The Use of Pain Drawings in Screening for Psychological Involvement in Complaints of Low-Back Pain

Hildebrandt, J.; Franz, Claudia; CHOROBA-MEHNEN, BEATE; Temme, Marita

doi:10.1097/00007632-198813060-00016

Cited by 49 publications

(6 citation statements)

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“…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%

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: Pain 5 Years After Instrumented and Non-instrumented Posteromentioning

confidence: 99%

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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“…Although pain intensity was significantly associated with both fear-avoidance work beliefs and pain catastrophising, we observed no relationship between pain diagram area and pain catastrophising, fear-avoidance beliefs, and psychological health (assessed by the SF-36 Mental Health component score. Previous studies using different scoring systems to the system used in this study also found that pain diagrams could not validly identify the presence of psychosocial factors [ 15 , 17 , 18 , 31 - 40 ].…”

Section: Discussionmentioning

confidence: 55%

“…It comprises front and back outlines of a body on which patients may mark areas that correspond to the distribution of pain (Figure 1 ). Several scoring methods have been used to identify psychosocial factors, including the Ransford Scoring System [ 16 ]; Modified Ransford Scoring System [ 17 ]; Pain Sites Scoring System [ 18 ]; and Body Map Scoring System [ 18 ]. However, none of these systems have been found to be valid measures [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

The association between pain diagram area, fear-avoidance beliefs, and pain catastrophising

et al. 2014

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BackgroundThe development of clinical practice guidelines for managing spinal pain have been informed by a biopsychosocial framework which acknowledges that pain arises from a combination of psychosocial and biomechanical factors. There is an extensive body of evidence that has associated various psychosocial factors with an increased risk of experiencing persistent pain. Clinicians require instruments that are brief, easy to administer and score, and capable of validly identifying psychosocial factors. The pain diagram is potentially such an instrument. The aim of our study was to examine the association between pain diagram area and psychosocial factors.Methods183 adults, aged 20–85, with spinal pain were recruited. We administered a demographic checklist; pain diagram; 11-point Numerical Rating Scale assessing pain intensity; Pain Catastrophising Scale (PCS); MOS 36 Item Short Form Health Survey (SF-36); and the Fear Avoidance Beliefs Questionnaire (FABQ). Open source software, GIMP, was used to calculate the total pixilation area on each pain diagram. Linear regression was used to examine the relationship between pain diagram area and the following variables: age; gender; pain intensity; PCS total score; FABQ-Work scale score; FABQ-Activity scale score; and SF-36 Mental Health scale score.ResultsThere were no significant associations between pain diagram area and any of the clinical variables.ConclusionOur findings showed that that pain diagram area was not a valid measure to identify psychosocial factors. Several limitations constrained our results and further studies are warranted to establish if pain diagram area can be used assess psychosocial factors.

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“…This is due to the fact that there are a number of problems with the way that patients behave towards the test when filling them out, especially regarding the way that they like to present themselves to medical staff (Hildebrandt et al, 1988).…”

Section: Pain Drawings -Conclusionmentioning

confidence: 99%

“…Most of the methods which are investigated are not able to be used on their own (Ohlund et al, 1996;Parker, Wood and Main, 1995) or need further evaluation (Ginzburg, Merskey and Lau, 1988;Hildebrandt et al, 1988;Margolis, Tait and Krause, 1986). …”

Section: Pain Drawings -Conclusionmentioning

confidence: 99%

Using geographical information systems for management of back‐pain data

Ghinea

Gill

Frank

et al. 2002

Journal of Management in Medicine

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In the medical world, statistical visualisation has largely been confined to the realm of relatively simple geographical applications, such as locating of patients' beds in a hospital, or the monitoring of the spread of a disease. This remains the case even though hospitals have been collecting spatial data relating to patients. In particular, hospitals have a wealth of backpain information which includes, besides questionnaire data, pain drawings, usually detailing the spatial distribution and type of pain suffered by backpain patients. In this paper, we propose several technological solutions which permit data within backpain datasets to be digitally linked to the pain drawings in order to provide methods of computer-based data management and analysis. In particular, we propose the use of Geographical Information Systems (GIS), up till now a tool used mainly in geographic and cartographic domains, to provide novel and powerful ways of visualising and managing backpain data. A comparative evaluation of the proposed solutions shows that, although adding complexity and cost, the GISbased one is the most appropriate for visualisation and analysis of backpain datasets.

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The Use of Pain Drawings in Screening for Psychological Involvement in Complaints of Low-Back Pain

Cited by 49 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

The association between pain diagram area, fear-avoidance beliefs, and pain catastrophising

Using geographical information systems for management of back‐pain data

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