Search

Face2face was a project where patients with facial pain collaborated with a visual artist to create photographic images that would expand the language around pain. These images have now been made into a pack of 54 pain cards which can be used with other patients to improve consultations between healthcare professionals and patients. Two patients who participated in this project describe their experiences, which began with the difficulty of getting a diagnosis and unnecessary, irreversible dental treatment. The only medications available eventually became ineffective and resulted in significant side effects. They lived in fear, isolation, and low mood. Neurosurgery proved to be the successful treatment, resulting in freedom from pain. This chapter includes ten images they co-created over a period of time with artist Deborah Padfield.

Pain is socially and culturally experienced. This chapter builds on previous research into the value of visual images for communicating pain in the UK, which evidenced ways in which images can improve doctor–patient interaction. It discusses ways in which photographs co-created with people living with chronic pain can be catalysts for discussion of pain and suffering in a range of cultural contexts, including higher education and healthcare training. We draw on a pilot project in Delhi, India where images were used as stimuli to dialogue and exploration of shared understanding of pain and current work in UK higher education using visual and other participatory methods. Students have a chance to work with and discuss images which depict qualities and characters of pain. Through seeing and hearing about patients’ experiences of pain, students learn about the commonalities and diversities in people’s experiences of their bodies and minds and how these impact on lives. As future health professionals, their own responses to this are important. Chronic pain can be a disabling condition leaving people vulnerable, with their sense of self and how they are seen by others threatened. People living with pain have to (re)negotiate their identity, with themselves and others, to see who they can be, as well as what they can do in this new state. Exploration of this through visual arts and verbal participatory activities can provide otherwise untapped insights and understandings of the human condition and its diversity. Exploring ways in which this approach could be extended to and adapted to other contexts are part of our future plans.

What is persistent pain? How do we communicate pain, not only in words but in visual images and gesture? How do we respond to the pain of another, and can we do it better? Can explaining how pain works help us handle it? This unique compilation of voices addresses these and bigger questions. Defined as having lasted over three months, persistent pain changes the brain and nervous system so pain no longer warns of danger: it seems to be a fault in the system. It is a major cause of disability globally, but it remains difficult to communicate, a problem both to those with pain and those who try to help. Language struggles to bridge the gap, and it raises ethical challenges in its management unlike those of other common conditions. Encountering Pain shares leading research into the potential value of visual images and non-verbal forms of communication as means of improving clinician–patient interaction. It is divided into four sections: hearing, seeing, speaking, and a final series of contributions on the future for persistent pain. The chapters are accompanied by vivid photographs co-created with those who live with pain. The volume integrates the voices of leading scientists, academics and contemporary artists with poetry and poignant personal testimonies to provide a manual for understanding the meanings of pain, for healthcare professionals, pain patients, students, academics and artists. The voices and experiences of those living with pain are central, providing tools for discussion and future research, shifting register between creative, academic and personal contributions from diverse cultures and weaving them together to offer new understanding, knowledge and hope.

Aims To investigate how photographic images (Pain Cards) co-created by an artist and chronic pain patients could be used in groups of patients with burning mouth syndrome to facilitate characterization of their pain and its impact on quality of life. Methods Ten groups of patients with burning mouth syndrome attending a 2.5-hour information session in a facial pain unit were presented with 54 Pain Cards put in a random order on a table. They were asked to pick one card that described the quality of their pain and one that reflected the impact of the pain on their lives. The total number of patients was 119 (divided into groups of 8 to 14) over a 4-year period. Results A total of 114 patients chose a Pain Card; 24 cards (chosen a total of 73 times) were used to phenotype the pain and 39 cards (chosen a total of 127 times) were used to describe the impact of the pain. The most frequently used Pain Card (13 times) was a pair of lips closed with a clothes peg, whereas the other most frequently selected images were black and white. The choice of Pain Card and words used to explain the choice implied a neuropathic type of pain. Themes that were common included those of isolation, loss of confidence, low mood, and decrease in activities and socialization. Conclusion The Pain Cards chosen and the main themes support those found in the literature on BMS. The Pain Cards may help pain sufferers gain more empathy and support due to improved understanding by their health care providers.

This chapter examines the potential for photographs to improve interaction in the medical pain consulting room through the example of a Fine Art Medical Collaboration at University College Hospital, London, UK. It focuses on one specific series of images – the shadow sandwich – exploring the multiple interpretations it elicited, which, arguably, parallel the way multiple experiences of an encounter can co-exist in the consulting room. The chapter discusses the spontaneity of the creative process allows it to touch the shadows, to reach the unconscious and via the image bring elements to the surface. In language, ‘shadow’ is often used metaphorically to suggest diminished abilities, power, strength or beauty, as in ‘a shadow of his/her former self.’ If the shadow represents the unlived and repressed side of the ego, giving the shadow form could be a positive thing. Carl Gustav Jung, however, also claims this interpretation is a misunderstanding and that ‘the shadow is simply the whole unconscious.’

