Perspectives on the insidious nature of pain metaphor: we literally need to change our metaphors

Metaphorical language is used to convey one thing as representative or symbolic of something else. Metaphor is used in figurative language but is much more than a means of delivering “poetic imagination”. A metaphor is a conceptual tool for categorising, organizing, thinking about, and ultimately shaping reality. Thus, metaphor underpins the way humans think. Our viewpoint is that metaphorical thought and communication contribute to “painogenicity”, the tendency of socio-ecological environments (settings) to promote the persistence of pain. In this perspectives article, we explore the insidious nature of metaphor used in pain language and conceptual models of pain. We explain how metaphor shapes mental organisation to govern the way humans perceive, navigate and gain insight into the nature of the world, i.e., creating experience. We explain how people use metaphors to “project” their private sensations, feelings, and thoughts onto objects and events in the external world. This helps people to understand their pain and promotes sharing of pain experience with others, including health care professionals. We explore the insidious nature of “warmongering” and damage-based metaphors in daily parlance and demonstrate how this is detrimental to health and wellbeing. We explore how metaphors shape the development and communication of complex, abstract ideas, theories, and models and how scientific understanding of pain is metaphorical in nature. We argue that overly simplistic neuro-mechanistic metaphors of pain contribute to fallacies and misnomers and an unhealthy focus on biomedical research, in the hope of developing medical interventions that “prevent pain transmission [sic]”. We advocate reconfiguring pain language towards constructive metaphors that foster a salutogenic view of pain, focusing on health and well-being. We advocate reconfiguring metaphors to align with contemporary pain science, to encourage acceptance of non-medicalised strategies to aid health and well-being. We explore the role of enactive metaphors to facilitate reconfiguration. We conclude that being cognisant of the pervasive nature of metaphors will assist progress toward a more coherent conceptual understanding of pain and the use of healthier pain language. We hope our article catalyses debate and reflection

Physiological and metabolic characteristics of elite tug of war athletes

Objective—To determine the aerobic power ([Image: see text] O(2)MAX), body composition, strength, muscular power, flexibility, and biochemical profile of an elite international squad of tug of war athletes. Methods—Sixteen male competitors (mean (SEM) age 34 (2) years) were evaluated in a laboratory. For comparative purposes, data were analysed relative to normative data for our centre and to a group of 20 rugby forwards from the Irish international squad. Results—The tug of war participants were lighter (83.6 (3.0) v 104.4 (1.8) kg, p<0.0001) and had less lean body mass (69.4 (2.1) v 86.2 (1.2) kg) than the rugby players and had lower than normal body fat (16.7 (0.9)%); all values are mean (SEM). Aerobic power measured during a treadmill test was 55.8 (1.6) ml/kg/min for the tug of war participants compared with 51.1 (1.4) ml/kg/min for the rugby forwards (p<0.03). A composite measure of strength derived from (sum of dominant and non-dominant grip strength and back strength)/lean body mass yielded a strength/mass ratio that was 32% greater (p<0.0001) for the tug of war group than the rugby group. Dynamic leg power was lower for the tug of war group than the rugby forwards (4659.8 (151.6) v 6198.2 (105) W respectively; p<0.0001). Leg flexibility was 25.4 (2.0) cm for the tug of war group. Back flexibility was 28.6 (1.4) cm which was lower (p<0.02) than the rugby forwards 34.2 (1.5) cm. Whereas blood chemistry and haematology were normal, packed cell volume, haemoglobin concentration, and erythrocyte volume were lower in the tug of war group than in the rugby players (p<0.05). All three haematological measures correlated with muscle mass (packed cell volume, r(2) = 0.37, p<0.0001; haemoglobin concentration, r(2) = 0.13, p<0.05; erythrocyte volume, r(2) = 0.21, p<0.01). Conclusions—The data indicate that international level tug of war participants have excellent strength and above average endurance relative to body size, but have relatively low explosive leg power and back flexibility. The data provide reference standards for the sport and may be useful for monitoring and evaluating current and future participants. Key Words: tug of war; body composition; [Image: see text] O(2)MAX; strength; power; flexibilit

Population consequences of the Deepwater Horizon oil spill on pelagic cetaceans

This research was made possible by a grant from the Gulf of Mexico Research Initiative to the Consortium for Advanced Research on Marine Mammal Health Assessment (CARMMHA). T.A.M. acknowledges partial support by CEAUL (funded by FCT−Fundação para a Ciência e a Tecnologia, Portugal, through project UIDB/00006/2020).The Deepwater Horizon disaster resulted in the release of 490000 m3 of oil into the northern Gulf of Mexico. We quantified population consequences for pelagic cetaceans, including sperm whales, beaked whales and 11 species of delphinids. We used existing spatial density models to establish pre-spill population size and distribution, and overlaid an oil footprint to estimate the proportion exposed to oil. This proportion ranged from 0.058 (Atlantic spotted dolphin, 95% CI = 0.041-0.078) to 0.377 (spinner dolphin, 95% CI = 0.217-0.555). We adapted a population dynamics model, developed for an estuarine population of bottlenose dolphins, to each pelagic species by scaling demographic parameters using literature-derived estimates of gestation duration. We used expert elicitation to translate knowledge from dedicated studies of oil effects on bottlenose dolphins to pelagic species and address how density dependence may affect reproduction. We quantified impact by comparing population trajectories under baseline and oil-impacted scenarios. The number of lost cetacean years (difference between trajectories, summed over years) ranged from 964 (short-finned pilot whale, 95% CI = 385-2291) to 32584 (oceanic bottlenose dolphin, 95% = CI 13377-71967). Maximum proportional population decrease ranged from 1.3% (Atlantic spotted dolphin 95% CI = 0.5-2.3) to 8.4% (spinner dolphin 95% CI = 3.2-17.7). Estimated time to recover to 95% of baseline was >10 yr for spinner dolphin (12 yr, 95% CI = 0-21) and sperm whale (11 yr, 95% CI = 0-21), while 7 taxonomic units remained within 95% of the baseline population size (time to recover, therefore, as per its definition, was 0). We investigated the sensitivity of results to alternative plausible inputs. Our methods are widely applicable for estimating population effects of stressors in the absence of direct measurements.Publisher PDFPeer reviewe

Returning to work after long term sickness absence due to low back pain – the struggle within: a qualitative study of the patient's experience.

Background: low back pain (LBP) is a major cause of work absence. Assisting individuals back into work is an important part of rehabilitation. Objective: to explore the experiences of individuals returning to work after an episode of sickness absence due to LBP. Participants: Five women employed by a UK University who had returned to work. Method: in this qualitative study, participants underwent semi-structured interviews about their experiences. The transcripts were analysed using interpretative phenomenological analysis. Results: two primary themes emerged 1) perceived pressure to return to work and 2) strategies employed to relieve the pressure to return. Pressure to return to work arose from a number of sources including guilt and a personal work ethic, internally, and from colleagues and management, externally. This pressure led to the individual employing a number of strategies to reduce it. These ranged from a simple denial of health concerns and decision to return to work regardless of their condition, to placing the responsibility of the decision not to return to work onto a significant other, such as a family member or health care professional. Cconclusions: individuals returning to work with LBP experience considerable pressure to return and use a range of strategies to mediate that pressure

The effect of unstable footwear on trunk muscle EMG and postural sway in healthy adults.

Includes photographs by Margot Schulman

Charting medical students’ attitudes and beliefs towards people with chronic pain as they progress through their undergraduate programme: an observational study

Background: Healthcare professionals' (HCPs') attitudes towards pain influence their pain management. Attitudes about pain should be aligned with the evidence-base at the undergraduate stage of an HCP's career but pain education at undergraduate level is often lacking, and negative attitudes can pervade HCP practice. Previous studies investigating change in pain attitudes in undergraduate HCPs are cross-sectional in nature and frequently report minimal change in pain attitudes. Objectives: To investigate medical students' attitudes and beliefs towards people with chronic pain over the course of their Scottish undergraduate programme. Design: Five year observational study. Setting: A Scottish university medical school. Participants: Medical students were recruited in first year and followed up to their final year (year one n=205/244, year two n=190/245, year three n=132/279, year four n=110/262, year four n=159/260) for five years. Outcome Measure: The Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS with scores ranging from 15-105) was completed annually. Results: A two-way ANOVA found that attitudes and beliefs improved significantly (p&lt;0.01) from first to final year (10.0 10.0). Medics showed a gradual reduction in scores (signifying improved attitudes) annually. Conclusions: This is the first known published study to chart changes in the same cohort of medical students' attitudes and beliefs towards people with chronic pain over time. Changes in attitudes improved steadily over the five year medical degree course. Future work should explore which aspects of degree courses, if any, impact upon attitudes and beliefs towards people with chronic pain so that courses can be enhanced accordingly

Long-term improvements following a residential combined physical and psychological programme for chronic low back pain

Objectives Evaluate the outcomes and explore experiences of patients undergoing a residential combined physical and psychological programme (CPPP) for chronic low back pain. Design A longitudinal observational cohort design, with a parallel qualitative design using semistructured interviews. Setting Residential, multimodal rehabilitation. Participants 136 adults (62 male/74 female) referred to the CPPP, 100 (44 male/56 female) of whom completed the programme, during the term of the study. Ten (2 male/8 female) participated in the qualitative evaluation. Intervention A 3-week residential CPPP. Outcome measures Primary outcome measures were the STarT Back screening tool score; pain intensity-11-point Numerical Rating Scale; function-Oswestry Disability Index (ODI); health status/quality of life-EQ-5D-5L EuroQol five-Dimension-five level; anxiety-Generalised Anxiety Disorder-7; depression-Patient Health Questionnaire-9. Secondary outcome measures were the Global Subjective Outcome Scale; National Health Service Friends and Family Test;. Results At discharge, 6 and 12 months follow ups, there were improvements from baseline that were greater than minimum clinically important differences in each of the outcomes (with the sole exception of ODI at discharge). At 12 months, the majority of people considered themselves a lot better (57%) and were extremely likely (86%) to recommend the programme to a friend. The qualitative data showed praise for the residential nature of the intervention and the opportunities for interaction with peers and peer support. There were testimonies of improvements in understanding of pain and how to manage it better. Some participants said they had reduced, or stopped, medication they had been taking to manage their pain. Conclusions Participants improved, and maintained long term, beyond minimum clinically important differences on a wide range of outcomes. Participants reported an enhanced ability to self-manage their back pain and support for the residential setting

Disordered enthalpy–entropy descriptor for high-entropy ceramics discovery

The need for improved functionalities in extreme environments is fuelling interest in high-entropy ceramics1,2,3. Except for the computational discovery of high-entropy carbides, performed with the entropy-forming-ability descriptor4, most innovation has been slowly driven by experimental means1,2,3. Hence, advancement in the field needs more theoretical contributions. Here we introduce disordered enthalpy–entropy descriptor (DEED), a descriptor that captures the balance between entropy gains and enthalpy costs, allowing the correct classification of functional synthesizability of multicomponent ceramics, regardless of chemistry and structure. To make our calculations possible, we have developed a convolutional algorithm that drastically reduces computational resources. Moreover, DEED guides the experimental discovery of new single-phase high-entropy carbonitrides and borides. This work, integrated into the AFLOW computational ecosystem, provides an array of potential new candidates, ripe for experimental discoveries