ABSTRACT Both metaphor and narrative are increasingly regarded as central to communication about the experience of illness. In this talk I begin by reflecting on the relationship between metaphor and narrative. On the one hand, narrative and metaphor can be defined and observed as distinct phenomena: it is possible to have narrative without metaphor and metaphor without narrative. On the other hand, they can interact in a number of ways, to serve a variety of communicative functions. I show different forms of interaction by looking at data from two particular areas within health communication: the expression of chronic pain and communication about cancer. The sensation of pain is notoriously difficult to communicate. This poses a problem particularly when the pain appears to be resistant to both diagnosis and treatment, and becomes chronic. I introduce an innovative interdisciplinary project that enabled chronic pain patients to communicate their experiences via the ‘co-creation’ of visual images with an artist. I show how the images involve a variety of powerful metaphors for pain, and I analyse their relationship with each patient’s own description of the images. These descriptions contain both verbal metaphors that interact with the visual metaphors in the images, and narratives that are developed within the metaphorical scenarios. The exploratory use of the images in pain consultations also shows how patients can exploit them to tell personal stories of the impact of pain on their lives. The use of metaphors for cancer has received much attention and has often become controversial, at least since Susan Sontag’s critique of ‘military metaphors’ for cancer in Illness as Metaphor (1978). A large-scale study of patients’ metaphors for cancer at Lancaster University has confirmed the importance of metaphor in expressing views, feeling and needs, but has also challenged the view that certain metaphors are inherently harmful and negative (e.g. being ill with cancer as a ‘fight’) while others are helpful and positive (e.g. being ill with cancer as a ‘journey’). I show how different patients can use the same broad kind of metaphor (e.g. a ‘fight’ metaphor) to tell different kinds of stories about themselves, and to present themselves as more or less empowered or disempowered within the experience of illness. I conclude by reflecting on the implications of both analyses for narratology and metaphor theory on the one hand, and, on the other hand, for practice and training in healthcare.