The devil in the corner: a mixed-methods study of metaphor use by those with spinal cord injury-specific neuropathic pain

Hearn, Jasmine Heath, Finlay, Katherine Anne and Fine, Philip A (2016) The devil in the corner: a mixed-methods study of metaphor use by those with spinal cord injury-specific neuropathic pain. British Journal of Health Psychology, 21 (4). pp. 973-988. ISSN 2044-8287

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Abstract

Objectives Metaphorical expressions of persistent pain play an influential role in the modulation of pain. This may be particularly distressing for those with physical disabilities such as spinal cord injury (SCI). Neuropathic pain (NP) after SCI is often described using metaphorical expressions such as burning and electricity. This study explored the use of metaphors by those with NP after SCI. Design A qualitative, semi‐structured interview design was employed. Methods Data were analysed using content analysis (CA) and interpretative phenomenological analysis to explore prevalence of metaphor use and its meaning. Sixteen individuals aged between 23 and 82 years, with chronic NP (persisting for 3 months or longer), arising from SCI were interviewed in their homes or on hospital wards (M = 10, F = 6). Interviews lasted between 40 and 120 min. Results The results capture a range of metaphorical expressions embedded in participants’ accounts. Three themes emerged: (1) pain as a personal attack, (2) the desire to be understood, and (3) conveying distress without adequate terminology. CA revealed that younger age, female gender, and outpatient status were associated with increased metaphor use. Conclusions This study highlights the power of metaphor in eliciting understanding of NP after SCI from others, whilst demonstrating the challenge of communicating NP. Cognitive treatment that incorporates image‐based techniques with acceptance and mindfulness‐based therapies may encourage adaptive responses to, and interpretation of, pain. This may subsequently reduce pain‐related distress and catastrophizing.