Differential diagnosis of low-back pain patients: A simple quantification of the pain drawing

Abstract

diagnosis of low-back pain patients. A simple quantification of the pain drawing. Nord J Psychiatry 1992;46:55-62. Oslo. ISSN 0029-1455.This study presents and evaluates a simple quantification method for the Patient Pain Drawing (PPD). It is hypothesized that the resulting score can serve as an estimation of psychologic vulnerability and somatization proneness among patients with back pain. The subject sample consisted of 146 consecutive back-pain patients who had been referred to an outpatient physiotherapeutic rehabilitation clinic by general practitioners. They were tested once on three variables from the MMPI (Minnesota Multiphasic Personality Inventory): hypochondriasis (Hs), depression (D), and hysteria (Hy), and four times by means of a test battery including a pain questionnaire, the PPD, and a visual analog scale (VAS). Between the first and second test occasions the patients participated in a physiotherapeutic treatment program. Two follow-up testing sessions were conducted 6 and 18 months after the treatment. Positive relationships were found between Hs, D, Hy and four PPD scores, with the highest correlation coefficients (rho=0.64-0.79, Spearman rank correlation) for Hs and the four different testings with PPD. Forty-eight per cent of the patients with very low PPD scores were without pain after 18 months, compared with only 2% of the patients with high PPD scores. The PPD appears to be a good test for early screening of psychologic vulnerability in back pain patients. The test could easily be used in different primary health care settings and serve as a help in referring patients to more extensive psychologic investigation and adequate treatment. Back pain, MMPI, Patient Pain Drawing, Psychologic vulnerability, Screening.Tatjana Sivik, MD, MA, Mhtensgatan 7, S-421 63 V:a Frolunda, Sweden; Accepted: 1 .11.1991. It is not common that the staff has training in the Nord J Psychiatry Downloaded from informahealthcare.com by University of Auckland on 12/22/14 For personal use only. Nord J Psychiatry Downloaded from informahealthcare.com by University of Auckland on 12/22/14 For personal use only. 416 65 Goteborg. Kerstin Klingberg-Olsson, authorized physiotherapist. Department of Physiotherapy, Olskroken, Redbergsv. 6 . 416 65 Goteborg. Nord J Psychiatry Downloaded from informahealthcare.com by University of Auckland on 12/22/14 For personal use only.

Pain-drawing does not predict the outcome of fusion surgery for chronic low-back pain: a report from the Swedish Lumbar Spine Study

“…They all gave the same result: the pain drawings could not predict outcome of either surgical or non-surgical treatment of chronic low back pain. This is in contrast to three studies reporting on predictors of outcome of non-surgical treatment [29,33,49] and two studies demonstrating prediction of surgical outcome [30,50]. McNeill et al [29] reported on a sample with mixed diagnosis and a variety of treatments, which makes conclusions uncertain.…”

“…While there is evidence of an association between non-organic or widespread pain drawing and psychological distress [6,8,24,31,33,35,45,48,59], there is also evidence that no significant association exists [15,16,21,39]. The original association of an abnormal pain drawing with hysteria/ hypochondriasis characteristics [41] has been replicated in one study [49], while others have found no such association [15,57]. While the majority of the studies include several diagnostic groups, making the study populations heterogeneous, low-back pain, with or without sciatica, is the predominant symptom in all of them.…”

“…The method devised by Sivik et al [49] is also a semi-quantitative, penalty point system, which involves counting the number of types of pain, total number of pain markings and markings outside the body outline, poor anatomic location and self-created markings. It gives a total score ranging from 0 to 20, grouped into three categories: <6 = low somatization tendency; 6-9 = medium somatization tendency; and ≥10 = high somatization tendency.…”

“…The qualitative analysis looks for dermatomal distribution of pain. Based on either a penalty point system [41,49] or on a general impression [48,55], the pain drawing is characterized as "organic" or "non-organic". Attempts have also been made to differentiate diagnostic sub-groups by expert evaluation [25,26] and by automated scoring with artificial neural networks [46].…”

“…The value of the pain drawing as a predictor of treatment outcome, the ultimate goal of a prognostic instrument, is rarely studied. While there is some evidence of an association between pain drawing and the outcome of non-surgical treatment of sub-acute low-back pain [33], low-back pain of varying duration [49], mixed treatment of mixed study populations [29], and surgical treatment of disc herniation [50], there is only one study demonstrating a significant predictive effect of pain drawing on the outcome of surgical treatment of CLBP. Möller and Hedlund [30] studied 103 patients with isthmic spondylolisthesis treated with posterolateral fusion with/without instrumentation.…”