The Most Infamous Phrase in Healthcare?

“I have a high pain tolerance” may be one of the most common phrases used to describe a pain experience. I am guessing you have heard it numerous times and have developed an opinion about it.  Among healthcare providers it may be perceived as an annoying declaration. A let it go in one ear and out the other kind of saying. The last time you heard it and how did you respond?  Smile on the inside, get frustrated saying to yourself “not again”, roll your eyes, nod intently, or talk about it with your co-workers over lunch?

I have heard this phrase several times recently and for some reason it spiked my curiosity.  Why is it used frequently and by so many during healthcare visits? Is there is a deeper meaning within these words? Here are three possible explanations for why someone might say, “I have a high pain tolerance”.

 

A Coping Strategy

Coping strategies are cognitive and behavioral approaches that can aide in dealing with, and overcoming, stressful events (here). Effective coping strategies differ from person to person and are best reflected in the individual functional abilities within a persistent pain population.  While one person may be relegated to immobility and depression, another may demonstrate high levels of function at home, in the community, and at work despite the pain. I think this may be the number one reason the “high pain tolerance” phrase is used so often.  These words may enhance cognitions and promote practical behaviors of an ideal self or hoped for reality that urge life forward in the midst of a struggle.

 

 Seeking Validation

When I think of validation I imagine a boy who fell and scraped his knee. He runs to mom for a comforting kiss and thirty seconds later he is in the back yard playing again. He needed mom to know he was hurt and get her loving approval that it would all be ok.  Viewing validation in regards to communicating pain is examined here. I think it is harder as an adult to find validation when something hurts.  Patients seeking validation from a healthcare provider may use the “high pain tolerance phrase” as a way of communicating a perception that the pain is real, significant, and limiting; without necessarily asking for help or admitting that they need someone else’s help to get better. The above linked study introduces validation by noting “Marsha Linehan, a key validation theorist, suggests that validation is a process in which a listener communicates that a person’s thoughts and feelings are understandable and legitimate.” The article goes on to say, “Though validating thoughts and feelings does not mean that the person validating necessarily agrees with the speaker’s perspective. For example, when responding to someone who has chronic pain, validation may include conveying acceptance and understanding of pain-related thoughts and feelings without encouraging potentially maladaptive behaviors e.g. It must be frustrating to have so much pain, I wonder how you will be able to manage your activities.”

The paper concludes that validation may or may not be an effective form of therapy to improve function and treat pain. Though I expect that when someone claims a pain tolerance is high there is some degree of validation-seeking at play.

 

Sign of Positive Affect

Positive affect refers to a feeling state that may be characterized by pleasant moods or emotions that instill a sense of relaxation, contentment, or serenity (here).  This one may be a little out there, but the more I thought about it the more it seemed to make sense. Saying to oneself “I have a high pain tolerance” may in fact instill a sense of positive affect about a current painful state. Verbalizing the perceived self as strong, stoic, persevering and resilient may be a method of shifting the internal state of wellbeing toward the positive. The above paper points out potential benefits of an induced positive affect may include lessening nociceptive sensitivity and modulating central pain networks. Say something enough times and it becomes a reality. Maybe saying “I have a high pain tolerance” induces the pain mediating effects of positive affect?

And the point is……..

Next time you hear these notorious words think again.

What is this person trying to convey and is it useful to help improve function? Can these words be used to leverage a better functional outcome by digging a bit deeper?

Never forget that all pain is real and every person’s pain is individually unique. The words used to describe a pain experience are noteworthy and often have an important meaning. Becoming a better clinician means continually looking for new ways to improve and interact with patients. I think I have ignored this phrase about a high pain tolerance for too long and am excited to examining this phrase more in the future.

I am interested in hearing from you.  Why do you think the expression “I have a high pain tolerance” is used so often?

10 responses to “The Most Infamous Phrase in Healthcare?

