Table 1.

Characteristics and results of selected arts therapy articles in chronic pain management

Art mode	Active/passive	Authors (year of publication)/funding	Study design	Scope of study	Participant characteristic population, health problems, type of therapy/type of media	Variables measured/methods	Findings/cost-effectiveness
Visual art	Active and passive	Angheluta and Lee (2011) [4] Funding: None	Literature review (until 2009) 12 studies included Databases: electronic and library databases unspecified in which databases the search took place Keywords: art therapy, chronic pain Including criteria: Chronic nonmalignant pain Design of included articles Journal articles, books, and book chapters Time of searching From: not specified —2009 Study registration: none	Art therapy as a treatment for chronic pain: (a) evaluation of quality of literature (b) link between arts therapies and biopyscho-social model (c) limitations and future directions	Population: adults Health problem: non-malignant chronic pain (additionally excluding AIDS, hospice care, and cancer)	Chronic nonmalignant pain intensity Emotional distress	Inconsistency in findings regarding its positive effects Distinction between art therapy and recreational use of art therapy Insufficient articles and research into this area of study Cost-effectiveness: n.d.
Visual art	Active	Stuckey and Nobel (2010) [20] Funding: Foundation for Art and Healing	Literature review (until 2007) 19 studies included Databases: PubMed, PsycINFO, CINAHL, Cochrane Library, Web of Science Keywords: arts and medical outcomes, creative arts and healing or wellness, creative expression and healing or wellness, arts and health care, creative expression and illness, music therapy, art therapy, and creative expression and humanities Design of included articles qualitative and quantitative Time of searching: 1995–2007 Study registration: none	To assess the state of peer-reviewed research on arts and healing Art therapy as a treatment	Population: adults Health problem: Mix of chronic nonmalignant and cancer pain; psychiatric patients population excluded	Pain intensity, fatigue, moods, social support, QoL	Most studies were observational or limited to pre/post intervention Cost-effectiveness: n.d.
Visual art	Active	Shella (2018) [31] Funding: none	Nonrandomized clinical study with consecutive patients and pre- and post-assessment Randomization: none Study registration: none	Perception of mood, anxiety, and pain before and after art therapy	Population: adults Health problem: bedside patients with chronic diseases (epilepsy, GI, cancer, chronic pain, and other chronic diseases) Number of participants: n = 195 (166, 85% of female); age 45.2 ± 16.9 Art therapy: pre- and post-ratings of mood, anxiety, and pain for at least one 50-min art therapy session Type of art therapy media: paint, beads, and mixed media	Chronic pain intensity and emotional distress (mood and anxiety) Methods of measurement: Roger’s Happy Sad face scale pre and post each art session	Significant reduction in negative mood, anxiety, and pain severity after therapy intervention within all patients (all p < 0.001) Cost-effectiveness: n.d.
Visual art	Active	Czamanski-Cohen et al. (2014) [34] Funding: none	Qualitative and quantitative evaluation, mixed methods methodology Randomization: none Study registration: none	Effect of art-based and cognitive behavioral interventions (CB-ART) on coping with pain, anxiety, and depressive symptoms	Population: Adults females Health problem: chronic illness (chronic pain, stroke, diabetes, cancer and post-partum and reactive depression) Number of participants: n = 13 (age above 21) Art therapy: six sessions of CB-ART Type of art therapy media: mixed	Chronic pain intensity and emotional distress Methods of measurement: Women were interviewed by telephone 4 weeks after the sessions concluded by a series of open questions The interviews were transcribed and analyzed along with artwork using a conventional content analysis approach	Reduction in distress (anxiety, depression) and in coping with pain Cost-effectiveness: n.d.
Visual art	Active	Kelly et al. (2012) [35] Funding: none	Self-reported evaluation of spontaneous creative arts Randomization: None Study registration: none	Spontaneous use of creative arts as means of coping with chronic illness	Population: adults Health problem: Only females living in rural areas coping with chronic illness Number of participants: unavailable Art therapy methods: 11-week research-based computer intervention, text queries, messages posted to an unprompted, online support and health education forum were examined for references to the spontaneous use of creative arts Type of art therapy media: mixed	Chronic pain and overall quality of life Methods of measurement: qualitative	Creative arts benefit in coping with pain, relaxation, and quality of life Cost-effectiveness: n.d.
