Metaphorical markers of pain catastrophizing, depression, anxiety, and pain interference in people with chronic pain

Hearn, Jasmine Heath ORCID: https://orcid.org/0000-0001-5988-5278, Munday, Imogene, Bullo, Stella ORCID: https://orcid.org/0000-0002-7402-0819, Rogers, Kris, Newton-John, Toby ORCID: https://orcid.org/0000-0003-4219-4985 and Kneebone, Ian (2025) Metaphorical markers of pain catastrophizing, depression, anxiety, and pain interference in people with chronic pain. The Journal of Pain, 26. 104733.

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Abstract

Metaphor to communicate chronic pain can reflect psychological appraisals of pain, and its impact, and may be beneficial in enhancing understanding of pain, its aetiology, and shared decision-making. This cross-sectional study examined metaphor use and relationships with pain intensity, pain interference, mood, and pain catastrophizing. Seventy participants with chronic pain completed measures of depression, anxiety and stress, the Brief Pain Inventory, and the Pain Catastrophizing Scale. They provided descriptions of their pain through metaphor and a primary condition related to their pain. Pain catastrophizing significantly predicted frequency of metaphor use (R2=.07, F(1, 62)=4.55, p=.041). More frequent use of metaphor was correlated with pain catastrophizing (r=.29, p=.03), rumination (r=.26, p=.05), magnification (r=.28, p=.03), helplessness (r=.28, p=.04), depression (r=.30, p=.02), and pain interference (r=.30, p=.02). Metaphors relating pain to physical damage were significantly associated with anxiety (OR 1.17, 95% CI 1.03-1.35, p =.02) and magnification (OR 1.27, 95% CI 1.05-1.57, p=.02). Metaphors referring to pain as caused by an external agent were significantly associated with depression (OR 1.11, 95% CI 1.01-1.23, p=.04) and pain duration (OR 1.05, 95% CI 1.00-1.11, p=.04). The findings indicate that there may be specific metaphorical markers of psychological and pain-related outcomes in the language used by people with chronic pain. Appreciation of metaphor may facilitate enhanced patient-provider communication and support for people with chronic pain.