs me.

This latest rant began when I read an article about dental implants that referred to “post-surgery discomfort.” This discomfort was described as being akin to that which happens when you have an extraction. They give you Tylenol 3s for extractions — opioids. That’s not for discomfort. That’s to deal with pain and pretty high levels of it.

Using the word discomfort has a sense of avoidance in it. It may relate more to the discomfort the speaker has with the pain of others than the actual experience of the person in pain. Or is it dismissal? Does this exist in the same place as the everspreading use of the term catastrophizing to describe someone’s intense worry about their pain or illness and the impact it may have on their life?

I had an invigorating conversation on Twitter about the discomfort versus pain conundrum. Leslie said (with some degree of sarcasm) “it’s like they’re understating it in an attempt to calm us excitable, fragile creatures down a bit.” Several, including myself and Ross, felt that using discomfort when speaking of pain diminishes or devalues the person’s experience. On the other hand, Chronicallyfabblog didn’t give a rat’s arse what words were used, as long as she gets the care she needs.

There are times when the word discomfort is appropriate. Cathy mentioned sometimes being stiff, rather than in pain. And then Teresa brilliantly described a certain kind of Fibro pain: “some of my fibro "pain," which is more of a squishy sort of itchy, sort of zappy crawling kind of thing. If someone asked me if I was in pain, I would probably say no, despite the fact I want to pull my arm out of my shoulder socket.” I knew exactly what she meant and she is absolutely right. It is not pain, but you want to forcibly remove the body part experiencing that sensation.

So. Discomfort is a different experience than pain. But the medical professional using the word discomfort could have the goal of starting wide and gradually narrowing down the description of what the person in front of them is feeling. Ann, who’s a nurse, mentioned not using the word pain when talking to patients, because people, including herself, suck at rating their pain. Instead, she explores, getting a more detailed description of the sensation. And that exploration is key, because if the person is in pain, it will lead you there. 

Dictionary definitions:
Discomfortan absence of comfort or ease; uneasiness, hardship, or mild pain.
Painphysical suffering or distress, as due to injury, illness, etc.

Assuming that what we are talking about is indeed pain, then I believe using the word discomfort serves to minimize the sensation and the experience. Language has power. The words we choose to describe something frames the experience. A medical professional who consistently using the word discomfort reframes the experience to something uneasy, uncomfortable, or, as described in the dictionary, mild pain. In using this description, it’s easy to eventually come to believe that what one’s patients experience is in reality a milder sensation than what they describe.

And it’s a short leap from seeing your patients’ description of their discomfort as somewhat exaggerated to perhaps believing them to have a pathological relationship with their pain. That they are catastrophizing.

Another point raised in the Twitter debate was your own role in such a situation. The patient’s responsibility to push back, to correct inappropriate word choice. Or as Chronicallyfabblog said, “if you’re not being heard, it’s because you’re not screaming loud enough.” And there is some truth in that.

But I don’t believe that you should have to scream in order to get to a situation where your doctor/nurse/physiotherapist/etc. listens to you and uses words that are appropriate to your experience. Not everyone is comfortable advocating for themselves. In fact, becoming a self-advocate is often a by-product of living with a chronic illness – in other words, people didn’t have those skills before.

Like it or not, the doctor-patient relationship has an inherent power dynamic. We believe that the doctor is the authority (at least initially). It is therefore the responsibility of the medical profession to pay attention to the language they use and how that frames the discussion. Because that discussion will often shape the interaction, the relationship, which in the end can shape the patient’s assessment of their experience. If someone came to an appointment needing help with pain, and through the doctor using minimizing language, left in discomfort and without a prescription, then that physician has failed in their responsibility to provide care.

Several well-known studies have established that when someone has a realistic expectation of post-surgery pain, they actually cope better and will rate their pain lower than someone who hasn’t received information about what to expect. In fact, someone who knows what to expect actually has a better outcome than someone who doesn’t.

Minimizing an experience of pain and avoiding an honest discussion of the intensity that such pain can have only serves to leave someone alone in a difficult situation. It doesn’t actually help at all. Perhaps if the medical field stopped pussyfooting around the reality of pain, they might help their patients ultimately cope better with their illness and their pain.


Annette said…
You know if you search on catastrophizing on PubMed you get 1726 pages or results at 20 papers per page. That is going to be an uphill battle.
If you add pain to the search there are 1550.
I personally hate the term completely. Of course people deal with pain in different ways, but there ought to be a different way to describe it that doesn't make patients feel that they are being blamed, and also doesn't sound patronizing and demeaning.

If there's going to be a trial and they use this to describe some of the participants they may get a lower rate of participation amongst the patients who read the informed consent

Wren said…
You wrote about pain: "In fact, someone who knows what to expect actually has a better outcome than someone who doesn’t."

This is profoundly true. Childbirth is a famously painful experience--I doubt any doctor would dare call it "discomfort." Yet for me, it wasn't horrible, mainly because I took Lamaze classes in advance. Not only did I learn to focus my mind on breathing, rather than pain, I was thoroughly educated as to what to expect during labor and delivery. Knowing and understanding what to expect was incredibly empowering. I gave birth to my daughter naturally, without drugs, and (heheh) lived to tell the tale with a smile on my face.

All that said, RD pain is another animal. I guess when it's very mild I could go with calling it "discomfort," but really, the sensation this disease causes is not discomfort. It's pain, pure and simple. Often intense, screamingly awful pain. Frankly, I'll take childbirth.

This was an excellent post, Lene. The way we describe, experience, and live with pain is, unfortunately, central to most of us who have rheumatoid disease. I hope that there are pain doctors and rheumatologists reading it--and I hope they'll pass it along to their colleagues. It would be great if our doctors would put some serious effort into understanding and comprehending our pain. Once they did, they'd be embarrassed to call it "discomfort."