Concept 2

Why Clinicians Need to Use Science to Explain Pain and Body Behavior

Real-Client Example 2

“I don’t know why my body isn’t doing what it is suppose to do. Maybe I’m just “that” broken. The physical therapist yelled at me and says that he knows I’m not doing the homework; he made me cry. I am doing it everything, it just isn’t working”

Actual Cause: The knee replacement the client had 6 years prior, needed to be revised. It was a problem with the unit itself, not the client’s adherence to the program.

Key Discussion:

Provider language, explanatory framing, and metaphor selection can influence:

• client expectations

• catastrophization

• therapeutic alliance

• adherence

• perceived fragility

• outcomes

Communication is largly about interpretation. The way that the client processes this information may or may not actually reflect the words the provider used. In Example 2, we do not know if the therapist actually raised his voice, or if he inferred to her compliance with the exercises, but the truth of the matter is that the client understood the conversation to indicate that the client’s body was “broken”. Research is available to reflect how provider’s language, explanatory framing and metaphor selection influence clients in the realms of:

• pain neuroscience education

• therapeutic alliance research

• placebo/nocebo research

• health communication

• linguistics

• cognitive appraisal theory

A few particularly relevant themes emerged from the literature:

1. Language Shapes Clinical Outcomes

Research consistently shows that communication style and patient interpretation affect:

• trust

• adherence

• expectations

• pain experience

• outcomes

• therapeutic alliance

A rehabilitation communication presentation summarizing multiple studies specifically discusses:

• “harmful vs healing words”

• enhancing self-efficacy

• minimizing passive attitudes toward healing

• improving outcomes through communication strategies

That aligns VERY closely with your framework.

2. Metaphors Can Influence Catastrophization

There is actual literature examining pain metaphors and catastrophization.

A 2025 study found:

• more metaphor-heavy pain descriptions correlated with:

  • pain catastrophizing

  • helplessness

  • magnification

  • anxiety

  • depression

  • pain interference

Importantly:
the paper does NOT say metaphors are inherently bad.

But it does support your concern that certain metaphorical framings may reinforce maladaptive interpretations.

3. Stigmatizing or Threat-Based Language Matters

A 2025 paper discussing the term “pain catastrophizing” notes that:

• stigmatizing/deprecating language contributes to:

  • distress

  • reduced perceived quality of care

  • negative patient experiences

That is VERY relevant to your “body fighting you” concern.

4. Therapeutic Alliance Influences Outcomes

There is substantial evidence that:

• feeling understood

• trust in the provider

• communication style

• patient-centered language

affect pain outcomes and adherence.

This is probably the safest and strongest scientific footing for your course.

Because you do NOT have to prove:

“guarding language causes harm.”

You only need to support:

explanatory models and provider language influence client interpretation and clinical outcomes.

That is well-supported.

5. The Literature Is More Nuanced Than “Metaphors Bad”

This part is important for your CE framing.

The research actually suggests:

• metaphors can help communication

• metaphors can improve understanding

• metaphors can help clients express complex experiences

BUT:
there is also caution that metaphors may:

• oversimplify

• increase fear

• reinforce helplessness

• create distorted interpretations

• unintentionally increase threat perception

Honestly?
That nuance actually strengthens your argument.

Because your position is NOT:

“never use metaphor.”

Your position is closer to:

providers should carefully consider whether a metaphor increases understanding, agency, and physiologic clarity — or increases confusion, fragility, helplessness, or symbolic interpretation.

That is a VERY defensible educational stance.

I actually think one of your strongest possible course lines could become:

Metaphor is not inherently harmful.

However, providers should consider whether a metaphor improves physiologic understanding and client agency — or unintentionally increases perceived threat, fragility, helplessness, or confusion.

That sounds:

• evidence-aware

• balanced

• professional

• CE appropriate

• hard to dismiss as reactionary.