Mind Your Body Podcast
Inspiration: Episode #7: Feeling Heard – Giving a Voice to Pain of the Mind Your Body podcast with Dr. Nevo.
I ask a patient to rate their pain on a scale of one to ten. They say seven.
What does that mean?
Is it the sharp, electric jolt that makes them gasp mid-sentence? The dull ache that’s been their constant companion for three years? The burning sensation that keeps them awake at night? The tightness that makes them hold their breath without realizing it?
I have no idea. And neither do they, really.
We’ve built an entire pain assessment system on a foundation of numbers that can’t capture what pain actually feels like. Despite communication being central to pain management, research shows we have scant empirical evidence to guide these conversations. Studies consistently point to a pressing need for improvement in how we talk about pain.[1]
The problem isn’t that people can’t communicate their pain. The problem is we’re asking them to translate a deeply personal, multidimensional experience into a single digit.
Why the Pain Scale Fails Patients
The numeric rating scale has become the default language of pain in healthcare settings. It’s quick. It’s standardized. It fits neatly into electronic medical records.
It’s also deeply flawed.
Research reveals significant limitations in how we clinically administer the NRS, including variation that reduces accuracy and incomplete data for people not receiving care. One study found that this most commonly used measure may have only modest accuracy for identifying patients with clinically important pain in primary care.[2,3]
But the real issue goes deeper than accuracy. Numbers strip away context. They erase the texture of experience. They turn suffering into data points.
A seven for one person might be a three for another. Your seven today might be different from your seven last week. The number tells me intensity, maybe, but it tells me nothing about quality, nothing about impact, nothing about meaning.
The Power of Metaphor
Here’s what I’ve learned: when I stop asking for numbers and start asking for descriptions, everything changes.
“What does your pain feel like?”
“If your pain had a texture, what would it be?”
“Describe it to me like I’ve never felt pain before.”
Suddenly, I hear about electric eels wriggling under the skin. Vises tightening around the skull. Hot coals pressed against the lower back. Broken glass grinding in the joints.
These aren’t just colorful descriptions. They’re diagnostic gold.
A 2023 study found that metaphor use is always helpful in clinical settings, whether due to increased understanding, rapport, or insights into patient functioning and pain type. Metaphors give clinicians a sense of the lived experience of chronic pain while building rapport. The research recommends that clinicians routinely encourage patients to use metaphor through questions like “Describe to me what your pain feels like.”[4]
When someone tells me their nerve pain feels like a thousand tiny electric eels sparking under their skin, I understand something fundamental about their experience. I know it’s sharp, unpredictable, moving. I know it feels alive, almost sentient. I know it’s exhausting to live with something that never stays still.
That’s information I can work with.
Pain Validation: The Missing Piece in Pain Management
But here’s what matters even more than the words themselves: whether someone feels heard when they speak them.
Pain invalidation has serious consequences. Research shows that when patients experience invalidation from family and medical professionals, they’re more likely to under-rate their pain in both medical and social settings. The dismissal of subjective experience creates self-doubt, reinforces cultural stigmas, and leads to alterations in pain communication that create barriers to treatment and increase suffering.[5]
Think about that. When people don’t feel believed, they literally hide their pain. They make it harder for us to help them.
The opposite is equally powerful. According to the biosocial model, when patients receive validation after sharing pain-related thoughts and feelings, they feel understood and accepted. They experience reductions in emotional arousal and negative affect. They may even experience a reduction in pain itself.[6,7]
Validation isn’t just emotionally supportive. It changes the pain experience.
This is why I always start with belief. “I believe you.” “That sounds incredibly difficult.” “Your pain is real.” These aren’t empty platitudes. They’re the foundation of everything that comes after.
Becoming a Better Listener
If you’re supporting someone in pain, whether as a clinician, family member, or friend, here’s what helps:
Ask open-ended questions. Instead of “How bad is it?” try “What does it feel like?” or “How does it affect your day?” Give people room to describe their experience in their own words.
Listen for metaphors. When someone uses imagery to describe their pain, pay attention. Those metaphors reveal the quality and character of their experience in ways numbers never will.
Observe non-verbal cues. Watch how they move, where they guard, what makes them wince. The body tells stories the mouth sometimes can’t.
Validate before you problem-solve. The urge to fix is strong, especially when someone we care about is suffering. But validation must come first. Acknowledge the experience before jumping to solutions.
Create space for complexity. Pain isn’t simple. It connects to emotions, memories, fears, identity. Let the conversation go where it needs to go.
How to Describe Your Pain: A Guide for Patients
If you’re the one trying to communicate your pain, know this: you’re not failing if you can’t find the right words. Pain is hard to describe precisely because it’s so personal, so subjective, so tied to your unique nervous system and life experience.
But you can get better at it.
Use comparisons. “It feels like…” is your friend. Draw on sensory experiences, even if they seem strange. Hot, cold, sharp, dull, burning, aching, throbbing, stabbing. All of these tell a story.
