The supreme art

“It is the supreme art of the teacher to awaken joy in creative expression and knowledge.”

Albert Einstein

Teaching people about pain can be difficult, complex, frustrating, slow, liberating, fun, exhausting…… The list of adjectives can be as long as the number of ‘students’ that one might encounter.

Finding better ways to teach people about pain, as well as teach people how teach others about pain, is a key focus of what we do at noi.

There is compelling evidence that people learn better from words and pictures than from words alone – this is known as the multimedia learning hypothesis (Mayer 2014).

Multimedia teaching is defined as presenting words and pictures that are intended to promote learning. Multimedia does not necessarily mean technology focussed learning – it can be as simple as using a picture that specifically relates to the material being taught.

Here are seven, simple, multimedia teaching gems that are very applicable to explaining pain from The Cambridge Handbook to Multimedia Learning (2014):

  1. People learn better from words and pictures than from words alone.
  2. People learn better when words and pictures are physically and temporally integrated – having relevant pictures that people can see at the same time as the hear or read words is better than having pictures that need to be looked up later.
  3. People learn better from illustrative graphics and narration than from graphics and printed text.
  4. People learn better when they are encouraged to generate self-explanations during learning – asking a person while they are learning “can you explain to me what you understand this to mean” helps the person prompted to explain, better grasp the information.
  5. People do not necessarily learn better from animation than from static diagrams.
  6. People learn better when they create drawings as they read explanitative text.
  7. People learn better when the words and multimedia presentation is delivered in a conversational style rather than a formal style.

I’ve seen education derided in rehabilitation circles as “just handing out leaflets”. Certainly giving someone some printed information and sending them on their way is not really education, and it is certainly not multimedia education. But sitting down with a person experiencing pain, having a conversation about the brain and pain, using simple, relevant diagrams to illustrate the points and asking the patient to draw and explain their own diagrams, might just be one of the more powerful approaches to encourage healthy movement and activity, change pain cognitions, reduce pain and help a patient along the road to a better life.

What multimedia approaches are you already using, or will you be adding, when you explain pain?

Let us know in the comments below.

Tim Cocks

www.noigroup.com

13 Responses to “The supreme art”

  1. Efwef Gwerb

    Hi Tim,

    Thanks for this. It reminds me to get clients to draw their pain. I can do this on PC or scan in a hand drawn picture, making use of the technology we now have. But I think I’ll need to be more careful than last time I asked someone to do this… (off topic but hopefully of interest).

    Many years ago I had a client with chronic neck/headaches and I couldn’t really help her. I decided to get her to draw her pain, and gave her a big sheet of paper and a few colours to use. When she’d finished we both looked at it and it was actually quite frightening. It was like one of those drawings that a disturbed child would draw, like they use in movies. I asked ‘what does this represent?’ pointing to a very ominous looking line drawn across her neck and she went silent and very pale. When she next spoke, she told me she felt like she was removed from her body, watching herself from the ceiling. At the time I didn’t know what this meant, but later discovered this was a dissociative experience. The stress of uncovering unconscious material too quickly was overwhelming and this triggered the dissociation. I felt out of my comfort zone and I’m sure it showed. Not my finest treatment.

    On a positive note! :P ….. what I discovered from this client is that the representation of pain as a picture gives an enormous amount more information than the conscious verbal report. The picture will uncover some aspects of the pain that were previously unconscious. We can use this to get an intimate understanding of the client’s experience, as it is for her. Maybe I could experiment with asking the client to alter the drawing, once complete. Erasing some areas, adding elements. Re-assessing the drawing after an explain pain session. Lots of possibilities. Technology could be useful there.

    EG.

    Reply
    • timcocks0noi

      Hi EG

      Thanks for dropping by and sharing this. Amazing really, that something the client had drawn ‘with her own hand’ had such an effect upon her viewing it. How we ‘represent’ pain internally is a field ripe for study, I think. There’s an increase in interest towards how we represent pain with language, but of course this is just one mode of expression open to us.

      There is some interesting evidence that body image (and the ability to represent our bodies pictorially) is distorted in people experiencing chronic pain (Chicken, egg??) http://www.bodyinmind.org/wp-content/uploads/Moseley-2008-PAIN-i-cant-find-it1.pdf, and I recall some research suggesting that creative writing – not journalling or writing about the pain experience, but good old fashioned making stories up, was found to be quite analgesic. Creativity is often reported as lost with people experiencing chronic pain too. Lots to learn from the arts and humanities!
      Cheers
      Tim

      Reply
  2. Efwef Gwerb

    Very clever study design showing such an obvious link between pain and body image awareness. I didn’t know about this. I wonder if there’s any follow up with potential treatments.

