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Art Therapy for Chronic Pain: Applications and Future Directions L’art-thérapie

Art Therapy for Chronic Pain: Applications and Future Directions L’art-thérapie dans le traitement de la douleur chronique : Cas d’utilisation et orientatons à venir Anne-Marie Angheluta Calgary, Alberta Bonnie K. Lee University of Lethbridge abstract Chronic pain is acknowledged as a phenomenological experience resulting from biologi cal, psychological, and social interactions. Consequently, treatment for this complex and debilitating health phenomenon is often approached from multidisciplinary and bio psycho social perspectives. One approach to treating chronic pain involves implementing mind-body treatments such as art therapy. Art therapy for chronic pain is a nascent area of study, and this literature review endeavours to (a) evaluate the quality of literature in vestigating this area, (b) discuss how art therapy and other creative arts therapies treated the bio psycho social dimensions of chronic pain, and (c) identify challenges and future directions for research on this topic. résumé La douleur chronique est reconnue comme une expérience phénoménologique qui résulte d’interactions biologiques, psychologiques, et sociales. Par conséquent, le traitement de ce phénomène complexe et débilitant est souvent l’objet d’une approche et de perspectives multidisciplinaires et biopsychosociales. L’une des approches adoptées pour traiter la douleur chronique consiste à mettre en œuvre des traitements corps-esprit comme l’art- thérapie, qui est un domaine de recherche tout nouveau. La présente revue de la littérature vise à (a) évaluer la qualité de la documentation d’études dans ce domaine; (b) discuter de la façon dont l’art-thérapie et d’autres formes de thérapie par les arts créatifs ont permis de traiter les dimensions biopsychosociales de la douleur chronique; et (c) identifier les défis à relever et les orientations à suivre dans la recherche à ce sujet. Chronic pain is a mysterious experience and has been the subject of human study for centuries�� (Todd, 1999)�� . In contemporary society, chronic pain is re sponsible for hundreds of millions of dollars in lost work and compensation (Harstall & Ospina, 2003). In the year 2000, healthcare costs related to chronic pain in Canada were estimated to be $6.2 billion a year, exceeding the health care costs expected by individuals not suffering from chronic pain by $4.25 bil lion (Lynch, Schopflocher, Taenzer, & Sinclair, 2009). Chronic pain is clearly a considerable problem, and the purpose of this article is to investigate, by way of a literature review, how art therapy has been used to treat this condition. Before Canadian Journal of Counselling and Psychotherapy / 112 Revue canadienne de counseling et de psychothérapie ISSN 0826-3893 Vol. 45 No. 2 © 2011 Pages 112–131 Art Therapy for Chronic Pain 113 presenting the literature review, however, we will first introduce the definitions of chronic pain followed by an overview of the pain experience. The rationale describing the compatibility of art therapy as a chronic pain treatment will then be discussed. definitions On a personal level, the psychosocial impact of chronic pain can be considerable because it is a difficult condition to explain, treat, and overcome (Asmundson, Vlaeyen, & Norton, 2004; Butler & Moseley, 2008; Caudill, 2002; Chapman & Turner, 2001; Harstall & Ospina, 2003). When it comes to defining chronic pain, it becomes apparent why it is a challenging condition to treat. Many sources describe chronic pain as pain lasting longer than three to six months from the date of injury (Hardin, 2004; Harstall & Ospina, 2003; Koenig, 2003). Yet, other authors consider it arbitrary to define chronic pain based on a time frame. For example, Niv and Devor (1999) suggest that more emphasis should instead be placed on the increased complexity of chronic pain. Butler and Moseley (2008) propose a different approach in asserting that “all pain experiences are a normal response to what your brain thinks is a threat” (p. 26), and part of treating the pain is finding out why the brain is indicating a state of danger by maintaining a pain response. Another way of understanding chronic pain and the related maintenance of a danger signal from the brain can be achieved through the subdivision of chronic pain into malignant and benign categories (Hardin, 2004). Malignant chronic pain refers to pain originating from the progression of a life-threatening illness whereas benign pain refers to pain occurring without significant physical cause (Hardin, 2004). Finally, under the classification of benign pain, Niv and Devor (1999) advocate for the term “recurrent pain” when referring to pain originating from temporary changes in physiology. This definition is meant to account for recurrent pain conditions such as migraines, since migraine sufferers are not in constant pain—rather, they only experience pain during a migraine episode. Al though