There’s some exceptional work being done around the world in the field of pain science that may shine some light on the language we use to talk about the aches and pains we experience.  (For a simple, and yet reliable, presentation on some of the new insights into pain, in general, I suggest the 8 short lessons offered for free on

Australians Lorimer Moseley and David Butler have authored a highly regarded (and very accessible) book, Explain Pain, which is now in its second edition and will soon be available at Encourage for purchase.

They’re continually (and generously) sharing where their research is taking them and their colleagues. Here’s an excerpt from their most recent newsletter (which you, too, can sign up to receive at

“Metaphors are all around us

There are many different kinds of metaphor and they lurk everywhere. Read the quote from a patient below, and see how many metaphors you can pick:

‘The pain can be a real killer. It goes around and down the inside of the driver muscle and into my old knee which I stuffed up years ago. Sometimes it goes into my right ball. That drives me crazy. I get pins and needles in the bloody right foot too. I can’t put my finger on why it’s happening, but I am ready for the scrapheap! The treatment so far has been bullshit.’

There are between 20 and 30 metaphorical statements in the quote above depending on who you are arguing with! (Clue – the pain is metaphorical.) But before we chat on, reflect for a moment on the beauty of metaphor as a communication tool. A vast amount of medical information has been expressed by a nonmedical person through this short statement – everything from anatomical, diagnostic, psychological and prognostic information and even a blunt view of the health system. It has also facilitated discussion of more intimate issues such as testicle pain and the statement has opened negotiations. The patient is talking in language that he believes both he and the health practitioner can understand and thus it invites discussion and adaptation. Therein lies the power of transformative metaphor.

Some metaphors help orientate

One kind of metaphor that helps make up the numbers above are orientational metaphors such as goes around and down or goes into. Many of us have probably forgotten that this is metaphorical language, but so did we before we got into this stuff. We have been collecting and researching these metaphors for some years now and there are dozens of these orientational metaphors used in health.

Orientational metaphors can be very useful diagnostically. Down and around and into or it goes from here to here may provide information about a known neural zone such as a dermatome. Equally pressure deep in my chest going up to my jaw should raise suspicions of heart ischaemia. But orientational metaphors such as in, around, down under and up may also allow sufferers to get a grip on a problem – the metaphor allows expression in language that both patient and clinician understand. But of course we know that pain can’t go anywhere – it doesn’t travel by bike or boat or plane. Believing that pain physically moves can reinforce a false relationship between tissue damage and pain, and so sometimes we may need to deconstruct this.

Transformational language – UP IS GOOD and DOWN IS BAD

Below is a sneak peak at a table from Explain Pain Supercharged. These are orientational statements, usually metaphors and we have classified them as DIMs (Danger in Me) neurotags and SIMs (Safety in Me) neurotags. Notice how the notion of up in orientational metaphors is usually linked with positive conceptualisations – on top of it all today; upbeat, and notions of down are usually more negative – fell ill; down in the dumps. This pattern has always been strong in health where primary metaphors are HEALTH IS UP and LIFE IS UP as well as SICKNESS IS DOWN and DEATH IS DOWN (Lakoff and Johnson 1980).


From Moseley GL Butler DS 2017 Explain Pain Supercharged, Noigroup, Adelaide

An awareness of these primary orientational metaphors offers opportunities for DIM (Danger in Me) neurotags to SIM (Safety in Me) neurotag transformations and also enhancement of the language of SIMs. By including up, front and forward in metaphorical language offered back to learners we promote the positive or put simply, we promote SIMs. Other positive metaphorical language might include goal, reach and balanced. Avoid negative metaphorical language for example under, out, imbalanceand behind because they promote the negative – or promote DIMs. Just when it’s looking all neat and tidy, things are more complicated then they seem – it’s usually a good thing to be under control – see how this breaks the ‘rules’? Metaphors are clearly malleable.

So, metaphors can be helpful clinical descriptors, but also may have the power to perpetuate a pain neurotag. We go into the neuroimmunological consequence of negative and positive conceptual neurotags in the book. For now, best we be aware, identify, deconstruct and dethreaten them – and when able, turn a DIM metaphor into a SIM.”