Patients should be able to use images and metaphors alongside traditional medical scales to describe their pain to doctors, a new study says.

Pain cards with pictures to describe feelings and poetry can all help people portray chronic pain more meaningfully, according to the research

Doctors will get a better understanding of the impact of pain – and patients will be better able to express how they feel.

Giving patients other ways of expressing the impact of pain could help to reveal important information which will aid diagnosis or allow doctors to give better support.

Pain charts and visual-linguistic scales were developed during the twentieth century to help doctors and patients measure pain. But asking people to report pain in this way can be challenging for some.

Researchers have said only using scales “displaces the patient’s own story, sidesteps the issue of pain’s private meaning, and disrupts the potential for humane communication between patient and doctor”.

The research, by Nicole Miglio from the University of Milan and the University of Haifa and Jessica Stanier from the University of Exeter, is published in the journal Frontiers in Pain Research.

Ms Stanier said: “Feeling supported rather than stigmatised can help people cope with pain. We need better ways to express and describe pain other than a scale of one to ten. 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.

“A far more radical understanding of the role of imagination in the expression of pain can take us 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. 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.”

The study explores creative ways people in pain have found to express sensations, bodily feelings, and their psychical impact through metaphor to clinicians and communities. Metaphors make it possible to express and understand a given experience in terms of another, increasingly the potential for others to understand and relate to the experience..

Pain cards — a set of laminated images representing aspects of pain — can encourage patients to volunteer descriptions of their experience without solicitation by the practitioner. They rely less on language and more on visual imagination and could help patients from different backgrounds to feel more in control of their time with doctors and better express how they feel.

Creating pain portraits – a visual description of pain – could help patients relay information to doctors and help them make sense of their pain.

Pain cards and portraits in the clinic can be complemented with poetry, zines, and other community-based schemes, so that people in pain can explore their experience beyond the medical setting.

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

Patients should be able to use images and metaphors alongside traditional medical scales to describe their pain to doctors, a new study says.

Pain cards with pictures to describe feelings and poetry can all help people portray chronic pain more meaningfully, according to the research

Doctors will get a better understanding of the impact of pain – and patients will be better able to express how they feel.

Giving patients other ways of expressing the impact of pain could help to reveal important information which will aid diagnosis or allow doctors to give better support.

Pain charts and visual-linguistic scales were developed during the twentieth century to help doctors and patients measure pain. But asking people to report pain in this way can be challenging for some.

Researchers have said only using scales “displaces the patient’s own story, sidesteps the issue of pain’s private meaning, and disrupts the potential for humane communication between patient and doctor”.

The research, by Nicole Miglio from the University of Milan and the University of Haifa and Jessica Stanier from the University of Exeter, is published in the journal Frontiers in Pain Research.

Ms Stanier said: “Feeling supported rather than stigmatised can help people cope with pain. We need better ways to express and describe pain other than a scale of one to ten. 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.

“A far more radical understanding of the role of imagination in the expression of pain can take us 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. 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.”

The study explores creative ways people in pain have found to express sensations, bodily feelings, and their psychical impact through metaphor to clinicians and communities. Metaphors make it possible to express and understand a given experience in terms of another, increasingly the potential for others to understand and relate to the experience..

Pain cards — a set of laminated images representing aspects of pain — can encourage patients to volunteer descriptions of their experience without solicitation by the practitioner. They rely less on language and more on visual imagination and could help patients from different backgrounds to feel more in control of their time with doctors and better express how they feel.

Creating pain portraits – a visual description of pain – could help patients relay information to doctors and help them make sense of their pain.

Pain cards and portraits in the clinic can be complemented with poetry, zines, and other community-based schemes, so that people in pain can explore their experience beyond the medical setting.

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

New Zealand tree nettle (ongaonga) CREDIT Institute for Molecular Bioscience, University of Queensland

Researchers at The University of Queensland (UQ) have found that a native New Zealand stinging tree produces toxins that could hold clues for future pain medication.