  1. Love this post! I think patients using this phrase are doing so for two main reasons:

    First, to let the practitioner know that they really have a major problem, even though they are not moaningand groaning due to such high pain tolerance.

    Second, to demonstrate how unique they are compared to others(everyone has the need to feel special).

    Depending on my mood, my response to this comment is”Good, but I never know how patients measure that”or less cynically: ” Great, you should be able to handle an intense rehab program very successfully”.

    Bet we have all heard this phrase hundreds of times!

    1. Jarrod says:

      James,
      Thanks for reading and sharing your thoughts. I like your last response about being able to handle the rehab program. Good one!

      Jarrod

  2. Kory Zimney says:

    Jarrod,

    Great post, I think words and phrases patients choose to use to express their internal discomfort is a very interesting topic.

    On a slight side note the definition between pain tolerance and pain threshold are often times confused. Pain tolerance is not something clinically that is measure or all that useful for clinical treatment or evaluation of progress (i.e. cold pressor test) but pain threshold (i.e. pain pressure threshold) is useful to test and measure.

    1. Jarrod Brian says:

      Thanks for your thoughts Kory. Much appreciated.

      I like the distinction you bring up between pain tolerance and pain threshold. I was actually going to discuss this in the blog, but it would have been too long. Do you know of any studies that have compared people who claim a high pain tolerance to their actual pain threshold? That would be interesting…

      Jarrod

  3. Mary says:

    I love this post, and even more, I really enjoyed your reflection on the meaning behind this statement. Thanks for the reminder for us as clinicians to remain open and curious to each individual’s experience instead of rushing to judgment. It can be easy to forget how vulnerable our patients have to be when they are not at their best and realize they need help.

    1. Jarrod Brian says:

      Mary,
      Thanks for reading and your comments.

      I totally agree with your thoughts on how important it is to stay open to the potential of what a patient is trying to say. In the middle of a busy day it can be easy to occasionally rush to judgement and miss the vulnerability that a person is expressing. This in turn creates missed opportunities to help.

  4. Ina Diener says:

    Jarrod, agree……. Thanks for some good insights! I have often heard this from people with persistent pain. I have found [during a sensitive interview] that their pain is down-played by a spouse or co-workers, and that they need to convince you that their pain is higher than the average. I believe their expressed experience, and use that in PNE. It is amazing how they change when you have examined and convinced them that there is not really ‘an issue in the tissue’ and that the pain is due to a sensitised nervous system… …..

    1. Jarrod Brian says:

      Ina,
      Really cool thoughts and experience on this topic. I appreciate your addition to the discussion. Great perspective!

      It is nice to hear how you explore these words and then re-frame them in during the PNE. I too have noticed that once a patient understands more about their pain, this phrase becomes almost nonexistent.

      Thanks Ina,

      Jarrod

  5. Tony Varela says:

    Thank you, Jarrod. I have been waiting for someone to discuss this specific issue, patient commentary.
    A key concept in the discussion is cognitive processing, which is often analyzed through the words communicated. The idea of a high pain tolerance reflects a certain level of ambiguity as well as a certain level of meaning. The communication of a high pain tolerance is an issue of asking for help, distortion of self-perception, and loss of self-efficacy. In other words, there is a distortion in the way they see themselves handling persistent distress. They are telling us they do not understand the person they are in comparison to the person they want to be or used to be. The idea of validation in this case reflects the need to understand the different layers of the meaning and context of the words communicated. The essence of validation then comes by way of understanding the relationships between chronic pain states, self-schemas, and a processing bias. This understanding enables consistent and compassionate two way communication.
    Thank you for letting me share.
    Sincerely,

    1. Jarrod Brian says:

      Tony,
      Your welcome… Thanks for reading. You make several good points in your commentary. I can tell you have thought about this statement and its meaning before.

      I agree with you and like the conclusion. Understanding always creates an improved ability to communicate and improved communication can lend to improved outcomes.

      Thanks for taking the time to share your thoughts…

      Jarrod

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