Unmasking Pain

Unmasking Pain, is an innovative project exploring creative ways to depict life with persistent pain. During its two-year pilot phase (2021-23), this Fuse Award-winning initiative aimed to illuminate chronic pain through an artistic lens. The project, led by BSDC and various partners, conducted collaborative workshops and diverse creative activities. Participants discovered new ways to articulate and manage their pain, sparking important conversations about mental and physical health.

Unmasking Pain is one part of BSDC's broader focus on creative health and environment in all its activities. The company aims for deep engagement at the intersection of arts and health, collaborating with various institutions and expanding its reach across different sectors. This framework aims to integrate arts into healthcare, offering innovative solutions to health challenges and promoting mentorship and education for future generations.

2023 to 2024

Defining the project

Persistent pain is a huge worldwide health challenge. It is the primary reason people in the UK see their GP. One of the biggest frustrations reported by pain livers is its invisibility. They want to tell their stories, but they are often faced with limited time of healthcare professionals and lack of understanding. They do not always have the vocabulary to express their stories. Unmasking Painwas initiated by BSDC, following conversations with Dr Frances Cole, a retired GP and renowned pioneer in the field of pain management, the founder of Live Well With Pain (LWWP). Balbir Singh, director of BSDC, then conceived Unmasking Pain to explore creative approaches to tell stories of life with persistent pain.

Collaborators from the clinical and arts world came together to understand what difference might occur to people and their health when engaged in a more socio-artistic creative approach. What transpired was a new partnership between BSDC, Leeds Beckett University and Durham University, LWWP and Space2. Additional expertise was brought by Dr Cole and Rosie Cruikshank, a pain physiotherapist at St Thomas’ Hospital, London. All partners shared a commitment to understanding the impact of non-clinical interventions in pain management practice and challenging the established biopsychosocial model. The project’s experimentation was supported by a range of creative arts within different supportive and stimulating contexts. The team evaluated outcomes both quantitatively and qualitatively.

Project Partners:

Balbir Singh Dance Company

Durham University’s Wolfson Research Institute for Health and Wellbeing and Pain Academy (WRIHW)

Live Well With Pain (LWWP)

Leeds Beckett University Centre for Pain Research

Space2

Contributors in Brief:

Balbir Singh // Dr. Frances Cole // Prof. Paul Chazot // Prof. Mark Johnson
Rosie Cruickshank // Emma Tregidden // Dawn Fuller // Louise Trewern
Chris Speye // Adam Strickson // Anamaria Willis // Lottie Keyse

Key aims

Co-create new vocabularies and ways of expressing pain
Enable pain livers to unlock their creative potential and gain a sense of autonomy over their own stories where pain is not a defining feature them
Support in-depth research that places equal value on clinicians and lived experience contributions
Stimulate conversations and practice to transform pain self-management long term
Explore evaluation including testing new technology that enables quantifiable measuring of the impact of arts participation of individuals taking part

Our approach

The project tackled diverse ways to explore pain with a non-judgemental and curious approach to engage those with pain in a rich mixture of creative arts. Balbir Singh believes that the arts are about story, emotion and expression - abstract, literal and places in-between. Dance is technical and expressional, movement is instinctive and purposeful, music stimulates the imagination.

BSDC’s outlook is global, creating work that celebrates the human condition and makes sense of who we are, our relationship with our bodies, minds and the world around us. Balbir facilitated a team of experienced, multidisciplinary artists including South Asian and Western contemporary dancers, musicians, visual artists, film makers, photographers and writers. The creative team met at the outset to explore themes and approaches and to embed a co-creative framework for Unmasking Pain. The sessions took place around the country with activity in Durham, Leeds, Huddersfield, Devon and London.

The lynchpin

Dancer and movement artist Kali Chandrasegaram has had chronic back pain since 2002. In exploratory sessions with BSDC, Kali was interviewed and able to respond with words, movement and rhythm to express his understanding of his long-term pain. Over time, this iterative process allowed the team to pinpoint the most effective questions and format, enabling the artist to explore pain through shape, music/sound, rhythm, colour, and its journey through the body.

