Encountering pain: images as a tool for collaborative approaches to pain medicine

Chronic pain remains a multifactorial complex common condition, difficult for patients to communicate or fully understand. We argue the arts can raise public awareness, play a role in capturing patients' subjective narratives, improve wellbeing, and increase mutual understanding in the clinic. Through sharing findings from over 2 decades evidencing the value of photographic images as both assessment and communication tools, we demonstrate images can facilitate democratic and collaborative interaction, enabling patients to retain ownership of their illness experience. We describe how the cocreation of photographic images by a visual artist with chronic pain patients enabled individual pain meanings to emerge. The images were subsequently tested in NHS clinics with patients not involved in making them, and their impact evaluated from a variety of perspectives: linguistic; nonverbal, clinical, and psychotherapeutic. Through a series of projects, it was discovered that the visual language did not necessarily replace verbal language but reinvigorated it. Patients used the images to talk about their emotional and subjective states, the impact pain had on their lives and voice issues that mattered most to them, aligning with patient-centred care. Increased rapport and clinician patient affiliation was observed with image use and the value of an active shared physical space between clinician and patient. We posit that eliciting pain meanings is as valuable as measurement in a chronic pain context and that images can significantly increase validation. Cocreating an international set of images/pain cards could provide an economic and fruitful starting point for pain conversations and assessment globally.