Dr Kate Thompson

Background Persistent pain is a highly prevalent, global cause of disability. Research suggests that many healthcare professionals are not well equipped to manage pain, and this may be attributable at least in part to undergraduate education. The primary aim of this study was to quantify and compare first and final year nursing, midwifery and allied health professional (NMAHP) students’ pain related knowledge and attitudes. The secondary aim was to explore what factors influence students’ pain related knowledge and attitudes. Methods In this cross-sectional study, 1154 first and final year healthcare students, from 12 universities in five different countries completed the Revised Neurophysiology of Pain Quiz (RNPQ) [knowledge] and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) [attitudes]. Results Physiotherapy was the only student group with statistically and clinically improved pain related knowledge [mean difference, 95% CI] (3.4, 3.0 to 3.9, p = 0.01) and attitudes (-17.2, -19.2 to 15.2, p = 0.01) between first and final year. Pain education teaching varied considerably from course to course (0 to 40 h), with greater levels of pain related knowledge and attitudes associated with higher volumes of pain specific teaching. Conclusions There was little difference in pain knowledge and attitudes between all first and final year NMAHP students other than physiotherapy. This suggests that for most NMAHP disciplines, undergraduate teaching has little or no impact on students’ understanding of pain. There is an urgent need to enhance pain education provision at the undergraduate level in NMAHPs. Trial Registration The study protocol was prospectively registered at ClinicalTrials.Gov NCT03522857.

The content of pain education in pre and post professional health courses is thought to be lacking both in the UK and internationally which is unacceptable considering the prevalence of pain. As developing countries improve there is an increased demand for pain management training. Many of our colleagues have spent significant time teaching abroad, however what happens when they leave? Often the training and service provision disintegrates without the visiting doctors driving force. This workshop will explore who we can evaluate the effect of education which is complex in that the outcome (improved pain management) is some distance from the educational approach and discuss what we can learn to ensure sustainability.

In the IASP Global Year of Excellence in Pain Education, it is essential that we critically review the evidence around pain education in clinical and university settings. This exciting and interactive workshop will open with three short presentations; the first two will examine university and clinical education separately but both will discuss the current evidence, potential models and competency of the learner and educator. The final presentation explores the gulf between the theory espoused by educators and the clinical practice witnessed and adopted by learners. Using group work, we will be identifying the most effective methods of knowledge transfer.

Background Unmasking Pain explores creative approaches for telling stories of life with persistent pain using a co-creative framework between artists and people living with pain. People with pain attended workshops facilitated by artists that included drawing, clay making, music, games, taking your shoes for a walk, and conversing with your puppet. Here we report insights from the Unmasking Pain project and how this may offer a fuller understanding of pain and its management. Methods The project was evaluated using mixed methods. Additionally, two research studies were embedded in the project, (i) a scientific study to evaluate pain and related behaviour (see Chazot et al. this meeting) and (ii) a phenomenological study to gain description about taking part in Unmasking Pain through one-to-one interviews. Insights and emerging themes are summarised below. Results People with pain reported being empowered to creatively explore themselves. They reported improvements in their emotions, sense of self, sense-making, and ability and confidence to communicate and engage in new relationships. Unmasking Pain moved 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 it … I am not alone’. Artists described ‘circling around pain’, often not mentioning pain unless people wished to do so themselves. Artists were mindful of being compassionate in their approach ‘You don’t have to do anything if you don’t want to. Just watch’. Discussion From the outset people with pain reported ‘Don’t see me for my condition. See me for me’. They described their encounter with Unmasking Pain as ‘a new set of rules’ that contrasted with clinical contexts. Artists reported engaging with people as people, rather than ‘chronic pain sufferers’, something clinicians may find difficult to do. Through this process artists were not seen as intrusive or threatening and people with pain quickly gained a sense of trust and confidence to engage in collaborative creative conversations. Involvement in Unmasking Pain highlighted the power of art to make-sense of oneself with or without pain and to communicate bodily experience and personal stories in clinical encounters. Debates included whether Unmasking Pain should be considered an ‘intervention’, ‘therapy’, or something else, and how Unmasking Pain could be used to reconceptualise pain from neuro-mechanistic models towards an ‘ecology of wholeness’. In conclusion, Unmasking Pain is a multi-disciplinary project that has potential to improve population health research by making the familiar strange and strange familiar.

Raw list of in vivo codes, patterns, and sub-themes

Chronic pain presents a complex challenge in general practice, often leading to cycles of over investigation, overprescribing, and underutilization of holistic support. This article explores how GPs can be better supported to identify chronic pain early, make clinically appropriate decisions without overmedicalizing, and confidently signpost patients to non-medical pain support at the right time. Drawing on the example of Rethinking Pain in Bradford, England–a cross-sector initiative that invests in GP education and provides demedicalised, culturally informed, person-centered pain support–we argue for a shift in the primary care paradigm. Importantly, this approach recognizes the valuable and needed role of GPs in chronic pain care–one that does not necessarily require more time, but rather a shift in mindset and confidence. By enabling GPs to intervene more effectively and holistically, this model has the potential to reduce repeated consultations and break the cycle of high-frequency GP use among people living with chronic pain. Empowering GPs with the tools, training, and networks to navigate chronic pain holistically can reduce harm, improve outcomes, and align care with national strategies for sustainable pain management.

Exploring physiotherapy students experiences and thoughts of simulation practice across the curriculum

In this perspective article we advocate community-based system change for people living with persistent pain. Our view is that greater use of the voluntary and community sector, in partnership with the clinical sector, creates the conditions for a “whole person” approach to pain management, leading to greater personalised care for adults living with long-term pain whilst having the potential to ease some of the pressures on General Practitioners and other clinical services. We advocate pain care that is socially connected, meaningful within socio-cultural contexts and aligned with the principles of salutogenesis. We provide an example of a UK National Health Service (NHS) commissioned pain service called “Rethinking Pain” that operationalises this perspective. Led by the voluntary and community sector, Rethinking Pain works in partnership with the clinical sector to provide a central holistic pathway of care for people experiencing persistent pain. This is the first time that this model of care has been commissioned for persistent pain in this area of England. The Rethinking Pain service is underpinned by core values to work with people to manage their pain holistically. The Rethinking Pain team proactively engage with people in the community, actively approaching and engaging those who experience the biggest health inequalities. In this article we provide an overview of the context of pain services in the UK, the rationale and supporting evidence for community-based system change, and the context, pathway, values, goals, and aspirations of the Rethinking Pain service.

Objectives: The purpose of this study was to engage with physiotherapy clinicians, academics, physiotherapy students and patients to explore the acceptability, feasibility, and practical considerations of implementing person-focused evidence-based pain education concepts, identified from our previous research, in pre-registration physiotherapy training. Design: This qualitative study took a person-focused approach to ground pain education in the perspectives and experiences of people who deliver and use it. Data was collected via focus groups and in-depth semi-structured interviews. Data was analysed using the seven stage Framework approach. Setting: Focus groups and interviews were conducted either face to face, via video conferencing or via telephone. This depended on geographical location, participant preference, and towards the end of data collection the limitations on in-person contact due to the Covid-19 pandemic. Participants: UK based physiotherapy clinicians, physiotherapy students, academics and patients living with pain were purposively sampled and invited to take part. Results: Five focus groups and six semi-structured interviews were conducted with twenty-nine participants. Four key dimensions evolved from the dataset that encapsulate concepts underpinning the acceptability and feasibility of implementing pain education in pre-registration physiotherapy training. These are (1) make pain education authentic to reflect diverse, real patient scenarios, (2) demonstrate the value that pain education adds, (3) be creative by engaging students with content that requires active participation, (4) openly discuss the challenges and embrace scope of practice. Conclusions: These key dimensions shift the focus of pain education towards practically engaging content that reflects people experiencing pain from diverse sociocultural backgrounds. This study highlights the need for creativity in curriculum design and the importance of preparing graduates for the challenges that they will face in clinical practice.

