Communicating Medical Chronic Pain in an Intercultural Context

Pain is a special diagnostic problem in medicine. It is intensely private and personal. Chronic pain, defined as lasting more than 3–6 months, is a subjective symptom and may have no clearly identifiable cause. And yet we still have no workable, objective, clinical proof (technological, biochemical, or other) of the existence, intensity, nature, or location of pain in a person. As a result, language communication about pain remains crucial for effective communication between people in pain and their health care providers. From a language-based perspective, the diagnostic pain instruments in medicine currently depend primarily on patients’ responses to the list of 78 words in the McGill Pain Questionnaire. But this approach has major limitations and problems and is not widely used in clinical medicine. A particular difficulty is the postulate that 78 individual words can provide sufficient descriptive power and sophistication to capture the multi-dimensional, biopsychosocial, intercultural, intergenerational, and multiorgan experience of an individual with a complex set of pain symptoms. There have been some explorations of non-lexical resources like metaphor in pain talk and of pain talk’s grammatical properties. However, sequential pain talk and cross-cultural investigation of pain talk have been less studied, despite our knowledge that cultures can differ radically in their norms and practices employed for pain communication. Importantly, there has been little investigation of pain as a culture itself. A constant theme running through Farzad Sharifian’s work involved the relations between cultures, values, and language systems. (The last time that Farzad Sharifian and Roland Sussex collaborated was in composing an obituary for our friend and colleague Michael Clyne (Sharifian and Sussex, Curr Issues Lang Plann 11(4):371–377, 2010). It is a sad example of memento mori that I now contribute to a chapter in memory of a valued and inspirational friend (R.S.).) We take this perspective further by considering, in this chapter, how the concept of culture – as a system of values within which language statements find meaningful expression – applies to pain talk. It links to Sharifian’s framework of cultural categories and cultural-conceptual metaphors (Sharifian, World Englishes 34(4):515–532, 2015), and the medical pain consultation can be seen in his terms as a cultural schema. This conceptual extension also draws on insights from Kecskes (2015) that in intercultural pragmatics, intercultural and intracultural communication are not disjunct, but are part of a continuum. This means, in turn, that differences between languages and cultures do not necessarily align. The implications of these insights are explored by considering pain talk as an instance of intercultural communication in a monolingual context. As part of a wider investigation into pain, pelvic pain, and female pelvic pain in particular (Evans and Bush 2015), an online survey was undertaken in 2019 asking women suffering from a wide range of pelvic pain conditions to respond to questions about their pain experiences, including free-form text responses. These text responses by 1034 women amount to more than 300,000 words and contain rich evidence of how pain sufferers exploit language in creative ways in an attempt to clearly capture and communicate the complex and subtle nature of their pain to others. In this chapter a preliminary report on results from this survey is provided. This pain talk is analyzed as a special genre and register of language and as a culture; and interpersonal pain talk as an instance of intercultural communication. Being in pain constitutes a specific culture of human existence.