The effect of preconditioning on the modalities of pain management

OBJECTIVES

This study investigated the effect of positive preconditioning on the specific modality of verbal and touch interventions, in pain management.

METHODS

We compared pain ratings in 51 participants who underwent a cold pressor test twice (T1, T2). The results from the first test were used as a reference. For the second test, the participants were divided into 5 groups. Four groups received verbal or touch intervention during the test, with or without preconditioning. The fifth group was a control group. We compared dVAS (pain ratings at T1 minus T2) between groups to assess the effect of the interventions and the preconditioning. We also explored the within-group association between dVAS and pain-related traits.

RESULTS

We found a significant effect of preconditioning on dVAS. The post hoc test showed that the preconditioned verbal group reported higher dVAS than the non-preconditioned one. Participants' emotional awareness scores were negatively correlated with dVAS in the preconditioned touch group.

CONCLUSION

These data suggested that preconditioning enhances pain management, regardless of intervention modalities. However, the preconditioning effect for the touch modality was negatively associated with the participants' emotional awareness.

PRACTICE IMPLICATIONS

Communication must be adapted with caution, depending on the treatment and the patients' emotional status.

Body-oriented gestures as a practitioner's window into interpreted communication

With increasing global migration, health care providers and patients may lack a shared language. Interpreters help to secure understanding. Doctors and patients cannot evaluate how the interpreter translates their utterances; however, they can see hand movements, which can provide a window into the interpretation process. While research on natural language use has acknowledged the semiotic contribution of co-speech gestures (i.e., spontaneous hand and arm movements that are tightly synchronized with speech), their role in interpreted interactions is unstudied. We aimed to reveal whether gestures could shed light on the interpreting process and to develop a systematic methodology for investigating gesture-use in interpreted encounters. Using data from authentic, interpreted clinical interactions, we identified and analyzed gestures referring to the body (i.e., body-oriented gestures). Data were 76 min of video-recorded doctor-patient consultations at two UK inner-city general practices in 2009. Using microanalysis of face-to-face dialogue, we revealed how participants used body-oriented gestures and how interpreters transmitted them. Participants used 264 body-oriented gestures (doctors = 113, patients = 54, interpreters = 97). Gestures served an important semiotic function: On average, 70% of the doctors' and patients' gestures provided information not conveyed in speech. When interpreters repeated the primary participants' body-oriented gestures, they were highly likely to accompany the gesture with speech that retained the overall utterance meaning. Conversely, when interpreters did not repeat the gesture, their speech tended to lack that information as well. A qualitative investigation into the local effect of gesture transmission suggested a means for quality control: visible discrepancies in interpretation generated opportunities to check understanding. The findings suggest that clinical communication training could benefit from including skills to understand and attend to gestures. The analysis developed here provides a promising schema and method for future research informing clinical guidelines and training.

Beyond the binaries: reshaping pain communication through arts workshops

Pain is difficult to communicate and translate into language, yet most social research on pain experience uses questionnaires and semi-structured interviews that rely on words. In addition to the mind/body dualism prevalent in pain medicine in these studies pain communication is characterised by further value-laden binaries such as real/unreal, visible/invisible, and psychological/physical. Starting from the position that research methods play a role in constituting their object, this article examines the potential of participatory arts workshops for developing different versions of pain communication. Twenty-two participants were involved in workshops using drawing, digital photography, sound and physical theatre to explore pain communication. The use of arts materials made pain tangible. By manipulating pain-related objects, participants could consider alternative relationships to their pain. Pain's sociality was also explored, with relations with clinicians and others emerging as potentially cooperative rather than adversarial. Discussions considered whether pain felt internal or external, and whether it was possible to conceive of a self without pain. We argue that the socio-material context of participatory arts workshops enabled these alternative versions of pain. Such methods are a useful addition to medical sociology's heavy reliance on qualitative interviewing.

Survey on hand gestures relevance in patient practitioner communication: a homeopathic example

BACKGROUND

Gestures play an important role in medical communication.

METHODS

94 homeopaths (Mean age 49.6 years, 20% male) completed a 20-item questionnaire on utilization and relevance of gestures in patients' symptom description.

RESULTS

After excluding nine items due to low validity (n = 4) or low item total correlation (n = 5), factor analysis of the questionnaire resulted in the following three dimensions explaining 66.6% of variance: 'Hand gestures in relation to verbal expressions' (5 items; Cronbach's α = 0.81), 'Hand Gestures describing the experience of bodily and mental symptoms' (4 items; Cronbach's α = 0.74) and 'practitioners' behavior and active attitude in observing hand gestures' (2 items; Cronbach's α = 0.86).

