What’s in a name?

The final update from my trip to Canada and the US was an announcement from Dr David Clarke, who some of you will know as one of the team who edited the Psychophysiologic Disorders (PPD) textbook. He announced that the Psychophysiologic Disorders Association is changing its name, to the Association for Treatment of Neuroplastic Symptoms (ATNS), with a catchphrase of “symptomatic”. His aim is to reflect the neuroscientific research of the field.

PPD practitioners spend a lot of time thinking about names, as they can be very significant to patients, practitioners and their relatives. Describing pain as “chronic” can sometimes be difficult for people, as they feel they are somehow not entitled to this term, or their pain is not “bad enough” to meet a certain threshold. I use the term chronic pain to describe pain that has been present for more than three months, while acute pain does not last as long. Importantly, chronic pain is not the same as “permanent” pain, and if it is caused by stress illness then it is possible for it to be resolved. 

A word that used to be in common usage was “psychosomatic”, referring to a physical symptom with a non-physical cause such as stress. However, I find this term unhelpful, as it has become associated in popular usage with something that is “not real” or “made up”, undermining the very real symptoms referred to. As you all know, I find it important to recognise that the symptom of pain is both physical and very real.

The names that we use can sometimes influence the outcomes of our pain, as names influence how we mentally frame a situation. Emphasising the dramatic, chronic, and seemingly “permanent” nature of pain can make it feel as though that pain will never be resolved, decreasing the motivation to try. On the other hand, dismissing very real physical symptoms as minor or “made up” can in turn increase feelings of isolation, misery and frustration, increasing the stress response and further exacerbating pain.

Something that I am frequently told by patients who have successfully diminished their pain through their work with me is that they appreciate that the resolving chronic pain process is individual and patient-focused. While working with me they come to appreciate the importance of recognising that the words we use matter and that using particular words may have ramifications.