Visual art	Active	Rao et al. (2009) [50] Funding: Johnson and Johnson and the Society for Arts in Healthcare	Randomized clinical trial Randomization: stratified randomization procedure assigned participants to two conditions: one in which they participated in a session of art therapy or one in which they viewed a videotape about art therapy Study registration: none	Influence of art therapy for relief of symptoms (pain, depression, fatigue associated with HIV/AIDS)	Population: adults HIV/AIDS Health problem: HIV/AIDS 79 people (average age 42) 1st group 39 participants assigned to the “control” condition viewed once a 1-h-long videotape on the uses of art therapy 2nd group 40 participants assigned to the intervention condition participated in one 1-h-long art therapy session with a licensed art therapist Art therapy: 1 h of arts activities Type of art therapy media: mixed	Somatic symptom, emotional symptoms and pain Methods of measurement: Edmonton Symptom Assessment Scale (ESAS) State–Trait Anxiety Index (STAI)	Reduction in all HIV/AIDS connected somatic (pain) and psychological symptoms (anxiety) Cost-effectiveness: n.d.
Visual art	Active	Hass-Cohen and Findlay (2009) [33] Funding: none	Report (case study) Study registration: none	To demonstrate the application of art therapy relational principles such as creativity, relational resonance, and adaptability illuminate the potential of art therapy approaches Art Therapy Relational Neurobiology (ATR-N) brief assessment protocol for the assessment of different psychosocial dimensions of pain	Population:adults Health problem: chronic back pain Number of participants: 1 adult 64-year-old Caucasian women artist One-time 2-h assessment meeting with a follow-up interview 2 years later Art therapy: 2-h Art Therapy Relational Neurobiology (ATR-N)-based medical arts protocol Type of art therapy media: oil pastels, markers, and watercolor dry blocks	Chronic pain and emotional distress Methods of measurement: qualitative measurement of awareness and creativity in mitigating pain experience	The role of strengths, awareness and creativity, in mitigating pain experience are underscored in the protocol's structure Cost-effectiveness: n.d.
Music	Active	Cepeda et al. (2006) [40] Funding: none	Literature review of randomized control trials (until 2004), 51 studies included Databases: Cochrane Pain, Palliative & Supportive Care Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, LILACS Keywords: music, music therapy, analgesia*, and pain Design of included articles: randomized controlled trials (RCTs) Time of searching: 1966–2004 Study registration: none	Efficacy of music on pain and opioid requirements To evaluate the effect of music on acute, chronic, or cancer pain intensity, pain relief, and analgesic requirements	Population: Mixed population (children and adults) with pain Health problem: mixed: acute, chronic nonmalignant pain and cancer pain	Pain intensity level (no emotions)	Listening to music reduces pain intensity levels and opioid requirements Cost-effectiveness: potential advantages of low cost, ease of provision, and safety of music therapy Patients who reported at least 50% pain relief, and reduced requirements for morphine-like analgesics Positive effects is small Future research needed
Dance and movement therapy	Active	Simões et al. (2020) [43] Funding: FEDER [POCI-01-0145-FEDER-007746]	Case series study Study registration: ClinicalTrials.gov Identifier: NCT03493308	To describe a group intervention of pain neuroscience education and dance in institutionalized older adults with chronic pain	Population: institutionalized older adults in a nursing home Health problem: chronic pain Number of participants: N = 7 (5 women, 2 men; age (69–99) Dance and movement therapy (DMT): group intervention of six sessions of pain neuroscience education PNE and senior dance 1 session per week, 65 min (dance for the elderly 30 min) and a theoretical component of pain neuroscience education PNE (35 min)	Assessment at baseline and at the end of the intervention regarding knowledge of pain neurophysiology, pain intensity, depressive symptoms, catastrophizing, fear of movement and lower-limb performance Methods of measurement: numeric rating scale (NRS); Neurophysiology of Pain Questionnaire (NPQ); Geriatric Depression scale short form (GDS-SF); Pain Catastrophizing Scale (PCS); Tampa Scale of Kinesiophobia (TSK-13); 4-m walk test; Timed up and go test (TUG)	Mean (± SD) decrease of − 1.0 ± 2.3 for pain intensity and of − 6.1 ± 9.7 for pain catastrophizing and a mean increase in the score of the pain neurophysiology questionnaire of 4.0 ± 3.1 Cost-effectiveness: n.d.
