Pain through the perspective of art and creativity: insights from the Unmasking Pain project.

People struggle to tell their story of living with pain and when they do it is articulated in a way that may not be understood, heard or taken seriously. Unmasking Pain is an artist-led project that explored creative approaches to tell stories of life with pain. The project was led by a dance theatre company that specialises in storytelling and emotional experiences for players and audiences. The project involved artists and people living with ongoing pain co-creating activities and environments to curiously explore "oneself", through imagination and creative expression. This article discusses insights and perspectives emerging from the project. The project revealed the power of art to make-sense of oneself with or without pain, and how art facilitates expression of complex inner experience and personal stories. People described Unmasking Pain as "explorative joy despite pain", and "a new set of rules" that contrasts with those experienced during clinical encounters. We discuss how art has the potential to improve clinical encounters and promote health and well-being, and whether artist-led activities are an intervention, therapy, or something else. Pain rehabilitation specialists from the project described Unmasking Pain as "freeing-up thinking", allowing conceptual thought beyond the biopsychosocial model of pain. We conclude that art has the potential to shift people living with pain from "I can't do, I am not willing to do it" to "Perhaps I can, I'll give it a go, I enjoyed".

A preliminary investigation into the effect of coffee on hypolagesia associated with transcutaneous electrical nerve stimulation.

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, inexpensive analgesic technique used to relieve pain. It has been suggested that caffeine, an adenosine antagonist, may interfere with TENS action. This double-blind controlled pilot study investigated the effect of coffee on response to TENS in healthy human participants experiencing experimentally induced pain. Twelve participants (7 female, age range = 20-41 years) took part in two experiments separated by 24 h. Each experiment lasted 80 min and consisted of 3 x 15 min cycles: pre-TENS, during TENS predrink and during TENS postdrink [coffee (100 mg caffeine) or decaffeinated coffee randomized across experiments]. During each cycle, thresholds for electrical (EPT), mechanical (MPT) and cold pressor (CPT) pain were recorded. The statistical analysis modelled the responses for the coffee and decaffeinated coffee conditions during TENS (i.e. as a standard crossover) and detected no statistically significant effects between coffee and decaffeinated drinks for the natural logarithm (ln) transformed values of electrical pain threshold [ln EPT Coffee-ln EPT Decaffeinated coffee mean (standard error) = 0.0147 (0.2159)], mechanical pain threshold [ln MPT Coffee-ln MPT Decaffeinated coffee mean (standard error) = 0.1296 (0.0816)] and cold pain threshold [ln CPT Coffee-ln CPT Decaffeinated coffee mean (standard error) = 0.0793 (0.1139)]. We conclude that a single cup of coffee (100 mg caffeine) had no detectable effect on TENS outcome. Reasons why coffee did not produce a detectable effect on pain threshold are discussed.

An investigation into the effect of electrode placement of transcutaneous electrical nerve stimulation (TENS) on experimentally induced ischemic pain in healthy human participants.

INTRODUCTION: It is claimed that transcutaneous electrical nerve stimulation (TENS) operates via a segmental mechanism by reducing ongoing transmission and sensitization of nociceptive dorsal horn neurons. Hence, TENS electrodes are usually placed at the site of pain. OBJECTIVE: This study compared TENS administered at the site of experimentally induced ischemic pain (ipsilateral forearm) with TENS administered at a location not related to pain (contralateral lower leg). METHODS: Ten healthy, pain free volunteers took part in a cross-over study during which ischemic pain was induced in the nondominant arm using a modified version of submaximal effort tourniquet technique. Pain intensity was taken at 1-minute interval/s for 5 minutes while receiving TENS either at the ipsilateral arm or contralateral leg. RESULTS: There were no statistically significant differences in pain intensity or McGill Pain Questionnaire ratings between TENS given at the arm compared with the leg. DISCUSSION: Taken at face value, the findings suggest that TENS effects were nonspecific and that electrode location does not affect outcome. However, this study should be seen as a call for further research rather than a definitive conclusion.

An investigation into the analgesic effects of different frequencies of the amplitude-modulated wave of interferential current therapy on cold-induced pain in normal subjects.

OBJECTIVE: To investigate the analgesic effects of different amplitude-modulated frequencies of interferential current therapy (IFT) on cold-induced pain in healthy subjects. DESIGN: Single-blind parallel group methodology was used. Subjects completed 6 cycles of the cold-induced pain test (2 pretreatment, 2 during treatment, 2 posttreatment). During each cycle, subjects plunged their hand into iced water and the time taken to reach pain threshold was recorded. The hand remained immersed in the iced water for a further 30 seconds, after which the self-reports of pain intensity and pain unpleasantness were recorded. SETTING: Laboratory in the United Kingdom. PARTICIPANTS: Sixty unpaid, pain-free volunteers without a known pathology that could cause pain. INTERVENTIONS: IFT delivered on the nondominant arm at a "strong but comfortable" intensity without visible muscle twitches, using a quadripolar application technique at 1 of 6 possible amplitude modulated "beat" frequencies (20, 60, 100, 140, 180, 220Hz). MAIN OUTCOME MEASURES: The percentage change in pain threshold, pain intensity, and pain unpleasantness from the pretreatment baseline. RESULTS: Two-way repeated-measures analyses of variance found no effects for groups for pain threshold (P=.11) or pain ratings (P>.05). There were no effects for cycle for any of the outcome measures. Effects for group by cycle interaction were noted for pain intensity and unpleasantness ratings (P<.05), although post hoc analysis failed to determine the nature of this interaction. CONCLUSIONS: Experimentally induced cold pain was not influenced by IFT frequencies.

