Using a linguistic approach in pain medicine: advances in doctor-patient communication

      Physicians are confronted daily with the task of interpreting their patients’ narration, making pain-related speech a recurrent concern in the medical encounter. Yet, despite the important role of language and culture in the representation of pain, few studies have tackled the topic. We examine it here with a linguistic-anthropological methodology. Pain is described as a private experience that can be made public through gestures, mimics, and language. Subjective reporting still dominates much patient-doctor communication about pain and it has been suggested that there are four levels of linguistic representations of pain: (1) cries and moans; (2) pain interjections specific to each language; (3) lay descriptions; and (4) professional descriptions. It is noted that pain interjections and lay descriptions of pain by patients can vary greatly across languages, due to the specifics of their phonetics, grammar, semantics, and lexicon. We show that miscommunication can arise from subtle linguistic differences, even between people who speak the same language. Examples from different regions of the world are presented to illustrate how linguistic factors interfering in doctor-patient communication can lead to problems of interpretation and unfavorable clinical outcomes. Finally, actions that can be taken in the clinical setting to optimize the understanding of patients’ pain description using basic linguistic tools such as health professionals’ awareness of potential linguistic discrepancies, self-monitoring, as well as familiarity with the patients’ linguistic expressions and cultural beliefs are suggested to improve doctor-patient communication, diagnosis, and treatment outcome.