    If chronic pain is the manifestation of psychological disturbance, this sort of study would fit in nicely. Emotional pain becomes ‘stuck’ in the psyche when it is judged too painful or too shameful to admit to conscious awareness. We simply cannot ‘see’ those problems that are judged unacceptable. One common way to treat such pain is to apply awareness + non-judgment.

    I think I need to do some experiments with this. The awareness component could potentially be achieved much more readily with drawings. Now to work out a method.

    EG.

    Reply
    • timcocks0noi

      Hi EG

      I suspect this http://ptjournal.apta.org/content/91/4/535.full.pdf came out of the work on 2PD.

      Nice little article, haven’t seen any replication or larger study, but the appendix of this paper provides a very detailed protocol for 2PD as treatment.

      The underlying idea seems to be that 2PD (GMI too) helps via increased precision of representations of the body via re-inhibition of dis-inhibited neuronal populations in the brain.

      Hope the article can give you some ideas for your clinical science work.

      Cheers
      Tim

      Reply
      • Efwef Gwerb

        Hi Tim,

        Sorry just saw your reply today. You’re always a good one for such links and resources. The outcomes of those 3 cases was impressive. On its own this looks like it could be an excellent approach to treatment. Will have a good look at the details.

        EG

        Reply
        • timcocks0noi

          Hi EG. No problems – there’s some really good stuff in that paper that i reckon warrants a bit more attention. But like GMI, treating back pain with a pointy vernier caliper will take some really good explanation and plenty of presence and congruence!
          Cheers
          Tim

          Reply
  3. Ian Stevens

    http://www.somasimple.com/forums/showthread.php?t=19133

    Jo posted this here …again chicken and egg perhaps but I was interested in your comment about lack of creativity in cpain . When I did my humanties in health course I really got interested in creative ways out of situations , usually c pain/depression . Oliver Sacks a leg to stand on is a classic and Nature cure another . This may fit with the idea of allowing creative non volitional activities so music and swimming for Sacks , immersion in nature for Bowlby . The ‘hairy all over’ body charts that often create an inward groan if you are rushed or dont have a lot of energy in the clinic are quite common in chronic pain . The narrative is never straighforward . Certainly the way out of these situations sometimes needs experimentation , a creative leap perhaps , support and guidance …Many people are unable to do this and the systems geared towards acute protocols don’t tend to allow this space ? More postively these multimedia videos that are just out (on opiates and strategies out of pain) are excellent examples of presenting information in short periods of time that is easily digested .

    Reply
  4. Explain Brain | noijam

    […] At NOI, we have trialled, played with, and guessed at ways to tell people about their brain and pain. Like many clinicians out there, we have had some great wins –“Yes. I understand it now, of course that makes sense, thanks“… and some spectacular failures – “bloody physio thinks it’s all in my head”. Over time I think we are getting better and better at this complex intervention – future clinical studies will let us know. But for now, there is research from educational psychology and science that we can and should apply – there are ‘guidelines’ from evidence based multimedia to power up and improve our ‘made in the brain’ narratives. (We have written about these before.) […]

    Reply
  5. 365 days of noijam | noijam

    […] “At NOI, we have trialled, played with, and guessed at ways to tell people about their brain and pain. Like many clinicians out there, we have had some great wins –“Yes. I understand it now, of course that makes sense, thanks“… and some spectacular failures – “bloody physio thinks it’s all in my head”. Over time I think we are getting better and better at this complex intervention – future clinical studies will let us know. But for now, there is research from educational psychology and science that we can and should apply – there are ‘guidelines’ from evidence based multimedia to power up and improve our ‘made in the brain’ narratives. (We have written about these before.)” […]

    Reply
  6. DIM SIMs | noijam

    […] manuals – some are excellent, some are scary, others are plain wrong and many defy basic multimedia principles. We’ve noted that some, including published books and manuals, closely resemble the […]

    Reply
  7. The silent epidemic | noijam

    […] that are associated with images are more memorable – they’re more ‘sticky’. There are some simple guidelines for effective, evidence based multimedia education, and a good infographic can make a strong point […]

    Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Basic HTML is allowed. Your email address will not be published.

Subscribe to this comment feed via RSS

%d bloggers like this: