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.

Pain is common and difficult to communicate or reduce into the verbal or numerical scales commonly used in clinical practice. Some academics have argued that pain resists description in language while others have argued conversely that it generates language. This chapter identifies the limitations of verbal language and current standardized scores for assessing pain, highlighting the social and economic (as well as individual) costs of pain’s incommunicability, so often resulting in inadequate treatment and increased suffering. It 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. Against the backdrop of other work exploring the value of arts and humanities to pain medicine, it 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, it also reports early research findings suggesting that the verbal language is enriched and the non-verbal interaction impacted on. It concludes that further investigation is necessary from multidisciplinary perspectives but that images and image-making processes should be considered valuable tools for enhancing and democratizing medical pain encounters.

Background: Visual images may facilitate communication of pain in consultations. Objectives: In order to test whether photographic images of pain enrich the content and/or process of pain consultation, we compared 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 not offered images. Ten clinicians conducted assessments in each condition. After consultation patients and clinicians completed ratings of aspects of communication and, where 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 (except for confidence in treatment plan which was rated more highly in the image group). However, only in consultations with images, patients’ and clinicians’ ratings of communication were inversely related. Methodological shortcomings may underlie our 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 does not have negative impacts on the consultation but did not improve communication or satisfaction. Findings will inform analysis of behaviour in the video-recorded consultations.

Pain is unwanted, is unfortunately common, and remains essential for survival (i.e., evading danger) and facilitating medical diagnoses. This complex amalgamation of sensation, emotions, and thoughts manifests itself as pain behavior. Pain is a moti-vating factor for physician consultations 1 and for emergency department visits and is T he IASP definition of tri-geminal neuralgia (TN) is "sudden, usually unilateral, severe, brief, stabbing, recur-rent episodes of pain in the distribution of one or more branches of the trigemi-nal nerve." 1 Here's now one sufferer describes the pain: "Supper with friends. Candles and wonderful food. Suddenly my face is split apart—the bones feel as though they are shattering and the flesh raked aside by red-hot claws. I lean forward, the food falls from my mouth. The guests stare, concerned and appalled. I cannot speak to explain why the tears stream down my face. I cannot even swallow, my own saliva dribbling onto my plate. All I can do is try not to scream. If I look into a mirror I cannot believe that there is no sign of injury, no blood pouring out of my eye. " Both descriptions highlight the key features of trigeminal neuralgia, but the second is far more graphic than the first. Only the patient's ar-resting report gives us insight into the personal experience of TN pain, illustrating the suffering and fear accompanying the first attack, which many patients remember because of its dramatic onset. TN has an enormous psychological impact, but few scholarly papers high-light the ways it can affect the quality of life. 2 TN is a neuropathic condition with a unique clinical manifestation; it is also one of the few chronic pain conditions in which sufferers can be rendered 100% pain-free either with medications or surgery. 3 For this reason, correct diagnosis is crucial so that patients can then follow a general-ly acknowledged care pathway as soon as possible. 4,5 Patients' verbal and visual descriptions provide a vividness and a level of detail missing from the generic medical criteria for classification. Pay-ing attention to these accounts can help improve the speed and accuracy of diagnosis and appropriate referral. This edition of Pain: Clinical Up-dates explores TN through the eyes, ears, and voices of patients alongside our clinical evidence-based guidelines. We collected these stories, descriptions, and images by means of focus groups, targeted emails, patient support-group meetings, and a photographic project. To gather material for her book, Insights—Facts and Stories Behind Trigeminal Neuralgia, 6 orofacial pain specialist Joanna Zakrzewska invited patients with TN to attend focus groups in the United Kingdom and United States. Sessions were recorded and transcribed. Patients in the U.S. support group also emailed their stories to relate their route of diagnosis, their symp-toms, and the impact of the condition on their lives and those of the people closest to them. Another important source of information was the collaborative art and medicine project face2face, based in London. Photographer Deborah Padfield worked individually with a group of facial pain patients, including three with TN, to create images and audio recordings of their pain and its impact at three points of treatment: before, during, and after pain management. This arc of time al-lowed the images to represent changes the patients had experienced in their perception of pain. The images also elicited significant narrative and emo

Pain is difficult to communicate and constrict into the verbal or numerical scales commonly used. This thesis explores how photographic images can expand pain dialogue in the consulting room to include aspects of experience frequently omitted using traditional measures. It draws on material generated by the face2 face project, a collaboration with facial pain specialist Professor Joanna Zakrzewska and clinicians and patients from University College London Hospitals. The project has many strands: art workshops for clinicians and patients to attend together; the co-creation of photographs with facial pain patients reflecting their experience at different points in their treatment journey; the creation of an image resource developed as an innovative communication tool for clinical use; and an artist’s film focusing on doctor-patient dialogue and the role of narrative. The thesis argues that photographs of pain placed between patient and clinician can trigger more negotiated dialogue in the consulting room. It presents the co- creation of ‘pain portraits’ with pain sufferers as part of a Fine Art practice, extending the boundaries of what is considered Fine Art by shifting the power- dynamics inherent within the act of portraiture. Through shared control of the lens and a negotiated aesthetic, pain sufferers retain control of how their pain is visualised, instead of being on the passive receiving end of a medical/photographic gaze. The thesis explores and questions the specificities of photography as a particularly apposite medium for this work. It validates and makes visib le the invisible subjective experience of pain, addressing its incommunicable nature. Semiotic and metaphoric analyses of the material reveal the possibility of a developing inter-subjective and trans -cultural iconography for pain. The thesis aims to demonstrate that not only is medicine capable of providing new material for the gallery space, but art is capable of bringing new knowledge into the consulting space.

Texts by Brian Hurwitz and Charles Pither. Perceptions of Pain is a moving and startling collection of images that explores the interface between doctor and patient, photographer and subject, maker and viewer, science and art.

Pain is common and difficult to communicate or reduce into the verbal or numerical scales commonly used in clinical practice. Some academics have argued that pain resists description in language while others have argued conversely that it generates language. This chapter identifies the limitations of verbal language and current standardized scores for assessing pain, highlighting the social and economic (as well as individual) costs of pain’s incommunicability, so often resulting in inadequate treatment and increased suffering. It 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. Against the backdrop of other work exploring the value of arts and humanities to pain medicine, it 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, it also reports early research findings suggesting that the verbal language is enriched and the non-verbal interaction impacted on. It concludes that further investigation is necessary from multidisciplinary perspectives but that images and image-making processes should be considered valuable tools for enhancing and democratizing medical pain encounters.

UCL PRESS Open Access book which will be made fully available when completed and will be deposited accordingly