Background Pain is a complex, global and multidimensional phenomena that impacts the lives of millions of people. Chronic pain (lasting more than 3 months) is particularly burdensome for individuals, health and social care systems. Physiotherapists have a fundamental role in supporting people who are experiencing pain. However, the appropriateness of pain education in pre-registration physiotherapy training programmes has been questioned. Recent research reports identify the need to integrate the voice of patients to inform the development of the pre-registration curriculum. The aim of this meta-ethnography was to develop new conceptual understanding of patients' needs when accessing physiotherapy for pain management. The concepts were viewed through an educational lens to create a patient needs-based model to inform physiotherapy training. Methods Noblit and Hare’s seven-stage meta-ethnography was used to conduct this qualitative systematic review. Five databases (MEDLINE, CINAHL Complete, ERIC, PsycINFO and AMED) were searched with eligibility criteria: qualitative methodology, reports patient experience of physiotherapy, adult participants with musculoskeletal pain, reported in English. Databases were searched to January 2018. Emerge reporting guidelines guided the preparation of this manuscript. Results A total of 366 citations were screened, 43 full texts retrieved and 18 studies included in the final synthesis. Interpretive qualitative synthesis resulted in six distinct categories that represent patients’ needs when in pain. Analysing categories through an education lens resulted in three overall lines of argument to inform physiotherapy training. The categories and lines of argument are represented in a ‘needs-based’ model to inform pre-registration physiotherapy training. Discussion The findings provide new and novel interpretations of qualitative data in an area of research that lacks patient input. This is a valuable addition to pain education research. Findings support the work of others relative to patient centredness in physiotherapy.

Objectives The purpose of this preliminary study was to investigate the feasibility of carrying out research to determine the diagnostic accuracy of routine clinical neurological examination in patients with lumbar radiating leg pain. Design: A preliminary investigation Setting: Primary Care NHS Leeds spinal injection clinic. Participants: Fifteen patients were contacted. Ten patients attended spinal injection clinic, six of which consented to take part in the study. Interventions: Participants agreed to a clinical neurological examination consisting of dermatome, myotome and reflex testing by a Physiotherapist (Rater 1). The physiotherapist made a diagnosis whether lumbar radiating leg pain was radicular in nature based on the clinical examination. Prior to attending clinic all patients received a lumbar MRI. A musculoskeletal physician (Rater 2) reported whether there was radiological evidence of radicular symptoms. Rater 1 and Rater 2 were blind to each other's findings. Results: The level of agreement on the existence of radicular symptoms was calculated to be 100% between Rater 1 and Rater 2. When results were analysed for agreement on exactly which spinal level was affected agreement was calculated to be 66%. Conclusions: Initial results indicate that a composite clinical neurological examination is promising in its diagnostic ability in patients with radiating leg pain. Limitations are discussed and proposals for further research highlighted.

Background: The management of chronic pain is inherently multidisciplinary, requiring collaboration across health and care professions because pain is multidimensional, involving psychological, social, biomedical, cultural, and environmental factors. However, pain education has often focused more on biomedical aspects, limiting the capacity of professionals to deliver integrated, person-centred care. Shifting pain education away from biomedically driven curricula may better prepare graduates for meaningful consultations and biopsychosocial care. Objective: This manuscript reports the development and pilot evaluation of a virtual patient simulation designed to help physiotherapy students develop person-centred pain assessment skills. Methods: We developed and piloted a virtual patient with complex pain scenarios for physiotherapy students. To evaluate the simulation, students completed a self-reported questionnaire assessing their ability, self-confidence in person-centred assessment skills, and their attitudes and beliefs regarding the simulation. Results: Frequency and confidence in person-centred inquiry ranged from 100% to 16.3%, depending on the complexity of information. Inductive thematic analysis revealed four themes: (1) Environmental factors & preferences—students’ preference for the learning environment; (2) Learning experience—including engagement, feedback, discussions, and a ‘safe’ space for building confidence; (3) Professional development—insights into person-centred inquiry, personal biases, and emotional challenges; (4) Limitations—including the desire for more complexity, and technical challenges noted. Conclusions: The development of this virtual patient simulation enabled healthcare students to engage with a multidimensional perspective on pain, fostering skills essential for biopsychosocial pain assessment and patient-centred care. Although designed and piloted with physiotherapy students, this model holds potential for broader application across healthcare disciplines.

