Deborah Padfield

'Representing' the pain of others.

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.

Do Photographic Images of Pain Improve Communication during Pain Consultations

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.

The body as image: image as body

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.

Can images of pain enhance patient–clinician rapport in pain consultations?

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.

Face2face: Sharing the Photograph Within Medical Pain Encounters—A Means of Democratisation

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.

Images as catalysts for meaning-making in medical pain encounters: a multidisciplinary analysis

The challenge for those treating or witnessing pain is to find a way of crossing the chasm of meaning between them and the person living with pain. This paper proposes that images can strengthen agency in the person with pain, particularly but not only in the clinical setting, and can create a shared space within which to negotiate meaning. It draws on multidisciplinary analyses of unique material resulting from two fine art/medical collaborations in London, UK, in which the invisible experience of pain was made visible in the form of co-created photographic images, which were then made available to other patients as a resource to use in specialist consultations. In parallel with the pain encounters it describes, the paper weaves together the insights of specialists from a range of disciplines whose methodologies and priorities sometimes conflict and sometimes intersect to make sense of each other’s findings. A short section of video footage where images were used in a pain consultation is examined in fine detail from the perspective of each discipline. The analysis shows how the images function as ‘transactional objects’ and how their use coincides with an increase in the amount of talk and emotional disclosure on the part of the patient and greater non-verbal affiliative behaviour on the part of the doctor. These findings are interpreted from the different disciplinary perspectives, to build a complex picture of the multifaceted, contradictory and paradoxical nature of pain experience, the drive to communicate it and the potential role of visual images in clinical settings.