The relationship between pain-expressing metaphors and graded exposure treatment in children with chronic pain
Pasco, John Carlo Custodio
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BACKGROUND: The biopsychosocial model of pain suggests that one’s perception of pain is affected by one’s beliefs about pain (Moseley & Butler, 2015). Metaphors have been shown to be effective in educating the patient about pain, which in turn reduces it (Gallagher et al., 2013). How might metaphors be used by the patient to express their pain, and what do these metaphors have in common? This qualitative study will examine the pain-expressing metaphors (PEMs) used by the pediatric chronic pain patients in a graded exposure treatment. METHODS: 36 patients recruited from Pain Treatment Service at Boston Children’s Hospital and the Pediatric Headache Program were enrolled GET Living, a pediatric chronic pain intervention composed of a series of individualized graded exposure sessions. Of these 36 patients, video recordings for GET Living sessions were available for 19. Of these 19 patients, video recordings of at least 5 sessions were available for 11 patients. Each video-recorded session for these 11 patients was viewed, reviewed, and coded for the use of PEM by the patient. RESULTS: Each of the PEMs patients used in this study could be organized into one of 6 categories: Sharp, Burning, Throbbing, Spectrum, Physical Qualities, and Other Sensation. “Other Sensation” was the category into which the most individual PEMs fell, but the category that had PEMs used by the most number of patients was “Sharp.” CONCLUSION: This study added to existing literature regarding categories of pain metaphors, supporting groupings such as sharp, throbbing, and burning. This study furthermore described groupings such as characterizing pain as a spectrum and characterizing pain as something with physical qualities. Future studies with more robust data sets could code PEMs in the same way and then conduct a quantitative analysis of metaphor use by patients enrolled in GET Living, correlating metaphor use with measures such as fear of pain and functional disability as recorded in the GET Living Child Assessment.
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