It's Not Written All Over My Face: Constructing Chronic Pain as Invisible in Pain Clinic Consultations and Interviews

Historically in medicine and beyond, the understanding of and treatment of pain is based on finding tissue injury. The fact that for chronic pain, there often is no (longer) any traceable tissue injury, in combination with the fact that pain essentially is a private experience, poses a challenge for clinical communication. This paper therefore examines how pain is linguistically and interactionally constructed as invisible.

The qualitative approach of interactional sociolinguistic analysis is used to analyze 37 consultations and 11 semistructured interviews with patients with chronic pain, collected at a Belgian pain clinic. This fine-grained approach to studying communication provides an in-depth empirical understanding of the phenomenon under scrutiny.

The data show that pain is constructed as invisible on several levels: (1) on the biomechanical and clinical level, in terms of its lack of visible or traceable tissue injury, (2) on the level of interaction, as pain needs to be made apparent to other people through pain displays, and (3) on the social level, as chronic pain often is not visible or apparent in society more broadly.

The discussion explores how on these 3 levels, notions of the abnormal or deviant body come into play, in which patients and health professionals complexly construct pain both as not normal (i.e., not a neutral or desirable state of being), whereas, at the same time, the lack of traceable tissue injury is constructed as medically normal for chronic pain. This also relates to how patients and health care providers often orient to the stigma around chronic pain.