Pain Drawings in Chronic Back Pain

Udén, Alf; Åström, Maria; Bergenudd, Hans

doi:10.1097/00007632-198804000-00002

Cited by 116 publications

(92 citation statements)

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“…The second method of scoring the pain drawings in this study was the classification established by Uden et al References [40], based on Ransford's scoring method [34]. Although this classification involves clinical judgement, it has been shown to have good reliability and repeatability, which can be increased by pooling the groups together [8, 24,28,40].…”

Section: Discussionmentioning

confidence: 99%

“…The pain drawings were classified by visual inspection as first described by Uden et al [40] and later used by Moller [24] into four categories: organic, possible organic, possible non-organic or nonorganic. This method has been shown to have a high reproducibility and acceptable inter-and intra-observer variability [8, 24,28,40].…”

Section: Visual Inspection Methodsmentioning

confidence: 99%

“…This method has been shown to have a high reproducibility and acceptable inter-and intra-observer variability [8, 24,28,40]. For ease of use, the organic and possible organic drawings were pooled to an "organic" group and those classified as non-organic or possible non-organic were pooled to a "non-organic" group as previously described [8, 24,40].…”

Section: Visual Inspection Methodsmentioning

confidence: 99%

“…Pain drawings have been used in spinal surgery for psychological evaluation of patients [8,18,32,40], for diagnostic purposes [5,29,30,31,33] and for prediction of outcome [15,23,24,37]. Few have used the pain drawing for evaluation of pain after spinal surgery.…”

Section: Pain 5 Years After Instrumented and Non-instrumented Posteromentioning

confidence: 99%

“…Several methods of interpretation have been applied. For psychological evaluation, the method described by Ransford et al [34] or modifications of it have been used [31,32,40]. The diagnostic value of the pain drawing is most often based on whether the pain markings correspond with relevant anatomical structures or not [3, 29,30,33,39].…”

Section: Pain 5 Years After Instrumented and Non-instrumented Posteromentioning

confidence: 99%

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Pain 5 years after instrumented and non-instrumented posterolateral lumbar spinal fusion

Andersen

Christensen

Hansen

et al. 2003

European Spine Journal

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IntroductionPosterolateral spinal fusion has become an evidence-based treatment of chronic low back pain caused by spondylolisthesis or spinal instability [12,26]. Although widely used, the beneficial effect on the clinical outcome of adding pedicle-screw fixation to the posterolateral spinal fusion has not yet been demonstrated [11,13,25,38]. All studies have shown reduction in pain and disability, but few have investigated the severity and localisation of residual pain several years after the procedure.Abstract Pain drawings have been used in spine surgery for diagnostic use and psychological evaluation of fusion candidates; they have rarely been used to evaluate pain status after spinal fusion. This study is a 5-year follow-up on a randomised clinical trial assigning patients to posterolateral spinal fusion with or without pedicle screw instrumentation. Patients were mailed a pain drawing and questionnaires including questions regarding work, social status, smoking status, the Dallas Pain Questionnaire (DPQ), and the Low Back Pain Rating Scale (LBPRS). Pain drawings were scored using a visual inspection method and a surfacebased point scoring and evaluated for the presence of donor site pain. Pain drawings from 109 patients (87% of the initially included patients), 56 men and 53 women, mean age at followup 51 years, were analysed. Fiftythree patients had undergone an instrumented fusion and 56 a non-instrumented fusion. Some presence of low back pain was marked by 79% and leg pain by 69%. Sixty-two percent of the pain drawings were classified as "organic" and 38% as "nonorganic". There was no difference between the instrumented and the uninstrumented group. DPQ and LBPRS scores were higher in the non-organic group (P=0.007). Using the point scoring, no difference between the instrumented and the uninstrumented group was seen. The results of the point scoring were found to correlate with the DPQ and LBPRS scores (P=0.001). Working patients (39%) had significantly better scores than the rest. Ten percent of the patients had donor site pain. Twenty percent of spinal fusion patients are totally pain free at 5-year follow-up. Ten percent still experience donor site pain. In general, instrumentation does not affect the amount and localisation of pain 5 years after lumbar spinal fusion surgery. The pain drawing seems to be a valuable tool when following spinal fusion patients, but its use as prognostic marker in connection with fusion surgery needs further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Visual Inspection Methodsmentioning

confidence: 99%

Section: Visual Inspection Methodsmentioning

confidence: 99%

Section: Pain 5 Years After Instrumented and Non-instrumented Posteromentioning

confidence: 99%

Section: Pain 5 Years After Instrumented and Non-instrumented Posteromentioning

confidence: 99%

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Pain 5 years after instrumented and non-instrumented posterolateral lumbar spinal fusion

Andersen

Christensen

Hansen

et al. 2003

European Spine Journal

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Disability and Sociopathy

Drukteinis¹

2020

The Wiley International Handbook on Psychopathic Disorders and the Law

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Exploring the association between patient‐drawn pain diagrams and psychological and physical health variables: A large‐scale study of patients with low back pain

Harsted,

Chang,

Nim

et al. 2024

European Journal of Pain

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BackgroundDespite the use of Patient‐Drawn Pain Drawings (PDPDs) in clinical settings, their validity as indicators of psychological distress remains debated. We aimed to assess the association between PDPD areas and physical health and psychological variables.MethodsThis study analysed digitally‐drawn PDPDs from 15,345 chronic low back pain (LBP) patients at a Danish outpatient hospital unit. We employed a novel quantitative approach to calculate four log‐transformed geometric pain areas for each PDPD. We assessed six psychological constructs and seven physical health variables. Associations were modelled using multivariable linear regression.ResultsIncreasing leg pain intensity (estimates from 0.12 to 0.25), disability (estimates from 0.3 to 0.14), and pain duration (estimates from 0.10 to 0.33) had the strongest associations with increasing pain areas. Conversely, increasing fear of movement (estimates from −0.02 to −0.05) and catastrophizing (estimates from −0.02 to −0.03) were associated with slight reductions in pain areas. Anxiety and depression had the weakest and most uncertain relationships to pain area size.ConclusionsIncreasing levels of leg pain intensity, pain duration, and pain‐related disability were consistently associated with larger geometric pain areas in PDPDs. Conversely, the associations between the psychological constructs and the geometric pain areas exhibited varying directions and were notably weaker. Clinicians are encouraged to focus on the association of PDPDs with physical symptoms rather than psychological conditions during clinical assessments.Significance StatementThis large‐scale study demonstrates that extensive pain areas in pain drawings drawn by LBP patients do not signify psychological distress. Our findings reveal that these pain representations are more closely linked to increased pain intensity, pain duration, and disability rather than being independently associated with psychological factors. Clinicians are encouraged to focus on the association of extensive pain areas with physical symptoms rather than psychological distress during clinical assessments.

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Pain Drawings in Chronic Back Pain

Cited by 116 publications

References 0 publications

Pain 5 years after instrumented and non-instrumented posterolateral lumbar spinal fusion

Pain 5 years after instrumented and non-instrumented posterolateral lumbar spinal fusion

Disability and Sociopathy

Exploring the association between patient‐drawn pain diagrams and psychological and physical health variables: A large‐scale study of patients with low back pain

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