Communication and expression of pain can be challenging for patients experiencing chronic pain. However, an open dialogue and expression of pain during consultations with doctors is beneficial to both the clinician and the patient. The authors of this article implemented the use of a series of visual representations of pain, previously co-created by the first author (an artist) and individuals experiencing chronic pain, during chronic pain consultations at their facility in London, United Kingdom. Both clinicians and patients were asked to comment on their satisfaction with the consultation, and these results were compared with those of a group of patients at the clinic who did not view the images., BACKGROUND: Visual images may facilitate the communication of pain during consultations. OBJECTIVES: To assess whether photographic images of pain enrich the content and/or process of pain consultation by comparing patients’ and clinicians’ ratings of the consultation experience. METHODS: Photographic images of pain previously co-created by patients with a photographer were provided to new patients attending pain clinic consultations. Seventeen patients selected and used images that best expressed their pain and were compared with 21 patients who were not shown images. Ten clinicians conducted assessments in each condition. After consultation, patients and clinicians completed ratings of aspects of communication and, when images were used, how they influenced the consultation. RESULTS: The majority of both patients and clinicians reported that images enhanced the consultation. Ratings of communication were generally high, with no differences between those with and without images (with the exception of confidence in treatment plan, which was rated more highly in the image group). However, patients’ and clinicians’ ratings of communication were inversely related only in consultations with images. Methodological shortcomings may underlie the present findings of no difference. It is also possible that using images raised patients’ and clinicians’ expectations and encouraged emotional disclosure, in response to which clinicians were dissatisfied with their performance. CONCLUSIONS: Using images in clinical encounters did not have a negative impact on the consultation, nor did it improve communication or satisfaction. These findings will inform future analysis of behaviour in the video-recorded consultations.

Pain is common and difficult to communicate or reduce into the verbal or numerical scales commonly used in clinical practice. This chapter explores the specificities of the photographic medium demonstrating that visual images (in particular photographs) can be alternative vehicles for eliciting language and narrative capable of expanding and improving communication and clinician-patient interaction within medical pain consultations. The chapter focuses on a fine art/medical collaborative project, face2face, at a leading London teaching Hospital, which co-created images of pain with pain sufferers and piloted a selection of these in the clinics of ten experts. Giving examples of images from the project as patients progressed through their management, we report early research findings suggesting that the verbal language is enriched and the non-verbal interaction impacted on.

A variety of treatment outcomes in chronic pain are influenced by patient–clinician rapport. Patients often report finding it difficult to explain their pain, and this potential obstacle to mutual understanding may impede patient–clinician rapport. Previous research has argued that the communication of both patients and clinicians is facilitated by the use of pain-related images in pain assessments. This study investigated whether introducing pain-related images into pain assessments would strengthen various components of patient–clinician rapport, including relative levels of affiliation and dominance, and interpersonal coordination between patient and clinician behaviour. Videos of 35 pain assessments in which pain images were present or absent were used to code behavioural displays of patient and clinician rapport at fixed intervals across the course of the assessment. Mixed modelling was used to examine patterns of patient and clinician affiliation and dominance with consultation type (Image vs Control) as a moderator. When pain images were present, clinicians showed more affiliation behaviour over the course of the consultation and there was greater correspondence between the affiliation behaviour of patient and clinician. However, relative levels of patient and clinician dominance were unaffected by the presence of pain images in consultations. Additional analyses revealed that clinicians responded directly to patients’ use of pain images with displays of affiliation. Based on the results of this study, we recommend further investigation into the utility and feasibility of incorporating pain images into pain assessments to enhance patient–clinician communication.

Pain consultations are often contested spaces where patient and clinician compete for the roles of speaker. Often patients are searching for mechanical explanations and clinicians for psychological ones - creating an impasse and causing distress to both parties. Meanwhile, as technology advances and we have increasing means of seeing inside a person’s body we seem to have less and less ability to see inside another’s world – to understand what it means to live with pain, the significance of that pain for that individual in their social context. In this paper we explore the potential for images of pain, co-created with patients, to intervene in this unproductive patient dynamic and bring the full experience of pain - social, emotional, physical - into focus. Narrative analysis is used on a series of transcripts of pain consultations.

