Talking Down Pain in the Prosthesis Clinic: The Emergence of a Local Preference

ABSTRACT

Understanding and evaluating pain is a growing concern in clinical practice and health care. In this article we examine how pain is talked about in 24 video-recorded visits of a team of medical professionals with postsurgery amputees. We identify a paradox: Although it is medically useful to identify postamputation pain (it can indicate problematic healing and deter application of a prosthesis), we found that there was a joint preference, by both patients and professionals, to minimize pain sensations. We show how both parties draw on turn design, sequential organization, and multimodal resources to acknowledge some kinds of unpleasant sensations while excluding types of pain that would be problematic in view of the prosthesis. We discuss the importance of the findings in terms of furthering the understanding of situated expression and reporting of pain, the emergence of local preferences in clinical settings, and preference organization in general. Data are in Italian.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

¹ For studies of medical interaction involving a team of practitioners, see Hindmarsch & Pilnick 2002 and 2007.

² “A physiatrist practices in the field of physiatry—also called physical medicine and rehabilitation—which is a branch of medicine that specializes in diagnosis, treatment, and management of disease primarily using ‘physical’ means, such as physical therapy and medications. Essentially, physiatrists specialize in a wide variety of treatments for the musculoskeletal system—the muscles, bones, and associated nerves, ligaments, tendons, and other structures—and the musculoskeletal disorders that cause pain and/or difficulty with functioning” (source: spine-health, https://www.spine-health.com/treatment/spine-specialists/what-a-physiatrist).

³ This function of doctors’ repetition is strictly linked to the participation framework of the first visit at the center. Different uses and functions of doctors’ repetition of patients’ answers about their pain in third position are analyzed in Jenkins et al. (2021).

⁴ We use the verb sway to indicate a marked sideways oscillation involving both head and neck.

⁵ Because of the patients’ lying on a bed, facial expressions are not available in the video recordings of lower-limb visits.

Additional information

Funding

This research was not supported by any grant from funding agencies in the public, commercial, or not-for-profit sectors.