Effects of visual arts on persistent pain: A systematic review

Background: Persistent pain impacts 30% of people worldwide. Evidence on the effectiveness of visual arts in treating persistent pain seems to be emerging. Thus, the aim of this systematic review was to investigate the impact of visual arts on patients with persistent pain. Methods: Studies were identified by searching seven databases from perception until Jan-2019, then screened by two independent reviewers. Studies were included if they were published controlled trials investigating the impact of visual arts on participants with persistent pain. Studies were excluded if they were abstracts, sampled participants who could not express pain, did not report relevant outcome measures, or did not have a comparator group. The study qualities were assessed by the PEDro scale. Results: After removing duplicates, 2,732 titles and abstracts were screened. Of 125 full-texts, four satisfied the eligibility criteria; all published within the last decade. Three of four controlled studies were randomised-controlled trials. Studies were conducted in inpatient settings (n=2) and outpatient clinics (n=2). Three studies included elderly participants (>60y/o), while one included patients with HIV (>18y/o). Visual arts interventions included painting, drawing, crafting, and others. Two studies utilised visual arts as the sole treatment, while two studies used visual arts as part of a multimodal treatment. Comparators received usual care in two studies, a music intervention in one, and an art-therapy video in another. The common outcome measure in all studies was pain level (0-to-10 scale). All studies also included psychosocial outcome measures. Quality of studies ranged from grade four to eight on PEDro scale; two had high quality, and two had fair quality. All studies reported statistically significant improvements in pain within intervention groups. Conclusions: Visual arts seem to benefit patients with persistent pain. Further investigation on the clinical significance of these positive findings on pain and other biopsychosocial factors are required. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.