In a quest to find new molecules that affect pain pathways, Dr Thomas Durek, Dr Sam Robinson and a team from UQ’s Institute for Molecular Bioscience (IMB) studied toxins from the tree nettle known as ongaonga, one of New Zealand’s most poisonous plants that can cause painful stings that last for days, and in severe cases can even be fatal.

Dr Robinson and a team from UQ previously investigated toxins found in an Australian gympie-gympie stinging tree but found the New Zealand tree nettle toxins activated pain receptors in a new way.

“We discovered that the New Zealand nettle tree toxins target the same receptor as their Australian counterparts, but they cause pain in a different way,” Dr Robinson said.

“The Australian stinging tree and New Zealand tree nettle are both members of the nettle family, but separated millions of years ago and have evolved differently.

“The New Zealand tree nettle can grow up to four metres tall and its leaves and stems are covered with stinging hairs that pierce the skin and deliver venom which causes long-lasting pain.”

Fossil remains show that the large flightless bird, the Moa, had a liking for eating the tree nettle and it’s likely the strong toxins evolved to fend off the now-extinct bird.

The team faced challenges during the study due to international COVID travel restrictions.

“COVID made it difficult to source nettles, but to keep our research going through the pandemic, we managed to source seeds from the New Zealand tree nettle and grow the plant under quarantine in the lab,” Dr Robinson said.

Professor Irina Vetter, Director of IMB’s Centre for Pain Research, said understanding pain pathways was key to finding new ways to treat chronic pain.

“Animal venoms have been studied for decades but plants have evolved toxins differently, and this gives us a chance to find molecules that work in a unique way,” Professor Vetter said.

“Our goal is to tackle pain more effectively without side effects and addiction.”

“There are several hundred nettles in the Urticaceae family with stinging hairs around the world — we’re keen to compare how they have evolved and whether they all use the same toxins,” Dr Gilding said.

This first-of-its-kind study by researchers at The Ohio State University Wexner Medical Center and College of Medicine and University of Michigan Medical School explored one potential mechanism – central sensitization – among individuals with OUD.Peer-Reviewed Publication

OHIO STATE UNIVERSITY WEXNER MEDICAL CENTERPrintEmail App

Scientists have long noted a connection between opioid use disorder (OUD) and chronic pain, however brain mechanisms linking OUD and chronic pain are poorly understood. This first-of-its-kind study by researchers at The Ohio State University Wexner Medical Center and College of Medicine and University of Michigan Medical School explored one potential mechanism – central sensitization – among individuals with OUD. 

Central sensitization refers to abnormal pain processing in the brain and spinal cord. People with central sensitization have spinal cords that are unusually good at sending pain signals to the brain, and brains that struggle to turn off those signals once they arrive. This means people with greater central sensitization tend to suffer more with pain than others. 

“Our study is the first to give patients with OUD a scale that measures central sensitization,” said Dr. O. Trent Hall, lead author of the study and an addiction medicine physician in Ohio State’s Department of Psychiatry and Behavioral Health. “Our study provides the first evidence of central sensitization underlying the chronic pain and OUD relationship and demonstrates a new tool for easily measuring central sensitization among individuals with OUD.” 

Study findings are published in the journal PAIN Reports, an official journal of the International Association for the Study of Pain.

Researchers recruited 141 study participants from Ohio State Wexner Medical Center’s addiction treatment center in Columbus, Ohio. As part of the study, researchers administered the American College of Rheumatology 2011 Fibromyalgia Survey Criteria via electronic survey. Participants also responded to questions about pain interference, quality of life and items regarding pain-beliefs and expectations of pain and addiction treatment. 

Chronic pain may lead to OUD, and people with chronic pain and OUD have a harder time quitting opioids than people with OUD only. So, it’s critical to find answers to how pain and OUD are connected in the brain. Researchers measured quality of life across eight life domains including general health, physical functioning, mental health, social functioning, vitality, bodily pain, role limitations due to physical health and role limitations due to emotional problems. According to Hall, they found that greater central sensitization was associated with worse quality of life among patients with OUD.