CONCLUSION

The survey shows how homeopathic therapists view patients' hand gestures, whether they use these diagnostically and how this relates to their homeopathic practice. Practitioners with only homeopathic influence on this topic are highly congruent to findings on hand gestures from other domains.

Expressive bodies: demented persons’ communication in a dance therapy context

Dementia is a disease that brings with it various limitations in the afflicted person’s communication with others. The purpose of this study is to explore, not the limitations, but the capacity of the demented person to communicate under conditions that differ from the everyday life of the care institution. Group dance therapy sessions with elderly, demented persons were video-taped and analysed with a focus on how verbal and non-verbal modes of communication were used by the participants. The ways the demented persons use body movements, free dance movements, speech and singing in different combinations is described and discussed in terms of different expressive modes, where body movements are used to substitute or support speech as well as to express thoughts, memories and emotions. The results from the study indicate that under conditions that allow for different modes of expression, the communication of the demented person can be found to be rich and varied in expression and content.

Increased pain intensity is associated with greater verbal communication difficulty and increased production of speech and co-speech gestures

Effective pain communication is essential if adequate treatment and support are to be provided. Pain communication is often multimodal, with sufferers utilising speech, nonverbal behaviours (such as facial expressions), and co-speech gestures (bodily movements, primarily of the hands and arms that accompany speech and can convey semantic information) to communicate their experience. Research suggests that the production of nonverbal pain behaviours is positively associated with pain intensity, but it is not known whether this is also the case for speech and co-speech gestures. The present study explored whether increased pain intensity is associated with greater speech and gesture production during face-to-face communication about acute, experimental pain. Participants (N = 26) were exposed to experimentally elicited pressure pain to the fingernail bed at high and low intensities and took part in video-recorded semi-structured interviews. Despite rating more intense pain as more difficult to communicate (t(25)  = 2.21, p =  .037), participants produced significantly longer verbal pain descriptions and more co-speech gestures in the high intensity pain condition (Words: t(25)  = 3.57, p  = .001; Gestures: t(25)  = 3.66, p =  .001). This suggests that spoken and gestural communication about pain is enhanced when pain is more intense. Thus, in addition to conveying detailed semantic information about pain, speech and co-speech gestures may provide a cue to pain intensity, with implications for the treatment and support received by pain sufferers. Future work should consider whether these findings are applicable within the context of clinical interactions about pain.

Achieving visibility? Use of non-verbal communication in interactions between patients and pharmacists who do not share a common language

Despite the seemingly insatiable interest in healthcare professional-patient communication, less attention has been paid to the use of non-verbal communication in medical consultations. This article considers pharmacists' and patients' use of non-verbal communication to interact directly in consultations in which they do not share a common language. In total, 12 video-recorded, interpreted pharmacy consultations concerned with a newly prescribed medication or a change in medication were analysed in detail. The analysis focused on instances of direct communication initiated by either the patient or the pharmacist, despite the presence of a multilingual pharmacy assistant acting as an interpreter. Direct communication was shown to occur through (i) the demonstration of a medical device, (ii) the indication of relevant body parts and (iii) the use of limited English. These connections worked to make patients and pharmacists visible to each other and thus to maintain a sense of mutual involvement in consultations within which patients and pharmacists could enact professionally and socially appropriate roles. In a multicultural society this work is important in understanding the dynamics involved in consultations in situations in which language is not shared and thus in considering the development of future research and policy.

Externalizing the private experience of pain: a role for co-speech gestures in pain communication?

Despite the importance of effective pain communication, talking about pain represents a major challenge for patients and clinicians because pain is a private and subjective experience. Focusing primarily on acute pain, this article considers the limitations of current methods of obtaining information about the sensory characteristics of pain and suggests that spontaneously produced "co-speech hand gestures" may constitute an important source of information here. Although this is a relatively new area of research, we present recent empirical evidence that reveals that co-speech gestures contain important information about pain that can both add to and clarify speech. Following this, we discuss how these findings might eventually lead to a greater understanding of the sensory characteristics of pain, and to improvements in treatment and support for pain sufferers. We hope that this article will stimulate further research and discussion of this previously overlooked dimension of pain communication.