Art, dance, and music therapy	Active	Pratt (2004) [51] Funding: none	Narrative review studies included: n.d. Databases: n.d. Keywords: n.d. Design of included articles: n.d. Time of searching: n.d. Study registration: none	Effect of arts therapies on mental wellbeing, pain, and physiological problems	Population: chronically ill population, chronical illnesses problems pain included	Pain, mental and physical wellbeing	Decrease in pain intensity Cost-effectiveness: n.d.
Written expression	Active	Broderick et al. (2005) [45] Funding: none	Randomized control trial Randomization: random assignment, method of randomization is not described in detail Study registration: none	Effect of writing intervention on improvement of psychological wellbeing and physical health variable	Population: adult women Health problem: fibromyalgia, pain Number of participants: N = 92 (women); mean age of 50 years (11.5) 1st group—trauma writing group—emotional disclosure n = 31 2nd group—control writing group—neutral writing n = 32 3rd group—usual care control group n = 29 Written expression therapy methods: written emotional disclosure (ED) focused on factual retelling of an important current or past traumatic event along with emotional expression and cognitive reappraisal neutral writing condition (NW) directed the patient to write without concern about spelling or grammar about day-to-day activities in relation to the time invested	Pain intensity, fatigue, psychological wellbeing Assessment pre and post treatment, with 4- and 10-month follow-ups Methods of measurement: Quality of Life Scale (QOL); State-Trait Anxiety Scale (STAI-S); e Beck Depression Inventory-II (BDI); Multidimensional Pain Inventory (MPI); McGill Pain Questionnaire; energy/fatigue 4-item subscale of the Medical Outcome Survey (MOS); Fibromyalgia Impact Questionnaire (FIQ)	Significant reduction in pain and fatigue, however benefits did not maintain for the long term The trauma writing group experienced significant reductions in pain (effect size [ES] = 0.49) and fatigue (ES = 0.62) and better psychological wellbeing (ES = 0.47) at the 4-month follow-up relative to the control groups. Benefits were not maintained at the 10-month follow-up The persistence of the effect must be in future confirmed and investigated Cost-effectiveness: n.d.
Written expression	Active	Gillis et al. (2006) [46] Funding: Blue Cross Blue Shield of Michigan Foundation, Arthritis Foundation, NIH grant R01 AR049059	Randomized control trial Randomization: random numbers table Study registration: none	Effects of at-home, written emotional disclosure about stressful experience at home	Population: adult Health problem: chronic pain, fibromyalgia Number of participants: N = 72 (70 women (97.2%) and 2 men); mean age of 50.3 years (range, 23–72 years) 1st group n = n.d. to write for 4 days at home about either stressful experiences (disclosure group) 2nd group n = n.d. to write for 4 days at home about neutral time management Written expression therapy methods: 4 days of writing compared to control, with 1- and 3-month follow-up	Group differences in immediate mood effects and changes in health (pain) from baseline to 1-month and 3-month follow-ups were examined Methods of measurement: pain, fatigue, psychological wellbeing Linguistic Inquiry and Word Count (LIWC) software; Positive and Negative Affect Schedule-Expanded Version (PANAS-X); Fibromyalgia Impact Questionnaire; FIQ; pain subscale from the Arthritis Impact Measurement Scale-2 (AIMS2); Fatigue Severity Scale (FSS); 4-item scale of sleep quality	Immediate increase in negative mood, did not attenuate across 4 day. Fewer health benefits after the long term; nonsignificant reduction in pain Integrate written disclosure with other techniques in holistic pain management treatment is necessary Cost-effectiveness: n.d.
