Perceptions of PainPadfieldDeborah128 pp Price £14.99 ISBN 1-904587-02-XStockport: Dewi Lewis Publishing, 2003
Authors: S M Yentis
Journal: Journal of the Royal Society of Medicine (2003)

What could be more subjective than the appreciation of art, except possibly the experience of pain? And not only subjective, but indescribable—how could I possibly explain to someone else what it feels like when I hit my thumb with a hammer, except to say that it hurts? Our best attempts to make pain objective, for example using pain scores and visual analogue scales, merely reinforce the futility of the exercise, for whilst certain forms of acute pain may conform to such measurement, pain generally—and chronic pain in particular—is more than just a sensation. How we feel about our pain, our situation, even ourselves, affects how we experience pain, and vice versa. Pain management programmes recognize this and aim to show sufferers how better to cope with their pain, and the INPUT Pain Management Unit at St Thomas' Hospital in London offers such a programme.

Attending the INPUT programme was one Deborah Padfield, her theatre career disrupted by chronic pain. Now a photographer, she undertook a project with the support of Dr Charles Pither, Consultant Anaesthetist and Medical Director of the unit, and a Sciart grant [www.sciart.org]. Over eight months, Ms Padfield worked with ten fellow sufferers designing, creating and reworking photographic images that they felt captured the essence of their pain. Originally presented in an exhibition, these images now appear in Perceptions of Pain along with commentaries by Professor Brian Hurwitz (D'Oyly Carte Professor of Medicine and the Arts, King's College, London), Ms Padfield, Dr Pither and the patients themselves.

Once one gets past the hyperbole (‘These images should galvanise clinicians into ensuring... the resources required for appropriate medical treatment of pain’), these are indeed provocative images. One is faced with pictures, both ‘natural’ and distorted or abstract, of frozen limbs, hot barbed wire, daggers, broken machinery and piles of rubbish, interspersed with patients' vignettes that describe the context of their pain. It was these tales, even more than the images, that affected me most, revealing as they do the dreadful impact that chronic, unremitting pain can have on one's life and making me feel guilty for spotting glimpses of bitterness with a medical system that has apparently failed (mentions of ‘unfortunate surgery and aftercare’, ‘operations that went wrong’ and ‘why won't they listen?’). Not that the images aren't disturbing in themselves—readers will find the ones that especially touch them but in my case it was a bruised apple, hospital sticker on the outside, the inside of which was rotten to the core.

This book could be useful on several levels. First, as an exercise for the patients involved in the project to think of their pain in new ways, to describe it and therefore to share it. Although the number of patients is small, their words describe how creating the pictures has helped them, suggesting that such activity may have value in pain management programmes. Second, these pictures might perhaps help other patients to describe their own pain to their doctors and others; this is alluded to in a BBC radio programme that discusses the book [www.bbc.co.uk/radio4/womanshour/28_07_03/wednesday/infol.shtml] although more work is needed to evaluate this. Third, those who treat patients in pain might gain better understanding of what their patients are feeling by looking through these pages, and thereby perhaps engender less bitterness in their ‘difficult’ cases. Finally, the challenge of portraying pain visually is a provocative intellectual exercise in itself. How would you present yours?