“Additionally, patients higher in central sensitization were more likely to report pain as a major reason for why their opioid addiction first began, as well as for putting off addiction treatment, continuing and increasing their use of opioids, and fear of pain causing OUD relapse in the future,” said senior author Dr. Daniel J. Clauw, director of the Chronic Pain and Fatigue Research Center at the University of Michigan.

This study suggests central sensitization may be an important underlying factor complicating the treatment of chronic pain and OUD. This provides an example for other clinicians and researchers to measure central sensitization in OUD, which could help them produce better treatments for people suffering with chronic pain and OUD. 

As a physician with a background in both pain and addiction, Hall has cared for many patients suffering deeply with both conditions and he realizes that treatment options are limited. 

“It’s important to me to search for new ways to help,” Hall said. “But we can’t create better treatments for chronic pain and OUD without first understanding how the two relate. I did this study because I believed it might offer a new window into what is happening in the brains of patients needing help with pain and addiction.”

Next, Hall plans to follow patients with central sensitization and OUD over time to find out if they respond differently to treatments or have different outcomes. He also plans to study whether existing treatments for central sensitization are beneficial for patients with chronic pain and OUD. 

Other Ohio State Wexner Medical Center researchers involved in this study are Dr. Julie Teater, Dr. Kara M. Rood and Dr. K. Luan Phan.

Funding was provided by the Care Innovation and Community Improvement Plan (CICIP), a program of the Ohio Department of Medicaid. 

Clauw has testified in state lawsuits against opioid manufacturers for their role in the opioid overdose crisis.

Adults, especially older adults, may be in pain or depressed but not able to convey details of their symptoms and quality of life to their doctors for various reasons including cognitive impairment. A new study from Regenstrief Institute and Indiana University School of Medicine researchers investigates whether adult patients and their proxies – typically spouses, children or other family caregivers – agree on what they tell physicians about a patient’s symptoms and quality of life, information critical to clinical care.

The researchers found that patients and caregiver proxies agreed on severity of symptoms of pain, depression and anxiety as well as functional status between 50 to 60 percent of the time, with agreement on physical symptoms (pain and functionality) more likely than agreement on psychological symptoms (depression and anxiety).

Proxies tended to overestimate patient impairment at lower levels of symptom severity and underestimate at higher levels. Caregivers who were under a lot of stress were more likely to over-report their patient’s symptoms.

“Unlike blood pressure and blood sugar, symptoms like pain, depression or anxiety can’t be objectively measured,” said Regenstrief Institute and IU School of Medicine faculty member Kurt Kroenke, M.D., who led the study. “Our group is very interested in symptoms – signs you can’t measure with an X-ray or a lab test. The only way to determine severity is with validated scales and if patients can’t report for themselves, then the proxy’s report is an important tool available to the clinician treating the patient.”

Even when a patient is able to self-report, complementary observations from a proxy providing a confirming or disagreeing perspective may inform treatment decisions, according to Dr. Kroenke, a primary care physician.

The study of 576 older adult and proxy participants (188 patient-caregiver pairs as well as 200 patients without identified caregivers) also found that when looking at group averages, patients’ self-reports and caregivers’ reports on patients were in line with each other because over and under reporting averaged out. Dr. Kroenke notes that this confirms the value of using proxy reports in research studies.

Paired patients and their caregivers who were White were 50 percent of study participants. An almost even percentage, 47 percent of the paired patients and 48 percent of their caregivers, respectively, were Black.

“Similar to what occurred during the pandemic, when we used rapid COVID tests rather than the more accurate PCR tests to make decisions about travel or attending events or other issues, because rapid tests were the best we had on hand, when patients can’t complete a symptom scale, proxy reports, while not the best, are the best available and provide valuable information,” said Dr. Kroenke.