Whose body is it anyway? Verbalization, embodiment, and the creation of narratives

This article examines the creation of narratives between people with severe disabilities and the personnel working with them. It shows that although a co-created narrative of what it means to be severely disabled ( the story of dependence) seems to prevail, another narrative ( the story of autonomy ) is also told, where the story of dependence is rejected by the person with disabilities. However, this story of autonomy only becomes clear if we recognize three central claims: (1) there is a connection between where the physical body of the person with disabilities is positioned in space and what he or she is allowed or able to be and do; (2) since the body is a communicative tool, the moving of the body could be interpreted as a narrative, told through the embodiment of space; and (3) the embodied story can challenge existing social structures. The article highlights the inherent struggle for power within narrations and how the creation of alternative narratives can contest existing social structures.

From pleasure to pain: The role of the MPQ in the language of phantom limb pain

In opposition to the argument that pain is private, personal and unsharable, I propose that the intersubjectivity of pain is fundamental to it. Using the case of phantom limb, I show how a specific language of pain emerged and became concretized in the US circa 1975 with the advent of the McGill Pain Questionnaire (MPQ). Through widespread use of the MPQ, a language of pain materialized, one that was commonly used to describe the qualitative dimensions of phantom limb. After 1975, the terminology used within the medical literature was overwhelmingly consonant with the set of descriptors advanced by the MPQ. The utilization of a pain questionnaire to assess the qualitative dimensions of phantom limb effectively accentuated pain, and by 1980, what was once considered relatively rare became a common sequela of phantom manifestation.

Living with low back pain-Stories of hope and despair

Previous qualitative research has illustrated a range of issues about the daily life of people living with low back pain (LBP). In this paper, we consider the struggle between hope and despair through consideration of six people's narratives about their experiences of chronic LBP. The six cases were selected from a larger qualitative study of 37 patients in the UK, sampled from a prospective cohort of people consulting their general practitioner. These six cases were selected for particular focus as they exemplify the fluctuating emotions of hope and despair. A number of linked themes emerged which influenced the extent to which people oscillate between hope and despair, the most salient of which were 'uncertainty', 'impact on self', 'social context of living with pain', and 'worry and fear of the future'. It is clear from the narrative accounts that it is not only just physical pain that the back pain sufferer must endure, but also that the psychosocial implications pose an added and often complicated challenge. Health care practitioners should consider these fluctuating emotions of hope and despair in order to facilitate more patient-centred strategies for treatment.

Establishing joint attention in remote talks with the elderly about health: a study of nurses' conversation with elderly persons in teleconsultations

This study is a contribution to the sparsely studied field of nurses' teleconsultations with frail elderly people. The aim was to describe how talk and interaction are accomplished and by what means problems are handled that emerge from the fact that the communication is conducted via videoconferencing techniques. Recordings were made of 22 sessions of teleconsultation between nurses and elderly nursing home residents aided by enrolled nurses. The data were analysed with a qualitative method inspired by conversation and discourse analysis. The findings indicate that in order to create a joint attention the participants often had to verbally confirm and reconfirm that contact had been established. The triad of participants played a special part in maintaining the joint attention through compensating for the contextual aspect of the medium's limitations and the demented elderly person's communication problems. 'Talks about the communication' and passages of social talk took place when the nurse or the staff member wanted to re-establish and maintain joint attention. The joint attention seemed connected to a special sort of eye contact and gaze and to the type of camera projection that was used. One conclusion was that to create joint attention in nurses' teleconsultations with frail elderly people, the limitations in transferring communication cues and the limitations of what the camera can reveal of the general context could, to some extent, be made up for by verbal communication within the triad of participants. Another conclusion was that these limitations in the context of interaction in some situations also seemed to be an advantage for the demented elderly and contributed to increased attention.

Joint working relationships: children, parents and child healthcare nurses at work

In child healthcare children's development is examined and assessed. The main aim of this article is to explore the different ways in which a child health nurse establishes joint working relationships with children and parents. Few studies in child healthcare include nonverbal interaction. It was found that a child often responds to the actions of the nurse and the parent by physical and bodily actions and by the direction of his/her gaze. The nurse has to be able to shift between several different interactional modes using various nonverbal communicative means. She uses her body to shift positions together with shifts in gaze in order to establish an interactional focus and a relationship with the child. The nurse also uses different artifacts in the room as well as the child's spontaneous activities during the assessment of the child's development. In addition, she uses the parents' relationships with their children in order to gain their support and to encourage their children in performing tasks. An important methodological consequence of this study is that it is necessary to use video-recorded data when interactions of this kind are analyzed.