Art and Pain

Art and Pain

Researchers from UC Davis are collaborating with the Crocker Art Museum to relieve chronic pain.

“Every day, you have a choice,” says Teresa Sedano. “Are you going to get out of bed today and do something? Or are you going to stay in bed and be depressed?”

This is a question Sedano and the estimated 100 million people living with chronic pain in the United States ask themselves every day. For some, it’s a matter of logistics—they literally can’t get out of bed. For others like Sedano, it’s more complicated.

“You don’t realize that you’re wearing a mask for most of your chronic pain life,” Sedano says. “You don’t want to worry your friends and family, but you also don’t want to leave the house and have to perform—to pretend you’re OK. The more time you spend alone, the more isolated and depressed you feel.”

The idea that one’s physical state has a direct connection to one’s mental state is not new, but a team of researchers led by Ian Koebner, Ph.D., the director of Integrative Pain Management and a clinical instructor in the Division of Pain Medicine at UC Davis School of Medicine, is discovering that the context in which that physical and mental state is experienced can have a profound impact.

“Chronic pain is bio-psychosocial,” Koebner explains. “The interaction between the biology and psychology of an individual experiencing pain is always happening in a social context, and that can have a real impact on their experience of pain.”

Koebner says that people who are more socially connected seem more able to withstand pain. (He cites a study in which subjects were given a mildly painful heat stimulus while holding a partner’s hand as well as by themselves. The study showed that the stimulus was perceived as less painful when holding hands.)

While Koebner says that researchers have known of the intimate relationship between social connection and pain for a long time, they hadn’t quite figured out how to “operationalize it clinically”—that is, how to create programs and interventions to facilitate social connection for those suffering from chronic pain. Then Koebner started to consider the transformative power of art.

To assess whether art could have an effect on chronic pain, it was necessary for Koebner to identify a location where patients could come into contact with both art and each other in a low-stress environment. Evidence from a small number of studies had shown that museums facilitate a sense of social connection, so Koebner decided to approach the Crocker Art Museum about a partnership.

“There are some parts of chronic pain management that are best handled outside of the clinical enterprise because there’s a stigma of going to a place to be diagnosed and treated for an illness,” Koebner says. “There’s no stigma of going to a museum with friends. The Crocker is an ideal partner: It’s an exquisite physical space, it houses diverse subject matter and, most importantly, it’s committed to accessibility.”

Erin Dorn, the Crocker’s adult education and art access coordinator, agrees.

“The Crocker not only offers an encyclopedic range of art, our building is also beautiful and light-filled, offering a sense of reprieve from the outside world and outside worries,” Dorn says.

With the location secured, it was time for Koebner and research colleagues Scott M. Fishman, Debora Paterniti, Doris Sommer, Claudia M. Witt, Deborah Ward and Jill G. Joseph to come up with a study that would show them whether their hypotheses about the potential restorative properties of art in a social setting were on the right track.

A pilot program—dubbed Art Rx—was devised. A one-hour, docent-led tour would be offered to individuals with chronic pain and their caregivers, family or friends. Survey data was to be collected pre-tour, immediately post-tour and three weeks later via phone interview and would include the participants’ ratings of pain intensity and unpleasantness, social disconnection, percentage of pain relief and program satisfaction. Fifty-four individuals—mostly female, with a mean age of 59—participated in the initial study, and included Sedano, who had already discovered the power of art in her personal quest for pain relief.

“My most recent injury was to my spinal column,” says Sedano, who was forced to retire from her job as an American Sign Language interpreter and adjunct professor at American River College due to injuries. “I was home alone a lot, so I started painting. Doing art helped take me out of my pain, to focus on something other than the sensations in my body.”

Sedano likens the process of painting to Art Rx as “a way of taking you out of your pain—for that hour, you’re focused on something else.”

The study findings echo Sedano’s experience. Fifty-seven percent of participants reported pain relief during the tour—with average pain relief of 47 percent—as well as decreased social disconnection and pain unpleasantness. But perhaps most interesting were the comments the researchers received while conducting post-tour interviews.

“We found an interesting juxtaposition between an individual’s experience with chronic pain during their interactions with a health care system and their experiences with chronic pain while participating in our museum-based program,” Koebner says. Participants regularly reported that they felt very isolated with their pain, feelings that were sometimes exaggerated by negative encounters with health care organizations that were difficult to navigate, impersonal and felt to lack empathy. Art Rx provided participants with a sense of community and was experienced as inclusive, engaging and validating in terms of listening to an individual’s perspectives on art.

Sedano understands this firsthand. “I can’t tell you the number of times I’ve left a specialist in tears, feeling like I’ve been mistreated and dismissed,” Sedano says, recounting a particularly memorable episode in which she brought a painting she’d done depicting the areas of her body that felt pain to an appointment with her neurologist and was all but laughed out of the clinic. “Each specialist is only looking at one part of you, so you start to feel like an object, not a person,” she says. “Chronic pain can make you feel marginalized and isolated, so being in a group of people at Art Rx who have also gone through similar things can make you feel like you belong again—like you’re normal.”

Koebner and his colleagues published their study findings, titled “The Art of Analgesia: A Pilot Study of Art Museum Tours to Decrease Pain and Social Disconnection Among Individuals with Chronic Pain,” in the July issue of the journal Pain Medicine. Their follow-up article, “Curating Care: The Design and Feasibility of a Partnership Between an Art Museum and an Academic Pain Center” appeared in Curator: The Museum Journal in August. Their current objective is to figure out how the positive outcomes of the Art Rx study can prove useful to a wider market.

“Because the Art Rx program is so beneficial to individuals, health care professionals and museums, we want to create a toolkit to help them adopt and adapt Art Rx elsewhere,” says Koebner.

He explains that while the one-hour time frame of Art Rx is perfect in its current iteration (offered bimonthly at the Crocker), there’s room for an increase to a monthlong program that includes music, art-making and meditation. (Koebner already guest teaches Artful Meditation at the Crocker, a program that the Crocker’s Dorn devised in response to an exhibition of David Ligare paintings back in 2015.)

“As both Art Rx and Artful Meditation developed, Ian and I began to see them as complementary,” Dorn says, “so in February, we began to offer them in alternating months.”

This is encouraging.

“There’s a growing appreciation for the social determinants of health outside of the clinical enterprise,” Koebner says. “How you eat, how you socialize, where you live, how much money you make—those things impact your health as much as or more than genetic findings, we’re discovering. All of those things coming together create a social context for a real need to explore innovative, safe alternatives to chronic pain management.”

Sedano concurs. “It’s so important to have programs like Art Rx,” she says. “You’re with this group of people and you may not know their full names or background, but you all feel connected through the experience of suffering—everybody there is the walking wounded. You don’t have to hide it; you can just be who you are. I may not have done anything all week, but when that email reminder comes from the Crocker, it makes me want to get out of bed and go.”