Time for a New Vocabulary

Would you like to be understood? If so, you will need a new vocabulary.

It has become very clear that as long as we keep using the same WORDS that we will never be able to send a different message. Because medical things are so word intensive, the use of the same word, “pain” produces the same pain language. The same language yields up the same impressions, and so we go round and round, never communicating about nerve injury pain.

Hence, we have scanned the literature and are encouraged by a similar unwillingness of researchers to simply use the word “pain” to describe nerve injury pain. This is gratifying and makes us admire the PhD’s even more.

Here are a few of the terms that might be employed to send a different message, different language to the listener.

NIR pain, or nerve injury related pain
NII pain, nerve injury induced pain

For central pain, there is also:

PCO pain, pain of central origin, using the phrase of both Weir Mitchell in the 1860′s and also Egger and Roussy, writing around the turn of the century.

“Central Pain” comes from George Riddoch, a great British neurologist who realized both the origin and the nature of central pain. He it was who called central pain “a pain beyond pain”. Riddoch should have been more listened to, but even today the doctors continue to expect us to be able to describe PCO pain in terms of ordinary pain. That is not possible. One cannot describe red in terms of green, nor green in terms of yellow and blue. Central Pains are likewise a mix of noxious sensation, rendering them something different. An intact pain system is required to feel the distinctions between pain and those with PCO pain lack an intact nervous system.

Following the above terms could also be

CNI pain or Central Nerve Injury Pain
CII pain, or Central Injury induced pain

If authors and clinicians began to use different words, they would produce different language. Communication is nearly always a battle of semantics. The words we use control the outcome and the reaction.

Consider the following:

A complacent woman vs. a slut
War of liberation vs. insurgency
frugality and thrift vs. poverty
demanding vs. tyrannical
salesman vs. benefactor from public gullibility
goddess vs. promiscuous tramp
website vs. shrine

The list goes on forever. The words we use are laden with judgment and stereotyping. To avoid misunderstanding, we feel it is time for some new wording relative to central pain. There is no such thing as central pain anyway, since “pain” is singular and the central pains are plural. Because an injured nervous system cannot draw clean lines between pains, one must endure a mix of sensations, sometimes paradoxical such as the “cold edge” on burning pain in CP, which some call metallic pain, but more often describe it as a chemical burn or acid burn. Nerve injury pains can be nondiscriminated, poorly localized burning or laser accurate electric shooting pains. Surely these do not all fit into one singular word. Add in the pain of muscles in the fusofugal apparatus, the pain in gut and bladder, and the pain in the dura, and one realizes the poverty of using one word, “pain” to describe all this. It is very misleading.

Terminology and nomenclature are badly needed in this area, both as to diagnosis and treatment. In the meantime, it would be best to ALWAYS indicate by some means that this pain is something particular, deserving a second look, something that the listener may not known all about. NIR pain and NII pain are both in use in the literature and both are good, but pain of central origin also needs its own category. We should begin using these terms so others will know there is something extra here.