P29 Long-term art therapy intervention for a teenage girl with chronic pain and enthesitis-related JIA

Abstract

Background: A 14 year old girl was referred to the rheumatology clinic at a tertiary children's hospital with a 2-3 year history of pain and fatigue. She was diagnosed with chronic pain and probable enthesitisrelated juvenile idiopathic arthritis (JIA). Since the onset of symptoms, she had lost confidence, become socially isolated, and had stopped attending school. Previous CAMHS input had been unsuccessful in addressing this. The rheumatology team were concerned that her condition was having a significant detrimental impact on her mental health and education and as a result she was referred for art therapy. Method(s): Art therapy was offered as a way to help her understand and manage her pain and symptoms effectively, and help her return to normal activities; school, socialising and swimming. She was able to identify that her aims for therapy were firstly to be able to express herself through talking and image making, and try and connect with some difficult feelings such as anger. Additionally she wanted to be more open about how she is feeling. To measure the success of therapy the following tools were used goal-based outcomes (GBO); Paediatric quality of life inventory (PedsQL) and PedsQL rheumatology module. Result(s): She attended weekly one-hour art therapy sessions for 56 weeks. Image making explored the connection between physical and psychological impact of pain. Life story work helped her understand the reason for responses to symptoms and chronic pain. Art materials were used to safely experience being out with control. Outcome measures were able to demonstrate improvement in many domains. She was able to return to school with a reduced timetable and has been accepted for college next year. She swims twice weekly and has signed up to join a gym. She recently completed 15,000 steps in one day without pain. Conclusion(s): Patients who have experienced chronic pain and fatigue for many years are considered by many medical professionals as hard to reach patients. Treatment is not straight forward, and patients and clinicians can often feel they've not provided a good-enough service. Work with this teenager clearly identified in images that without treating the psychological impact of her chronic pain and fatigue, one is unable to effectively treat symptoms. At the start of therapy she was unable speak about her condition, and so used art and symbolism to safely express and process her experiences. She was then able to begin verbally exploring her experiences, find meaning and gain resolution. Providing psychological interventions alongside medical treatment helps support patients to manage their condition and symptoms more effectively, and in this way regain agency over their lives.