An investigation into the analgesic effects of interferential currents and transcutaneous electrical nerve stimulation on experimentally induced ischemic pain in otherwise pain-free volunteers.

BACKGROUND AND PURPOSE: Interferential currents (IFC) and transcutaneous electrical nerve stimulation (TENS) are used for pain management. This study compared the analgesic effects of IFC and TENS on experimentally induced ischemic pain in otherwise pain-free subjects using a modified version of the submaximal-effort tourniquet technique. SUBJECTS: The subjects were 30 volunteers (18 male, 12 female) without known pathology that could cause pain. Their mean age was 33.5 years (SD=9.9, range=21-54). METHOD: A single-blind, sham-controlled, parallel-group method was used. The primary outcome measure was the change in the self-report of pain intensity during 1 of 3 possible interventions: (1) IFC, (2) TENS, or (3) sham electrotherapy. The IFC and TENS were administered on the forearm, and the sham electrotherapy group received no current output via a dummy stimulator. RESULTS: A 2-way repeated-measures analysis of variance revealed that there was no change in pain intensity during treatment when all 3 groups were considered together. Further analysis revealed that IFC reduced pain intensity when compared with sham electrotherapy but not when compared only with TENS. DISCUSSION AND CONCLUSION: There were no differences in the magnitude of analgesia between IFC and TENS. Interferential currents reduced pain intensity to a greater extent than sham electrotherapy.

A single-blind investigation into the hypoalgesic effects of different swing patterns of interferential currents on cold-induced pain in healthy volunteers.

OBJECTIVE: To compare the analgesic effects of differing swing patterns of interferential current (IFC) on cold-induced pain. DESIGN: Single-blind intervention study in which subjects completed 6 cycles of the cold-induced pain test-2 pretreatment, 2 during treatment, and 2 posttreatment. SETTING: Laboratory. PARTICIPANTS: Forty healthy volunteers. INTERVENTIONS: Subjects were randomly allocated to receive 1 of 4 IFC treatment interventions: 1 integral 1, 6 integral 6, 6 wedge 6, or burst. IFC was administered for 20 minutes via 4 electrodes attached to the forearm (quadripolar application) at a strong but comfortable intensity using amplitude-modulated frequencies of 1 to 100 Hz. MAIN OUTCOME MEASURES: Change in pain threshold and self-report of pain intensity and unpleasantness from pretreatment baseline. RESULTS: Two-way repeated-measure analysis of variance found significant effects for time and group by time interaction (P<.01), but effects for groups failed to reach statistical significance (P=0.1). This suggests that when all groups are considered together, subjects experience a rise in pain threshold when IFC devices are switched on but not when they are switched off. However, the rise in pain threshold was not dependent on the swing pattern employed. Analysis of pain intensity and unpleasantness ratings found no effects for group or group by time interaction. CONCLUSIONS: There were no differences in the hypoalgesic effects of different swing patterns.

A single-blind placebo-controlled investigation into the analgesic effects of interferential currents on experimentally induced ischaemic pain in healthy subjects.

The aim of this single-blind placebo-controlled study was to examine the analgesic effects of interferential currents (IFC) on experimentally induced ischaemic pain. Ischaemic pain was induced using the submaximal effort tourniquet technique (SETT) and pain intensity was recorded using a visual analogue scale at 1-min intervals was used as the primary outcome measure. Following baseline recordings 30 healthy volunteers received either active IFC, sham IFC, or no treatment (10 subjects per group). Data were analysed by calculating the mean change in pain intensity at each 1-min interval by subtracting data during treatment from the baseline data. IFC was administered throughout the duration of the ischaemic pain test via four electrodes (quadripolar application) on the forearm. Active IFC delivered electrical currents at a 'strong but comfortable' intensity. A 'dummy' stimulator that delivered no current was used as sham IFC. Subjects in the no treatment control group were informed that the IFC device was not switched on. There were significant effects for Groups (P=0.04) which were attributed to a significant reduction in pain intensity for the IFC group when compared with sham and no-treatment control (P< or =0.05). There were no significant effects for Time (P=0.69) or Group-Time interaction (P=0.45). In conclusion, IFC produced significantly greater analgesia than sham and no-treatment control groups under the present experimental conditions.