This article argues that visual images, particularly photographs, can provide an alternative visual language to communicate pain. It suggests that selected photographs of pain placed between clinician and patient can help trigger a more collaborative approach to dialogue within the consulting room. The participatory roles of artist and clinician as well as patient in the co-construction of meaning and narrative are acknowledged. Comparing images from two projects, Perceptions of Pain and face2face, the article uses Barthes’ distinction between a ‘denoted’ and ‘connoted’ message to suggest the possibility of an underlying generic iconography for pain. By drawing on selected images and audio recordings from both projects, the article demonstrates how visual images re-invigorate verbal language and vice versa. It highlights how, in placing a photograph between two people, meaning is created within a social context as much as via the configuration of signs within the photographic surface. It is suggested that a resource of pain images, such as that created in both the projects described here, could be a valuable communication tool for use in NHS pain clinics.

Aim To ascertain the influence of images depicting different qualities of pain on unselected outpatient pain clinic consultations. Methods A resource of 64 colour images depicting different qualities of pain was given to patients in clinic waiting rooms, which they could take into consultations and use as a focus for discussion with clinicians. A questionnaire enquiring into the value of such images was completed at the end of each consultation separately and anonymously by clinicians and patients. The questionnaires carried identifiers that allowed pairing in the analysis, which was undertaken qualitatively and thematically. Results Forty-four percent (20/45) of Pain Clinics declaring an interest in taking part in the study returned 64/80 (80%) pairs of questionnaires. Eighty-six percent (54) of patients related their pain to at least one image during their consultation and 67% found discussion of the images facilitated dialogue. Eighty two percent of clinicians reported improved communication as a result of the images with 78% reporting degrees of greater understanding of patients' pain. The four main themes identified in analysis of questionnaire data included: a broadening of verbal dialogue; a sense of improved clinician-patient relationship; limitations of setting (time); a variety of practical benefits for future use. The most prominent effect was that the images appeared to encourage discussion of the affective elements of the pain experience. Conclusion The results suggest that introducing a focus of images of pain into unselected pain consultations can facilitate discussion and lead to more fruitful dialogue between patients and clinicians.

General practitioners (GPs) along with other health and support workers have been assigned an ambiguous, but often crucial, role in decision-making for Employment and Support Allowance (ESA), the replacement for Incapacity Benefit (IB). It is important that GPs understand how ESA works and the help claimant–patients may need.

Indefinite and preventive detention: two archetypal danger-areas for the civil-libertarian mind. Both are permitted by criminal and mental health law, subject to the safeguards provided by common law and the European Convention on Human Rights (ECHR). Watchful eyes need to remain focused on the interpretation of such powers of detention.That any coercive power that can be abused by authority will be so abused seems a reasonable rule of thumb. Certainly it is the assumption on which responsible legislators ought to work; even if they are willing to trust their own imperturbability in the face of events they have no right to do so, or so to trust their successors. Stop-and-search has been heavily abused, while the limits on control orders are underjudicial scrutiny domestically and at Strasbourg.Terrorism trials and those involving notoriously violent criminals catch headlines, especially where mental disorder is involved. My concern here is the looseness of provisions which, operating out of the public eye, can indefinitely detain people on preventive grounds.

Deborah Padfield worked on ideas for images which Deborah photographed, either solely or with their assistance. The resultant images were reviewed in further sessions. The images that best expressed their experience were chosen by the subjects and the process reiterated until they were happy that the image ‘said something’ to them in terms of expressing what their pain felt like. They then had the opportunity of showing me the final images and discussing the result. I had at some point in the planning stage thought that the process may open diagnostic avenues, but I rapidly came to realise that this was a minor and temporary atavistic aberration of Cartesian thinking: Virchow has little place in chronic pain management. Here diagnosis is not the only end point. Listening and acknowledgement are fundamental. To paraphrase John Major: perhaps there are times when we need to understand less and accept more. The resultant images are extraordinary, moving and provocative. One fundamental question – could an artist develop images that had a meaning for the sufferer – was answered early on: some subjects still report a quickening of the pulse when they see ‘their’ images. The resultant exhibition, shown at St Thomas’ and Guy’s throughout May and June and followed by a stretch at the Royal College of Physicians, reaffirmed the effect that these remarkable images have on the interested bystander. The feedback has been uniformly positive, not in terms of the beauty of the images, although many do have a strange aesthetic quality; but in their impact. We will long remember the medical student who wrote ‘Thank you. I will now see chronic pain in a different light.’ For me the crucial aspect is the transference of the reality of experience. The sufferer stands brazen in front of an image of their disquiet one metre high. We cannot ignore it or walk away, it has gained a reality that has to be faced. Our confusion may remain but it is the subject who now has the strength and certainty. It is the physician who has to accept the premise, process the implications and respond. We have to take the representation as we find it; we can no longer disbelieve. It is humbling.