These sessions provided a safe space for vulnerability, anger or frustration, always concluding in a positive emotional state: ‘a good place’. With this extensive preparation, Kali became the lynchpin of the project, contributing significantly to its success. When the different groups came together to participate in the CoLabs, these often started with a performance shared by Kali using dance, movement, shapes, music and props to express his own pain. This reduced pressure on participants to contribute immediately and established a shared lived experience between artists and participants, an essential pre-requisite to the co-produced approach of the workshops, bringing parity of status to everyone in the space.

Bridging the gap

Balbir viewed the process of Unmasking Pain as a triangular relationship consisting of:

His creative process, involving in-depth research, conceptual thinking, improvisation, building a team of intercultural artists willing to be taken out of their comfort zones by a strong vision, to become the bridge in realising the concept.

Strategic thinking and partnership building, with a shared sense of ownership.

Building trust with the participants involved as audience, collaborators and eventually opening up to being artists in their own right.

At the heart of classical Indian dance and music is improvisation. That’s not to say “making it up as you go along”, rather it means to work organically in a responsive way – to think quickly, intuitively, sense the energy of the space and enable the process to shift and grow safely in the moment. Thus, much of what was planned ahead would change during the CoLabs in response to the people in the room and how the process was unfolding. Building trust with participants was in part made possible by the artists selected for the project, most of whom were deeply experienced in Balbir’s collaborative and improvisatory practice. They brought their different personalities, life experiences and sensitivities to the work, connecting with participants and audiences in different ways. Ultimately, the aim was to dissolve the distance between artist and participant, reaching a point where the participants become artists and co-create the sessions.

Distraction

An overarching theme of the process was the one of distraction. Engaging in various creative activities served as a purposeful distraction for participants, which allowed them to shift their focus away from pain and immerse themselves in the present. A simple greeting at the car park and a welcoming bouquet of colourful flowers before the sessions began would, for instance, set the tone for the day.

The cultural aspect: 6 Million+

A key aspect of the project was the multicultural landscape in which artists, partners and participants from all cultural backgrounds could create safely. To reinforce this idea, Balbir Singh partnered with Adam Strickson, teacher of intercultural performance at the University of Leeds, and lead artist at the the 6 Million+ Charitable Trust in Kirklees, West Yorkshire. The Trust works with an extended family of refugees and local communities, expressing stories of the Holocaust, genocides and contemporary persecution. Adam Strickson introduced Syrian and Kurdish refugee participants to the project. They have experienced injury in war and suffer from conditions like chronic arthritis and heart disease, the management of which has been hampered by the trauma of being displaced.

This added a new emotional dimension to Unmasking Pain. A significant number of artists and regular volunteers at the Trust also have long-term physical pain but never address the problem. Working as part of Unmasking Pain allowed them to address these issues, and create conditions for everyone to be involved on an equal, collaborative basis.Unmasking Pain brought the refugees, artists and volunteers to a deeper dialogue than is usually possible within the 6 Million+ programme. Activities included watching Kali explore his pain in dance, creative writing in Arabic and English, working with clay, pastel drawing, group dancing and composing individual music pieces for participants. Everyone participated on an equal basis. Deepening friendships and sharing food were also important at each session. A fruitful online exchange of cultures between the white North East group and the 6 Million+ participants enabled new pathways of vocabulary to express pain holistically.

“

We like to think of ourselves as an extended family, and the artists and co-ordinators from Balbir Singh Dance Company easily and happily fitted into this.

”

Adam Strickson

Language in the Landscape

The concept of Language in the Landscape seeks to awaken our senses creatively, both in the external environment and within ourselves. Originating from collaboration with the Huddersfield group of the Unmasking Pain project, Balbir Singh encouraged participants to observe shapes of trees and branches, searching for letters of the alphabet. This exercise aimed to stimulate the creative senses of participants both in Huddersfield and at the Durham Botanical Garden, urging them to perceive the world through a fresh lens. This approach reflects a fundamental curiosity about the human experience, inviting individuals to explore and engage with their surroundings in innovative ways.

