Can architecture improve the lives of chronic pain sufferers?


The rise of homework, welcomed by many, has been a double-edged sword for those suffering from chronic pain conditions. While this may have reduced the need for the arduous commute, many now spend more time in homes unsuitable for their conditions.

How much architecture and design can make life easier is an important and complex question. Rarely does a chronic pain patient show the same symptoms as another.

Chronic pain is defined by the UK NHS as pain that has persisted for more than three months after the initial injury or inflammation has passed. Affected people can be vulnerable to their surroundings not only for physical reasons, but also because of their feelings.

Research by the Center for Conscious Design, an international think tank, shows that reactions to design can be deeply ingrained: Pain patients, for example, are susceptible to light, the color of a wall or simply the layout of a room.

“When I have to navigate a messy room, I get exhausted,” said AG Parker, a novelist and disability activist with Ehlers-Danlos syndrome, an inherited disease that causes dislocation of bones.

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

“When I have to navigate through a chaotic room, I’m exhausted,” says AG Parker about the neat apartment © Thom Atkinson for the FT

One project designed by Cowan Architects is a holiday home in Cornwall that has been developed in consultation with a client that should be suitable for people with different needs. It includes mechanisms like pull-out shelves and adjustable kitchen countertops, as well as soothing colors, large windows for natural light and views, and underfloor heating for back pain that may have to lie on the floor.

However, such projects are rare. Several architectural firms responded to FT interview requests that pain was not something they considered when designing their buildings. Instead, most residents adapt through trial and error.

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

For Parker, who uses the pronoun “she”, sailing has a positive effect. So when you redesigned your ground floor apartment, you thought about the layout of a boat. “I just thought a boat was that perfect linear, enclosed environment. . . where everything has its place and is within reach, ”they say.

For Lucy, a former singer who now suffers from a painful vocal cord disease and prefers not to give her last name, references to the Mediterranean are helpful. Tiled floors, high ceilings and clear lines are “magically acoustic”, she says: “The voice can ring effortlessly.”

When she lived in carpeted rooms, she found that fabrics absorbed sound and she had to work harder to raise her voice. Now she wants to create more space in her home and have “less furniture, less musty stuff”.

“However, open spaces can lead to overstimulation,” says Amy Francis-Smith, an architect who specializes in accessibility and who herself suffers from chronic pain. She recommends creating a quiet area with upholstered furniture and light dimmers or blackout blinds to ease headaches. For chronic fatigue sufferers, such a room offers a place to flop without feeling bedridden.

A Cornish vacation home designed with input from managed needs users

A Cornish vacation home designed with input from managed needs users © Cowan Architects

In palliative centers and clinics, where pain relieving design excels, lessons are learned in home design. Horatio’s Garden, a UK charity that creates gardens at NHS spinal injury centers, aims to support the recovery of patients who have suffered life-changing injuries.

The work involves landscape architects, neuroscientists from Oxford University and hospital staff in consultation with patients and their families. Particular attention is paid to small things such as smooth, seamless flooring, because even small bumps on a wheelchair can cause stabbing pain for the user.

The project is building its gardens in such a way that people are not reminded of their pain, says Olivia Chapple, co-founder of Horatio’s Garden. Like Hockin, she insists that “accessible architecture should be beautiful and not look clunky or clinical.

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

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

The warm pods in the garden of Salisbury Hospital embody this principle, in which details such as accessible handles remain graceful. Aishwarya Narayana, neuroesthetic researcher at the Center for Conscious Design, says such elements “provide the space that people need to heal right now.”

But during the pandemic and its restrictions, patients were able to spend less time in rehabilitation centers. As a result, social and health personnel are under pressure to adapt people’s homes. When people leave a nursing home, they often find “that their home has turned against them,” says Narayana.

According to Andrew Gurza, an awareness advisor for people with disabilities and full-time wheelchair users, the lockdown made it clear “how tight and poorly my apartment was adapted to my needs”. Friends have since helped him paint and personalize his home, but there are parts he still can’t use – closets, for example, that he can’t open on his own.

The experience of two disabled or chronic pain sufferers will not be the same and bespoke designs come at a price. Fitting a home with the necessary features can cost more than £ 10,000 to £ 15,000, according to Francis-Smith, while many chronic pain conditions do not meet the criteria for council-funded adjustments.

Francis-Smith lists inexpensive technologies that can help: Voice-activated home hubs and smart plugs, for example, enable those affected to save their physical energy and cost less than £ 300.

She says that barrier-free living elements are usually “far behind in the design process, then it’s too late”. She is part of the Habinteg Housing Association #ForAccessibleHousing campaign. According to Habinteg, only 7 percent of homes in England offer basic accessibility, let alone a combination of accessibility with a beautiful living environment. From design students up, she says, “we need to develop these skills”.

In the UK, Basic Accessibility Requirements are met by Part M of the Government Building Regulations, but according to Narayana this generally includes “copying and pasting and adding space and naming assisted living”. As Gurza says: “We need more than just space, ramps and handlebars.”

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