Doctors told to use positive language in managing pain

New national guidelines in Australia on managing acute back and musculoskeletal pain advise GPs to use neutral and non-threatening terms to avoid frightening patients and delaying their recovery.

Terms such as inflammation, degeneration, instability, rupture, and even arthritis should be avoided, said the draft report, as they “carry connotations of erosion, destruction and inevitable chronic pain.”

The report, which was funded by the federal government and which sought comment from healthcare professionals and patients, continues: “Effective communication of information is fundamental to the success of any treatment plan.”

Project leader Professor Peter Brooks, executive dean of the Faculty of Health Sciences at the University of Queensland, said doctors could help recovery by putting a positive spin on their language and using neutral terms such as back pain.

“I feel it's an awful thing for a doctor to tell a patient they have a ruptured disc. They imagine they have their disc splattered on the inside of their spinal cord,” he said.

“If you don't explain to patients relatively quickly and have a pretty good idea what the diagnosis is . . . then they are the patients who will slip over to become chronic pain patients.”

The draft report—the result of a multidisciplinary review of the scientific literature—aims to promote partnership between clinicians and patients to manage pain and reduce disability.

The review focused on the treatment of pain in the lower back, neck, thoracic spine, knee, and shoulder, and it is described as one of the first comprehensive reviews to draft guidelines aimed at curtailing the use of “alarming, inappropriate or incorrect terms.”

But the report has provoked some hostile media reports, with headlines such as “Spin Doctors: What GPs Don't Want to Tell You.” It has also led to some angry editorials, with Sydney's Daily Telegraph (31 January, p 24) claiming that the project aimed to “sugarcoat” bad news to patients. But Professor Brooks said there was never any suggestion of sugarcoating. The aim was effective communication with consumers.

Table.

Unacceptable words	Acceptable words
Failure of organ	Compromise of organ
Degenerative	Wear and tear
Ruptured	Prolapsed