Pain as metaphor: The dialogical construction of chronic pain through a short-term music therapy intervention ___ a single case study.

Chronic pain is a major public health issue and economic burden in Western society, with poor prognosis rates and a lack of agreement on the most effective treatment methods. While the traditional biomedical model of health views chronic pain as a sign of physical injury or damage, the more recent biopsychosocial model recognises its non-physiological as well as physical roots, maintenance factors and consequences. Despite this more holistic view, however, chronic pain is often still conceptualised as a symptom of underlying physical or psychological processes, and the influence of the biomedical approach may be seen within patient and practitioner attitudes toward the condition. While music therapy has been employed as a chronic pain intervention with some evidence of success, the literature is sparse, and studies show significant variance in results, with the social processes involved in pain often given minimal attention. The current case study employs a dialogical model of pain in an investigation of the use of music therapy with an older man diagnosed with chronic neck pain and associated emotional difficulties. A flexible approach was adopted, and as the client chose not to engage musically, work focused on client-directed discussion of his condition. While music did not play an explicit role, it is argued that it remained influential via the expectations and choices within the therapeutic relationship. Using a dialogical model of music therapy, various metaphors of pain were uncovered through the therapist-client, client-music and therapist-music relationships. It is argued that the unique relational ground of music therapy provides a rich source of meaning for pain, which may be beneficial in providing alternative and more effective attitudes toward the client's condition, and potential direction for therapeutic work. Further research is required to fully establish the process of using a dialogical model of pain within music therapy.msc_musunpub1778_ethesesunpu