Describe the impact. Sometimes it’s easier to talk about what pain prevents you from doing than to describe the sensation itself. “I can’t pick up my daughter” or “I avoid social events because I never know when it will spike” gives crucial context.
Track patterns. When does it get worse? What makes it better? What triggers it? These details help both you and your healthcare providers understand what’s happening.
Don’t minimize. Research shows that invalidation leads people to under-report their pain. If you’re in pain, say so. You deserve to be believed.[5]
The Body’s Escalating Voice
Here’s something I’ve observed repeatedly in my practice: the body escalates its communication when whispers are ignored.
Pain often starts as a quiet signal. A twinge. A tightness. A subtle discomfort. If we listen at this stage, if we respond with curiosity and care, the body often doesn’t need to shout.
But when we push through, ignore, dismiss, or invalidate these early signals, the body turns up the volume. The whisper becomes a shout. The shout becomes a scream.
This isn’t punishment. It’s communication. Your body is trying to tell you something important. The question is whether you’re listening.
A Moment to Reflect
Before we move forward, pause here for a moment.
When was the last time you truly listened to your body’s signals? Not just the loud ones, but the whispers—the subtle tightness, the minor discomfort you’ve been pushing through.
If you’re supporting someone in pain, what might change if you asked “What does it feel like?” instead of “How bad is it?” How might that shift open new pathways for understanding and connection?
Are you minimizing your own pain to avoid burdening others? What would it mean to give yourself permission to be fully honest about your experience?
Moving Beyond the Numeric Pain Scale
I still use the numeric pain scale in my practice. It has its place, particularly for tracking changes over time or meeting documentation requirements.
But I never stop there.
Because pain is not a number. It’s an experience. It’s a story. It’s a message from your body that deserves to be heard, understood, and validated.
The research backs this up. A study of 200 adults with chronic neck or back pain found that effective physician-patient communication during the initial consultation helps patients manage their uncertainties, fears, anxieties, and confidence in their ability to cope. Patients’ reports of their physician’s communication were a consistent predictor of their post-consultation outcomes.[8]
Communication quality directly affects pain patient outcomes. Both speaker and listener matter.
When we create space for rich, metaphorical, honest communication about pain, we open pathways to better understanding, better treatment, and better outcomes. We move from standardized assessment to personalized care. We shift from data collection to human connection.
And sometimes, that connection itself becomes part of the healing.
So the next time someone asks you to rate your pain on a scale of one to ten, give them the number if you need to. But then tell them what it actually feels like. Paint them a picture. Use a metaphor. Help them understand.
Your pain deserves more than a number. It deserves to be heard.
This is where healing begins—not in the number, but in the listening.
About the Author
Dr. Zev Nevo is a double board-certified physiatrist, chronic pain survivor, and founder of the Body & Mind Pain Center. He helps people with persistent pain rebuild capacity and confidence using an evidence-based, trauma-informed mind-body rehabilitation approach.
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Medical Disclaimer
The information in this article is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. New or changing pain symptoms should always be properly evaluated by a medical professional.
References
[1] Thorn, B.E., & Kuhajda, M.C. (2019). Communication about pain: Biopsychosocial perspectives. Pain Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC6454797/
[2] Krebs, E.E., Carey, T.S., & Weinberger, M. (2007). Accuracy of the pain numeric rating scale as a screening test in primary care. Journal of General Internal Medicine, 22(10), 1453-1458. https://pmc.ncbi.nlm.nih.gov/articles/PMC2305860/
[3] Paice, J.A., & Cohen, F.L. (1997). Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nursing, 20(2), 88-93. https://academic.oup.com/painmedicine/article/22/10/2235/6179817/
[4] Wainwright, E., Colvin, L.A., & Fallon, M. (2023). Metaphors in pain: A scoping review exploring the use of metaphor in describing the experience of pain. Scandinavian Journal of Pain, 23(1), 15-27. https://www.degruyterbrill.com/document/doi/10.1515/sjpain-2022-0043/html
[5] Higgins, K.S., Birnie, K.A., Chambers, C.T., et al. (2023). Offspring of parents with chronic pain: A systematic review and meta-analysis of pain, health, psychological, and family outcomes. Pain, 164(11), 2397-2419. https://www.sciencedirect.com/science/article/pii/S1526590023006235
[6] Edmond, S.N., & Keefe, F.J. (2015). Validating pain communication: Current state of the science. Pain, 156(2), 215-219. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477266/
[7] Kool, M.B., Geenen, R., et al. (2022). The role of invalidation in chronic pain: A systematic review. Journal of Pain. https://pmc.ncbi.nlm.nih.gov/articles/PMC9614309/
[8] Thompson, K., Johnson, M.I., et al. (2024). Communication quality and uncertainty management in chronic pain consultations. Health Communication. https://medicine.illinois.edu/news/communication-with-doctor-during-first-visit-affects-pain-patients-outcomes