a universal system of categorizing pain does not exist, providing categories for different kinds of pain is meant to assist healthcare professionals specializing in this area to better meet the treatment needs of their patients. experience of pain Regardless of the nuances involved in its definition, chronic pain is widely accepted to be a phenomenological experience. In other words, the chronic pain experience is unique and based on the perception of the individual experiencing it. How people experience their pain is influenced by cultural ideas of pain, gender expectations of how one must cope with pain, the quality of personal relations with family or society at large, personal coping capacity, and the presence of other stressors, such as job loss ��Ã�� (Butler & Moseley, 2008; Camic, 1999; Garguilo, Mc 114 Anne-Marie Angheluta and Bonnie K. Lee Caffrey, & Frock, 2003; Hardin, 2004; Koenig, 2003). The experience of chronic pain can deprive individuals of their identity, occupation, healthy relationships, mental health, and general quality of life (Collen, 2005). The most common consequences of chronic pain cited in research studies and other scholarly literature related to the subject include increased reports of depres sion, anxiety, and anger in relation to increased pain (Camic, 1999; Caudill, 1999; Dersh, Polatin, & Gatchel, 2002; Hardin, 2004; Leo, 2003). Chronic pain can also impact family life (Harstall & Ospina, 2003; Koenig, 2003; Otis, Cardella, & Kerns, 2004); affect self-image; and contribute to decreased activity, mental deconditioning �� (Hardin, 2004; Koenig, 2003)�� , social stigma �� (Collen, 2005)�� , feel ings of loss (LeResche, 2001; Smith & Osborn, 2007), social isolation (Garguilo et al., 2003), memory deficiency, and suicidal ideation (Hardin, 2004). Furthermore, the long-term incapacities resulting from chronic pain can create economic strain, thereby adding yet another stressor (Collen, 2005). status of treatment As a consequence of the far-reaching impacts of chronic pain, researchers from a variety of disciplines such as medicine, physiotherapy, occupational therapy, psychology, social work, nursing, and the creative arts therapies have examined the cause, course, treatment, and impact of chronic pain in an attempt to ameliorate the immense personal, social, and economic cost it incurs. With no known cure for chronic pain (Butler & Moseley, 2008), interventions for chronic pain often require the collective efforts of each of the above professions to address and man age the biological, psychological, and social aspects of the chronic pain experience (Lipman, 2005). To address these areas in chronic pain management, professionals specializing in this field often use the bio psycho social model of treatment (Butler & Moseley, 2008; Caudill, 1999, 2002; Garguilo et al., 2003). The bio psycho social model tackles the aforementioned unique and multidimensional challenges implicit in treating chronic pain by explicitly drawing attention to the interactions among biological, psychological, and social aspects of the pain experience in order to foster self-management (Butler & Moseley, 2008; Caudill, 2002). Furthermore, because the biological, psychological, and social factors involved in the pain experience occur differently in each person, implementing the bio psycho social model allows for more specialized patient-centred treatment. Finally, by employing the bio psycho social model, a multidisciplinary team is able to assess the factors posing barriers to self-management of chronic pain for each patient and then collaboratively devises a treatment plan to support the patient in overcoming those barriers (Lipman, 2005). The bio psycho social model is the most widely employed for treating chronic pain because it transcends treating merely the physical symptoms of pain. However, this model is not without its pitfalls. Gatchel and Turk (2004) emphasize that the bio psycho social model can only be effective in a true multidisciplinary team in Art Therapy for Chronic Pain 115 which professionals are working collaboratively with the patient as opposed to a team wherein the patient is passed off from one professional to the next. Common barriers that impede effective chronic pain management can stem from various sources. One of the most common causes for chronic pain mis management is lack of education (Phillips, 2008). Contrary to the treatment of acute pain, which requires rest to allow the body time to heal, chronic pain management requires the patient to remain active. For an individual living with chronic pain, managing pain symptoms solely with passive strategies, such as rest, not only leads to physical deconditioning, exemplified by loss of muscle tone and physical stamina, but also to mental deconditioning (Butler & Moseley, 2008; Caudill, 2002). Mental deconditioning can lead to decreased ability to be mindful or the inability to uploads/Sante/ angheluta-lee-2011-art-therapy-for-chronic-pain-applications-and-future-directions.pdf