Metaphors

Whilst current practice uses techniques such as a scale of one to ten to ask patients to assess their pain, the creative approach was enabling participants to express their pain better through metaphor including movement, colours, music, shapes and other art-forms. Each session had a different creative focus, but were linked through growing creative confidence, creativity and aesthetic awareness.

Musical Treatments

Live music is a core ingredient of BSDC’s work and Balbir was keen to test the idea of non-medical treatments. Using tabla, a traditional North Indian percussion instrument, the team introduced the concept of rhythmic patterns, and cyclical motions. Participants linked these patterns to rhythms of the day, week, month, year and transposed these creative elements into other themes. Musical profiles for each person were built up including favourite music and moods or favourite places to listen to music. Balbir then collaborated with musicians Aniruddha Mukherjee and Joe Harris to create what he called Musical Treatments. Through converting each participant’s name into a rhythmic pattern, the artists worked up personalised compositions, blending Indian classical music and western guitar harmony. The whole process for the 12 Musical Treatments (one for each participant to take home) was recorded and filmed.

Outcomes

An interdisciplinary team of pain researchers, clinicians and non-clinician recorded with the artistic team the emerging multidimensional experience as well as the biopsychosocial change. It was drawn from three universities: Leeds Beckett University, University of Leeds and Durham University.

10 key outcomes were identified and evidenced:

1. Unmasking Pain encouraged participants to engage in creative activities

2. Participants felt more confident in managing pain without medication

3. Participants' perceptions of creativity underwent significant transformation

4. Reliance on pain medication decreased

5. Receptiveness to alternative creative ways to pain self-management increased

6. Participants’ Confidence Scores increased

7. Participants’ Pain Catastrophising Scores (PCS) decreased

8. Wellbeing index increased

9. Emotional Arousal Responses increased

10. Walking activity, general health and sleep quality increased; all physiological benefits of Unmasking Painwere maintained after completion for at least 3 months

Fuse Award

In February 2023, BSDC won the Fuse Award for Innovative and Creative Communications in partnership with Professor Paul Chazot and the WRIHW. Fuse, the Centre for Translational Research in Public Health, is a partnership of public health researchers across the five universities in North East England. The Centre works with policy makers, practice partners, the voluntary & community sector, and the public to improve health and wellbeing and tackle inequalities. The award was celebrated in a Durham University event. It extended the profile of the project with coverage in national and regional media.

Summary

Participants in the project experienced a range of changes in their health and well-being from their participation in a rich artistic sensory experience supported by artists. They became more resilient and more confident to step outside the self-isolation of pain and participate in artistic creativity and engage in more practice in behavioural activities to enable their confident control of life despite the pain. They were more willing and receptive to consider and engage in their self-management of pain.

So the painful journey took a different direction, and the people emerged with a changed perspective. The pain became less invisible, they could see and understand it much better. They discovered themselves through stories and creativity with others. Their health improved through a journey of “explorative joy” with their own selves, their creativity and awakening through supported, compassionate creative arts engagement.

The Unmasking Pain partnership wants to use the storytelling potential of the project to bring the message of arts and creativity as an effective treatment for self-management of pain into the mainstream. The partnership believes that it is imperative to counter the dominant narrative that exercise is the only non-clinical intervention available.

Dancers

Adam Strickson
Devika Rao
Bisakha Sarker
Kali Chandrasegaram

Madhura Godbole
Mansi Dabral
Sam White
Villmore James
Yakshadruva Patla Foundation

Musicians

Aniruddha Mukherjee
Ford Collier
Joe Harris
Mussarat Rahman
Oliver Dover

Visual Artists

Jordan Mereil
Louise Grassby
Natasha Joseph
Sarah Partridge

Writer and Performer

Jenn Wilson

Photographers

Julian Germaine
Karol Wyszynski
Malcolm Johnson
Paul Floyd Blake
Tim Smith

Videographers

Gareth Dakin
Mark Baker
Nathan Towers