Introduction Social prescribing links patients to community groups and services to meet health needs; however, it is uncertain what the benefits and impacts of social prescribing are for people with chronic pain. The National Institute for Health and Care Excellence (NICE) undertook a systematic review to investigate the clinical and cost effectiveness of social interventions aimed at improving the quality of life of people with chronic pain; no relevant clinical studies comparing social interventions with standard care for chronic pain were found, though the inclusion criteria for studies was narrow. Objectives To undertake a rapid review of all types of research and policy on social prescribing for adults with chronic pain in the U.K. (i) to describe the characteristics of relevant research and (ii) to synthesise data on impact. Methods A two-stage rapid review was planned. Stage (i) scoped and categorised knowledge from a comprehensive representation of the literature. In stage (ii), we undertook a descriptive synthesis of quantitative data along with a thematic analysis of qualitative data identified by stage (i). Results Of 40 full-text records assessed for inclusion, three met the inclusion criteria from academic databases. An additional five records were found in grey literature. Six records reported quantitative findings suggesting that social prescribing reduced pain severity and discomfort, pain medication and clinical appointments; and improved quality of life and ability to manage health. Five records captured qualitative data from interviews, case studies and anecdotal quotes that suggested positive impact on health and wellbeing; and increased self-efficacy in social prescribers undertaking training on pain. Conclusions There is tentative evidence that social prescribing improves health and wellbeing outcomes in adults with chronic pain and that there is a need to upskill social prescribers in contemporary pain science education. Research on the routes to referral, outcomes and impacts is needed. Perspective Social prescribing is valued and may be of benefit for people with chronic pain. There is a need to further develop and evaluate social prescribing services for people with chronic pain to enhance holistic patient centered care.

Background Pain education in professional health courses is key to producing healthcare professionals of the future that are competent to manage the needs of patients experiencing pain (IASP, 2015). In the UK, there is a lack of guidance from professional regulatory bodies, with only medicine and midwifery training specifically including standards for pain. Subject specific guidance is provided by specialist organisations such as the International Association for the Study of Pain (IASP), yet the uptake of this guidance in professional health courses is thought to be poor (Briggs et al., 2011). Recent surveys revealed that physiotherapy is one of the leading undergraduate health courses in regards to the average number of taught hours of pain education, however statistically it also has the most variance (Leegaard et al., 2014, Hoeger Bement and Sluka, 2015, Briggs et al., 2011).In addition to the number of taught pain hours, further information is needed regarding the structure of pain education. This scoping review will collate current available evidence that informs the provision of pain education across professional health courses. Aims Locate, map and report what evidence currently exists that has observed or investigated the structure of pain education in pre-registration professional health courses. Methods A systematic scoping review methodology was used (Levac et al., 2010). PRISMA guidelines were adopted where possible to ensure as robust a methodology as possible (PRISMA, 2015). The following search strategy was employed in Medline, Cinahl, ERIC, AMED, HMIC and EBM reviews; [Pain] AND [Education OR Curriculum] AND [Physiotherapy OR Allied health occupations OR Nursing OR Medicine]. MeSH or Thesaurus search terms were used within databases where possible. Two authors [KT & JM] independently screened titles and abstracts of all papers (2396) etrieved in the search strategy. Papers were included for data extraction if they had available abstracts written in English that referred to (1) pain AND (2) pre-registration education or curriculum AND (3) professional health education e.g. nursing, medical or other allied health professions such as Physiotherapy. Authors met to pilot the selection criteria at the beginning and midway through the screening process. A third reviewer [MB] was consulted where agreement could not be reached. The full text of all articles that met the inclusion criteria from the screening process were retrieved (68) and further assessed using eligibility criteria. Twenty nine papers were found eligible for this initial scoping review analysis. Results Twenty nine papers were found to be accessible and in a format that data could be extracted for initial analysis of results. Professional pain education provision has been investigated throughout more than 15 countries, with the majority of studies conducted in the USA (38%) and the UK (34%). 93% (27/29) of studies conducted primary research of which 67% (18/27) used a survey questionnaire methodology. No systematic reviews or RCTs were found. Professional pain education provision was investigated in the following pre-registration health courses; Nursing 62% (18/29), Medicine 31% (9/29), Physiotherapy 17% (5/29), Occupational therapy 17% (5/29), Dentistry 10% (3/29), Pharmacy 10% (3/29), Veterinary Science 7% (2/29), and Psychology 3% (1/29). Most studies surveyed student knowledge and skills based on current education provision 76% (22/29), whereas only 7 studies evaluated a ‘new’ educational strategy e.g. a dedicated pain course (24%). 89% of studies were conducted in the last 15 years Conclusion There is a body of literature that has examined pain education across professional health courses. The majority has been conducted in Nursing and Medicine, with a significant lack of research across the allied and other health professions. Much of the work describes a lack of pain knowledge and skills resulting from existing curriculum designs where pain teaching is embedded throughout modules. Studies that investigated dedicated pain teaching that was additional to the ‘usual’ curriculum generally reported more positive findings. Further in-depth analysis and synthesis of results is warranted. Where appropriate titles for systematic review and further empirical research will be proposed. Reference list BRIGGS, E. V., CARR, E. C. & WHITTAKER, M. S. 2011. Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. European Journal of Pain, 15, 789-795. HOEGER BEMENT, M. K. & SLUKA, K. A. 2015. The current state of physical therapy pain curricula in the United States: a faculty survey. Journal of Pain, 16, 144-152 9p. IASP, 2015 [Online] Available from http://www.iasp-pain.org/Education/CurriculaList.aspx?navItemNumber=647 [Accessed 13th December 2015] LEEGAARD, M., VALEBERG, B. T., HAUGSTAD, G. K. & UTNE, I. 2014. Survey of pain curricula for healthcare professionals in Norway. Nordic Journal of Nursing Research & Clinical Studies / Vård i Norden, 34, 42-45 4p. LEVAC, D., COLQUHOUN, H. & O'BRIEN, K. K. 2010. Scoping studies: advancing the methodology. Implement Sci, 5, 69. PRISMA, 2015 [Online] Available from http://www.prisma-statement.org/ [Accessed 13th December 2015]

