DVD Review

Exploring pain management through the lens of dance

Dancing with pain

Kuttner L, Director (2013). Film on DVD, 20 minutes: $39.00 CAD. Available from British Columbia Children’s & Women’s Hospital Bookstore: edreg.cw.bc.ca/bookstore/12504.
Trailer available at: www.youtube.com/watch?v=ZN7Pmiu14QA

Reviewed by Torie E. Carlson

printable version (PDF)

Dancing with pain is the latest cinematic expression from filmmaker and clinical child psychologist, Dr. Leora Kuttner, on what it’s like to be a youth with chronic pain. This is strikingly different from Kuttner’s previous documentary films on pain (No fears, no tears; No fears, no tears: 13 years later; Making every moment count; and Treatment programme for teens with recurrent abdominal pain: yoga programme). The characteristic, emotionally engaging, glimpses into the real struggles of youth living with chronic pain are there, but the difference is that this film helps the viewer understand the emotional impact in a visually novel and previously untapped arena in the world of chronic pain: that of interpretive artistic dance. The choreographer, Judith Marcuse, assists the dancer, Vanessa Goodman, to express the emotion and perspective of the four youth who speak in the film in a remarkable and poignant manner. This use of the arts assists the viewer to enter into the intensity and emotional angst of chronic pain in a way that is likely to be engaging and satisfying for those who appreciate this form of expression. The film is broken into seven chapters; Introduction, Pain, Confusion, Coming to grips, Social isolation, Digging out, and Acceptance. Beyond the introduction, the six remaining chapters parallel the familiar stages of grief (Kübler-Ross & Kessler, 2005) in loss, in terms of the journey from diagnosis to regaining balance that often accompanies the pain experience.

The film opens with a description of pain including the premise that the experience of pain persists when pathways established in the brain continue to generate pain. It then fades into a dynamic, moving representation of the body-self neuromatrix (Melzack, 1999, 2001, 2005). The neuromatrix theory of pain proposes that pain is produced by the output of a widely distributed neural network in the brain rather than directly by sensory input evoked by injury, inflammation, or other pathology (Melzack, 2005). The documentary then introduces us to both the dancer and the four adolescents who describe in words what chronic pain feels like to them.

The chapter entitled Pain begins with the dancer expressing what pain can feel like as the adolescents describe how they have experienced pain in their lives. We then hear the stories of the teens and their pain, with cuts to a specific dancer as she works to express what they are talking about.

The chapter entitled Confusion is aptly named as the dancer and accompanying music create the feeling of chaos that matches what the teens are describing in terms of their own struggle to understand what was happening to them. We hear about the all too common misinterpretation of the pain being all in your head, no one understands etc., as the teens share their stories of confusion. We are then presented with the idea that combining physical and psychological treatments with medication repatterns the brain's neural networks and eases pain.

Coming to grips begins with the neuromatrix model again as the teens talk about finding hope in their use of self-management techniques including self-hypnosis, breathing, imagery, body scan, writing music, exercise, stretching, etc. This is interpreted by the dancer as lighter movements and brighter facial expressions. The change from despair to hope is very clearly expressed. The techniques involved in pain management allow the teens to increase their independence by utilizing them whenever and wherever they are. This helps to decrease the reliance on others as well as the feelings of uselessness and helplessness many teens report.

The Social isolation chapter has the teens telling about how they have managed the difficulty faced by people around them in understanding the unrelenting nature of the pain. A common theme is that negative comments from friends and family and reactions from others are sometimes harder to deal with than the actual pain. One teen talked about how she wanted to just be normal and so would lie to people about the pain in order not to have to deal with their reactions.

In Digging out, the teens begin to shift away from disability and pain catastrophizing toward a self-management approach to their pain. They speak of recognizing that no good can come from the negative thoughts. One teen states that she tried to think of herself as more than just her pain. All the youth speak of the ability to utilize self-management techniques to dial it down and influence their own pain. We see their strength in deciding to move ahead aptly expressed in Vanessa Goodman’s softer movements and the obvious anticipation on her face.

The final chapter Acceptance begins with the teens talking about change: change in their understanding of themselves, coming to accept that perhaps the pain won’t get better but they will get better, seeing in themselves that they have changed in their relationship to the pain. Vanessa Goodman ends her performance walking an imaginary tightrope aptly expressing the challenge of living with chronic pain.

We are left with hope that adolescents can get on with their lives despite chronic pain. I think where this film shines is in bringing something new to the discussion of chronic pain particularly in the area of the silent or stoic teen pain patient. In my experience, many teens tend to minimize their distress and downplay the impact of pain. They don’t want to be different from their friends, to stick out, to struggle to participate. The form of artistic expression that Kuttner harnesses helps us to empathize in a greater way. We gain a much deeper understanding of the inherent complexities of pain that conventional modalities fail to capture, that Vanessa Goodman is able to capture, using her body as a fine expressive instrument in agonizing and poetic expression.

The film overall helps us to understand the biopsychosocial experience of chronic pain, consistent with the neuromatrix theory of how chronic pain works. There may be benefit for teens with pain to view this film so as to help normalize their own experience and to realize they are not alone in the pain journey. The film appears most suitable for parents and professionals seeking education on the effects of pain from the perspective of actual teens.

However, this film might not appeal to all audiences. If used in the education of adolescent pain patients, it is possible that some boys may not identify with the medium of dance or the sex of the dancer. Perhaps having an additional boy sharing his story would have more evenly balanced the film and helped to engage boys who might otherwise deem the film’s approach boring, as a 12-year-old male client of mine declared the film to be – although notably, this is a description he has applied to many aspects of our psychological work together. To enhance the engagement of other potential viewers, perhaps those not personally drawn to dance as a form of expression could be challenged to think of other ways that the experiences of the adolescents in the film (and perhaps their own experiences as well) might be expressed visually.

This film is a strong visual portrait of pain in the life and mind of some adolescents, giving the viewer a glimpse into the stages and growth through which pain can take individuals.

Cite as: Carlson TE. Exploring pain management through the lens of dance. Pediatric Pain Letter 2013;15(3):38-40. www.childpain.org/ppl 

Acknowledgements

A DVD of Dancing with pain was provided to the author by Dr. Leora Kuttner.

References

Kübler-Ross E, Kessler D. On grief and grieving: finding the meaning of grief through the five stages of loss. London: Simon & Schuster, 2005. Link

Melzack R. From the gate to the neuromatrix. Pain 1999:Suppl 6:S121-S126. PubMed Abstract

Melzack R. Pain and the neuromatrix in the brain. J Dent Educ 2001;65:1378-1382. PubMed Abstract

Melzack R. Evolution of the neuromatrix theory of pain. The Prithvi Raj Lecture: presented at the third World Congress of World Institute of Pain, Barcelona 2004. Pain Pract 2005;5:85-94. PubMed Abstract