Validity of pain drawings for predicting psychological status outcome in patients with recurrent or chronic low back pain

Abstract

Objectives: To investigate the association between baseline pain drawings and future psychological status, and estimate the prognostic value of pain drawing assessment for predicting somatization, distress, and depression at one-year follow-up, in patients with recurrent or chronic low back pain (RCLBP). Methods: This was a multi-center prospective cohort study of 138 patients with RCLBP. Participating patients completed at baseline and one-year follow-up: a blank pain drawing; the Modified Somatic Perceptions Questionnaire; modified Zung Depression Scale; and Distress and Risk Assessment Method. Pain drawings were analyzed quantitatively using the Pain Sites Score (PSS) and Simple Body Region (SBR) method. The association between baseline pain drawing assessment and one-year psychological status was estimated using correlation and Relative Risk (RR) statistics. Results: We obtained complete data from 81 patients (59%). Psychological status and pain drawings did not differ significantly between completers and non-completers. Pain drawing area at baseline was associated with depression and somatization at one-year follow-up (Spearman's Rho 0.25, P50.022; 0.31 P50.006, respectively). Stronger associations resulted from analyses using the PSS, compared with the SBR. Patients with abnormal PSS pain drawings at baseline had significantly greater RR of depression (RR 6.1, 95% CI 1.1, 33.5), somatization (RR 4.1, 95% CI 1.7, 9.9) and distress (RR 6.8, 95% CI 1.9, 25.3) at one-year follow-up. Discussion: These results provide the first evidence that abnormal baseline pain drawings predict greater risk of abnormal psychological states or poor psychological outcome at one-year follow-up, in patients with RCLBP.

Pain extent is associated with pain intensity but not with widespread pressure or thermal pain sensitivity in women with fibromyalgia syndrome

“…We do not know if pain extent would be associated with dynamic outcomes such as wind-up, spatial/temporal summation, or conditioned pain modulation. Finally, we did not investigate the presence of psychological features that can be associated with higher pain extent [10] or abnormal pain drawings in individuals with chronic pain [24]. Nevertheless, a recent review did not support the assumption that unusual pain drawings predict the presence of a disturbed psychological state [25].…”

The accuracy of pain drawing in identifying psychological distress in low back pain—systematic review and meta-analysis of diagnostic studies

“…No meta-analysis was performed and only English-language articles were included, raising the risk of publication bias. Finally, it is important to emphasize that the database search in Carnes’ review was performed in the first three months of 2003 and subsequently, different authors have expressed contrasting opinion about on the influence of psychosocial factors on PD in LBP 15 , 16 , 17 , 18 ) . In particular, Abbott 16 ) and Turk 18 ) have argued that for some patients, the drawing might be influenced by psychosomatic disorders, and could be used to alert medical and health professionals.…”

Peer Review #2 of "Relationship between healthcare seeking and pain expansion in patients with nonspecific chronic low back pain (v0.2)"

“…These data agree with previous studies, in which patients with chronic pain in several body regions at the same time had anxiety levels that were considered pathological compared with patients having more localized pain. Moreover, they had greater depression and feelings of distress (Abbott, Foster, Hamilton, Ravenwood, & Tan, 2015; Muñoz-García, Lopez-Uralde-Villanueva, Beltrán-Alacreu, La Touche, & Fernández-Carnero, 2016). Evidence has shown that CWP not only correlates with psychological variables but also correlates with somatosensory variables, such as the severity of symptoms or mechanical hyperalgesia (Ferrer-Peña, Muñoz-García, Calvo-Lobo, & Fernández-Carnero, 2018).…”