The International Association for the Study of Pain (IASP) have designated 2018 as the global year for excellence in pain education. Despite advances in pain research, there remains an inadequate understanding and implementation of pain education that health professionals obtain in training prior to professional registration, licensure or certification. This paper reports on a synthesis of pain education research that has been conducted in this period of health professionals training. A scoping review framework by Arksey and O’Malley was used to guide a search of medical and education databases for records that have examined or evaluated pain education. Fifty-six reports were identified representing sixteen professions across twenty nine countries, published between 1992-2017. A descriptive account of the reports is provided which includes a timeline, geography, methods of evaluating and main purpose of the research. A narrative synthesis was undertaken to summarise and explain the results and main findings from reports of studies included in this review. Further to this a concept analysis was conducted to identify and map key concepts that can be used by stakeholders to develop or evaluate future pain education. Future directions for research are proposed which includes factors that are repeatedly reported to be important in advancing pain education and should underpin the campaign for environments that promote excellence in pain practice as the norm in healthcare.

INTRODUCTION: Pain is a global health concern causing significant health and social problems with evidence that patients experiencing pain are receiving inadequate care. The content of pain education in pre-registration professional health courses is thought to be lacking both in the UK and internationally which is unacceptable considering the prevalence of pain. Evaluating the effect of education is complex in that the outcome (improved healthcare) is some distance from the educational approach. Best evidence medical education has been proposed as a continuum between 'opinion-based teaching' and 'evidence-based teaching'. Searching for evidence to inform best practice in health education is complex. A scoping review provides a practical and comprehensive strategy to locate and synthesise literature of varied methodology including reports from a variety of sources. The aim of this article is to describe a protocol for a scoping review that will locate, map and report research, guidelines and policies for pain education in pre-registration professional health courses. The extent, range and nature of reports will be examined, and where possible titles for potential systematic review will be identified. METHODS AND ANALYSIS: Reports will be included for review that are directly relevant to the development of the pain curriculum in pre-registration professional health courses, eg nursing, medicine, physiotherapy. The search strategy will identify reports that include [pain] AND [pre-registration education or curriculum] AND [health professionals] in the title or abstract. Two authors will independently screen retrieved studies against eligibility criteria. A numerical analysis regarding the extent, nature and distribution of reports will be given along with a narrative synthesis to describe characteristics of relevant reports. ETHICS AND DISSEMINATION: Formal ethical approval was not required to undertake this scoping review. Findings will be published in scientific peer-reviewed journals and via conference presentations.

