Speaking through art: co‑creating visual metaphors as conversation cards for chronic pain care

BACKGROUND: The experience of living with chronic pain is difficult to understand and discuss in clinical communication, especially in the context of the strong biomedical orientation in Western healthcare. This article discusses how research on metaphors in chronic pain discourses was used to develop conversation cards with pictorial renditions of images describing pain, in collaboration with healthcare professionals and patients. With these cards, we aim to provide a support tool to more comprehensively discuss the lived experience of chronic pain in clinical communication. METHODS: We conducted 8 online focus groups with chronic pain patients and healthcare professionals working in pain care. The meaning and usability of several concept illustrations in healthcare practice were explored. RESULTS: The focus groups gave insights into required levels of transparency of the images. This concerned both the conventionality of the metaphors themselves and the degree of abstraction in the visual representation. The effect of style, tone, colour, texture and various representational approaches was also explored. Finally, we examined how participants perceived the potential use of these images within healthcare settings. However, such a process of participation and co-creation, we found, also requires careful reflection and consideration on representation, empowerment and the balance between artistic voice, scientific evidence, and participants' input. CONCLUSIONS: These insights informed the development of the complete series of illustrations and their specific applications, while requiring careful reflection on the process.