Can architecture improve the lives of people with chronic pain?


The boom in working from home, which has been embraced by many, has been a double-edged sword for those with chronic pain. While this may have reduced the need for strenuous travel, many are now spending more time in homes unsuitable for their conditions.

How much easier architecture and design can make life is a vital and complex question. A person with chronic pain rarely has the same symptoms as another.

Chronic pain is defined by the UK NHS as pain that lasts more than three months despite the initial injury or inflammation resolving. People with the condition may be sensitive to their surroundings not only for physical reasons, but also for what they are feeling.

Research from the Center for Conscious Design, an international think tank, shows that responses to design can be deeply rooted, with people with pain being vulnerable, for example, to light, the color of a wall, or simply to the way a room is arranged.

“If I have to navigate a chaotic space, I tire myself out,” says AG Parker, a novelist and disability activist who suffers from Ehlers-Danlos syndrome, an inherited condition that causes dislocation of bones.

A homeowner or resident can become disabled or have chronic pain at any point in their life, Parker adds, and homes should be built with that in mind. Cowan, a Sussex-based architectural firm, works with users on their homes. Architects should design with those who have a disability or pain, not just for them, says Julia Hockin, architect at Cowan. The result, she adds, must always be beautiful.

“If I have to navigate chaotic space, I’m exhausted,” AG Parker says of the tidy apartment © Thom Atkinson for the FT

A project designed by Cowan Architects is a vacation home in Cornwall, developed in consultation with a client who wanted it to be suitable for people with a range of assisted needs. It includes mechanisms such as folding shelves and adjustable kitchen worktops, along with soothing colors, large windows for natural light and views, and underfloor heating for those with back pain who may need to lie on the floor.

However, such projects are rare. Several architectural firms, in response to the FT’s interview requests, said pain was not something they thought of in the design of their buildings. Instead, most residents adapt through trial and error.

London Pain Clinic consultant Dr Federico Febraro says people with pain can help their bodies by increasing activities that “feel good” around the house. For example, taking a slow, adaptive approach to gardening, even if it causes uncomfortable tightness, can distract an sufferer from “being stuck in your pain,” he says.

For Parker, who uses the pronoun “they”, the sail has a positive effect. So, when fitting out their apartment on the ground floor, they thought of fitting out a boat. “I just thought a boat was that perfect linear and contained environment. . . where everything has its place and is close at hand, ”they say.

For Lucy, a former singer who now suffers from a painful condition of the vocal cords and who preferred not to give her last name, Mediterranean allusions come in handy. The tiled floors, high ceilings and clean lines are ‘magically acoustic’, she says: ‘The voice can just sound effortlessly. ”

When she lived in carpeted spaces, she found that the fabric absorbed sound and she had to put more effort into raising her voice. She now plans to free up more space in her house and have “less furniture, less mittens”.

“Open spaces, however, can lead to sensory overload,” explains Amy Francis-Smith, an accessibility architect herself who suffers from chronic pain. She recommends creating a quiet space with soft furnishings and dimmers or blackout shades to help reduce headaches. For people with chronic fatigue, such a room provides a place to collapse without feeling bedridden.

A Cornish lodge designed with input from users with supported needs

A Cornish holiday home designed with input from users with supported needs © Cowan Architects

Home design lessons are learned from hospices and clinics where pain relief design excels. Horatio’s Garden, a UK charity that develops gardens at NHS spine trauma centers, aims to aid in the recovery of patients who have suffered life-changing injuries.

The work involves landscapers, neuroscience researchers from Oxford University and hospital staff, in consultation with patients and their families. Special attention is paid to details such as smooth, seamless floors, as even a tiny jerk on a wheelchair can cause severe pain for the user.

The project is building its gardens so that people don’t remember their pain, says Olivia Chapple, co-founder of Horatio’s Garden. Like Hockin, she insists that “accessible architecture must be beautiful,” not clumsy or clinical in appearance.

A garden designed by the Horatio's Garden charity at the Midland Center for Spinal Injuries at Robert Jones and Agnes Hunt Orthopedic Hospital, Oswestry, Shropshire

A garden designed by the Horatio’s Garden charity at the Midland Center for Spinal Injuries at Robert Jones and Agnes Hunt Orthopedic Hospital, Oswestry, Shropshire © Craig Colville

The Salisbury Hospital Garden Hot Pods embody this principle, where details such as accessible handles remain graceful. Aishwarya Narayana, a neuroesthetics researcher at the Center for Conscious Design, says such elements provide “the kind of space that people need right now to heal.”

But during the pandemic and its restrictions, patients were able to spend less time in rehabilitation centers. As a result, there is pressure on social and occupational health workers to adapt people’s homes. Often when people leave a care unit, they find that “their home has turned against them,” Narayana explains.

Andrew Gurza, a disability awareness consultant and full-time wheelchair user, said the lockdown highlighted “how cramped and ill-suited my apartment is.” While friends have since helped him paint and personalize his home, there are rooms he still can’t use – closets he is unable to open independently, for example.

The experience of two people with disabilities or chronic pain will not be the same, and custom design comes at a price. It can cost anywhere from £ 10,000 to £ 15,000 to fit out an apartment with the necessary features, explains Francis-Smith, while many chronic painful conditions do not meet council-funded accommodation criteria.

Francis-Smith lists low-cost technologies that can help: Voice-activated home hubs and smart plugs, for example, save people with physical energy and cost less than £ 300.

She says that accessible home features tend to be considered “at the bottom of the design process, then it’s too late”. She is part of the Habinteg Housing Association’s #ForAccessibleHousing campaign. According to Habinteg, only 7 percent of homes in England offer basic accessibility, let alone combine accessibility with a beautiful living environment. From the design student level, she says, “we have to develop these skills.”

In the UK, basic accessibility requirements are met by Part M of government building regulations, but, according to Narayana, in general, this involves’ cutting and pasting and adding space and call it assisted living ”. As Gurza says: “We need more than just space, ramps and handlebars. “

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