Relevance Pain education across professional health courses is known to be varied in method of delivery and number of taught hours, with the consensus that current pain education is inadequate. Physiotherapy is leading other health professions in the number of taught pain hours in pre-registration curricula, having the potential to promote and influence pain education policy. To understand how pain education should be structured, we firstly conducted part one of this scoping review to identify empirical evidence that informs pain education across professional health courses. In general, pain was embedded within modules on broader topics. There was tentative evidence that pain education additional to the ‘usual’ curriculum, rather than embedded, was more effective. In addition to research findings, health courses are guided by membership and subject specialist organisations, and must adhere to standards set by professional regulatory bodies. This second part of the scoping review will aim to identify this important information relevant to pain education that is additional to empirical evidence located in databases. Purpose To locate, map and report standards, protocols or frameworks that inform pain education in pre-registration professional health courses from non-research sources such as professional regulatory bodies and subject specialist organisations. Methods/Analysis A scoping review methodology was used to identify any professional standards relevant to pain education (health regulators), protocols or frameworks (membership organisations and special interest organisations). The following health regulator websites were searched; General Medical Council (GMC), Nursing and Midwifery Council (NMC), Health and Care Professions Council (HCPC), General Dental Council (GDC), General Chiropractic Council (GCC) , General Osteopathic Council, and General Pharmaceutical Council. This totalled 29 health professions. Seven membership organisations were searched; Chartered Society of Physiotherapy, Physiotherapy Pain Association (PPA), Royal College of Nursing (RCN), British Medical Association, British Psychological Society, British Dental Association, and Royal Pharmaceutical Society. Subject specialist pain organisations; British Pain Society and IASP were searched for any key documents relevant to pain education. Results Only five of the 29 health professions had a regulatory standard of education and training or proficiency that made some reference to the keyword ‘pain’; the GMC, NMC, the HCPC standard of proficiency for Operating Department Practitioners, and the GCC (1 reference each). The GDC outcomes for registration referred to pain on 7 occasions. Two membership organisations provided profession specific pain frameworks describing values, behaviours, knowledge and skills (PPA and RCN). IASP provide subject specific pain curricula for Pharmacy, Psychology, Physiotherapy, OT, Nursing, Medicine, Dentistry and Social Work. Discussion and Conclusions Physiotherapy and nursing membership organisations provide good examples of frameworks that can influence pain curriculum design within and across professional health courses. There is no professional regulatory standard for physiotherapy specifically for pain education. Dentistry is leading in terms of standards of training for pain, and should be considered as an example of good practice. Impact and Implications Physiotherapy has the potential to influence pain education policy, resulting in graduates that are better equipped to manage patients experiencing pain. Further research is needed to investigate how pain education is structured within current physiotherapy courses, identifying examples of good practice that can be shared.

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".

‘Unmasking Pain’ is an innovative artist-led project to explore creative approaches for telling stories of life with persistent pain. The purpose of this qualitative study was to explore and describe the lived experience of taking part in ‘Unmasking Pain’ from the perspectives of people living with pain (workshop attendees), artists (workshop facilitators) and pain rehabilitation specialists. Informed by descriptive phenomenology, data was collected via semi-structured interviews with three artists (workshop facilitators), five workshop attendees (all living with persistent pain) and one pain rehabilitation specialist. Data was analysed using thematic analysis for descriptive phenomenology. Three themes emerged from the analysis: Theme 1 Space to Breathe, reflects the context of ‘Unmasking Pain’ such as the conditions, environment and setting that people experienced; Theme 2 Flexibility to Participate, reflects the experience of the process of ‘Unmasking Pain’ such as the actions or internal workings/behaviours of the experience; and Theme 3 Possibility for Change, reflects the cognitive or emotional experience of ‘Unmasking Pain’. There were nine sub-themes: 1(a) Dissolved hierarchy, 1(b) Human connection, and 1(c) Personally meaningful; 2(a) Go with the flow, 2(b) Enjoyable experience, and 2(c) Curiosity to step into the unknown; and 3(a) Reforming pain, 3(b) Liberating in the moment (now), and 3(c) Gives you a boost (future). In conclusion, the uniqueness of ‘Unmasking Pain’ was to creatively facilitate curiosity and exploration of pain in a non-clinical, sociocultural, humanised context, to enable the possibility of a different pain experience. The findings from this qualitative study exploring the lived experience of taking part in ‘Unmasking Pain’ demonstrates the power and opportunity of the Arts sector and artist-led activities to support people with chronic pain to have a better pain experience.

Raw list of in vivo codes, patterns, sub-themes and overarching themes demonstrating data analysis process.