Written expression	Active	Graham et al. (2008) [47] Funding: American Psychological Association, Stony Brook University, NIH Grant R01HD39753	Randomized control trial Randomization: randomly assigned into two group Study registration: none	To prove the effect of expressing anger for chronic pain sufferers	Population: adult Health problem: chronic pain Number of participants: N = 102; 22–70 years old (M = 46.3, SD = 7.5) 1st group n = 51 to express anger constructively 2nd group n = 51 to write about goals non-emotionally in a letter-writing task Written expression therapy methods: two 20-min writing sessions, 2.5 weeks apart; utilizing the anger expression component versus non-emotional writing, with 4- and 9-week follow-up	Methods of measurement: anger, depressed mood, pain severity, control over pain Pain Severity subscale of the West Haven-Yale Multidimensional Pain Inventory (MPI); Control subscale of the Survey of Pain Attitudes (SOPA); Center for Epidemiological Studies Depression Scale (CES-D); Revised Life Orientation Test; Anger Behavior-Verbal scale; State-Trait Anger Expression Inventory	Over a 9-week period, participants in 1st group (anger-expression group) experienced greater improvement in control over pain and depressed mood, and greater improvement in pain severity than the control group Include more session and include in holistic approach of pain management Cost-effectiveness: n.d.
Drama–dance/movement therapy (DDMT)	Passive	Horwitz et al. (2010) [42] Funding: none	Experimental study Randomization: none Study registration: none		Population: 7 adults Health problem: fibromyalgia Number of participants: n = 7 (100% of female); age unavailable Drama, dance and movement therapy (DDMT): 3-month treatment period, participants recorded 3 different video films performing Medea by Euripides 1. Acting together with a professional actor 2. Acting without a professional actor 3. Dance performance of emotions evoked from Medea	Methods of measurement: after performing self-rate measurement of intensity of emotional expression; pain and health 3- and 6-month follow-ups	Increase in self-rated health and decrease in pain after 3-month follow-up Correlation between strong emotional expression and decreased pain only when actively engaging theatre play Cost-effectiveness: Inclusion of expression therapy could reduce health care costs for individuals with pain, but does not describe how or provide evidence of the cost-effectiveness of this method
Dance and movement therapy (DMT)	Active	Shim et al. (2019) [49] Funding: none	Literature narrative review (until 2018) Number of studies included: n.d. Databases: n.d. Keywords: n.d. Design of included articles: n.d. Time of searching: n.d. Study registration: none	To promote theoretical model of DMT	Population: adult Health problem: chronic nonmalignant pain	Pain, emotional control, and wellness	Five key concepts of DMT for chronic pain management were identified: activating self-agency, connecting to self, connecting to others, reframing and enhancing emotional wellness Cost-effectiveness: n.d.
Dance and movement therapy (DMT)	Active	Shim et al. (2017) [60] Funding: Marian Chace Foundation, Columbia 170333-6754; Rowan University School of Osteopathic Medicine, Stratford, NJ; KIDaF Arts and Culture Foundation, Seoul, Korea	Design: exploratory study with mixed methods Randomization: none Study registration: none	Effect of DMT on various biopsychosocial issues associated with chronic pain and resilience	Population: adults Health problem: chronic musculoskeletal pain people Number of participants: n = 19 (84% of female); age 52.3 Dance and movement therapy (DMT): 10 times weekly 70-min group dance and movement (DMT) Type therapy: verbal check-in and semi-guided movement warm-up, main activities (10 themes), cool-down, journaling, group discussion and closing	Measurement at baseline, week 5, week 10 and weekly, before and after each DMT Methods of measurement: Response of Stressful Experience Scale (RSES); COPE inventory Multidimensional Assessment of Interoceptive Awareness (MAIA); Tampa Scale of Kinesiophobia (TSK-11); Numeric Rating Scale (NRS); Visual Analogue Scales (VAS); Patient Global Impression of Change Scale (PGIC)	DMT resulted in statistically significant improvements in resilience (p < 0.001), kinesiophobia (p = 0.03), body awareness (p = 0.02), and pain intensity (p = 0.03) Cost-effectiveness: n.d.