Colored Pain Drawing As a Clinical Tool in Differentiating Neuropathic Pain from Non-Neuropathic Pain

Overview

Journal Pain Med

Specialties Critical Care
Neurology
Psychiatry

Date 2020 Nov 17

PMID 33200188

Citations 5

Authors

Nalini Sehgal

Debra B Gordon

Scott Hetzel

Miroslav Misha Backonja

Affiliations

Soon will be listed here.

Abstract

Objectives: This is a prospective, blinded, case-control study of patients with chronic pain using body diagrams and colored markers to show the distribution and quality of pain and sensory symptoms (aching, burning, tingling, numbness, and sensitivity to touch) experienced in affected body parts.

Methods: Two pain physicians, blinded to patients' clinical diagnoses, independently reviewed and classified each colored pain drawing (CPD) for presence of neuropathic pain (NeuP) vs. non-neuropathic pain (NoP). A clinical diagnosis (gold standard) of NeuP was made in 151 of 213 (70.9%) enrolled patients.

Results: CPD assessment at "first glance" by both examiners resulted in correctly categorizing 137 (64.3% by examiner 1) and 156 (73.2% by examiner 2) CPDs. Next, classification of CPDs by both physicians, using predefined criteria of spatial distribution and quality of pain-sensory symptoms, improved concordance to 212 of 213 CPDs (Kappa = 0.99). The diagnostic ability to correctly identify NeuP and NoP by both examiners increased to 171 (80.2%) CPDs, with 80.1% sensitivity and 80.6% specificity (Kappa = 0.56 [95% confidence interval: 0.44-0.68]). The severity scores for pain and sensory symptoms (burning, tingling, numbness, and sensitivity to touch) on the Neuropathic Pain Questionnaire were significantly elevated in NeuP vs. NoP (P < 0.001).

Conclusions: This study demonstrates good performance characteristics of CPDs in identifying patients with NeuP through the use of a simple and easy-to-apply classification scheme. We suggest use of CPDs as a bedside screening tool and as a method for phenotypic profiling of patients by the quality and distribution of pain and sensory symptoms.

Citing Articles

Spatial Distribution Dynamics of Sensory Disturbances in the Treatment of Obesity-Related Meralgia Paresthetica Using Transcutaneous Electrical Nerve Stimulation.

Al-Zamil M, Kulikova N, Shnayder N, Korchazhkina N, Petrova M, Mansur N J Clin Med. 2025; 14(2).

PMID: 39860396 PMC: 11765708. DOI: 10.3390/jcm14020390.

Bodily maps of emotions and pain: tactile and hedonic sensitivity in healthy controls and patients experiencing chronic pain.

Ojala J, Suvilehto J, Nummenmaa L, Kalso E Pain. 2023; 164(12):2665-2674.

PMID: 37678245 PMC: 10652713. DOI: 10.1097/j.pain.0000000000003027.

Physical therapist perceptions and use of clinical pain mechanism assessment in the musculoskeletal setting: a survey analysis.

Jayaseelan D, Scalzitti D, Courtney C BMC Musculoskelet Disord. 2023; 24(1):509.

PMID: 37349782 PMC: 10286424. DOI: 10.1186/s12891-023-06618-0.

'Painting my pain': the use of pain drawings to assess multisite pain in women with primary dysmenorrhea.

Rodrigues J, Avila M, Dos Reis F, Carlessi R, Godoy A, Arruda G BMC Womens Health. 2022; 22(1):370.

PMID: 36071417 PMC: 9449259. DOI: 10.1186/s12905-022-01945-1.

Determining the level of cervical radiculopathy: Agreement between visual inspection of pain drawings and magnetic resonance imaging.

Marco B, Evans D, Symonds N, Peolsson A, Coppieters M, Jull G Pain Pract. 2022; 23(1):32-40.

PMID: 35765137 PMC: 10083927. DOI: 10.1111/papr.13147.

References

Ohnmeiss D, Vanharanta H, Ekholm J . Relationship of pain drawings to invasive tests assessing intervertebral disc pathology. Eur Spine J. 1999; 8(2):126-31. PMC: 3611154. DOI: 10.1007/s005860050141. View

Abichandani D, Barbero M, Cescon C, Gallace A, Punt D, Sanchis-Sanchez E . Can People with Chronic Neck Pain Recognize Their Own Digital Pain Drawing?. Pain Physician. 2020; 23(2):E231-E240. View

Staud R, Price D, Robinson M, Vierck Jr C . Body pain area and pain-related negative affect predict clinical pain intensity in patients with fibromyalgia. J Pain. 2004; 5(6):338-43. DOI: 10.1016/j.jpain.2004.05.007. View

Brismar H, Vucetic N, Svensson O . Pain patterns in lumbar disc hernia Drawings compared to surgical findings in 159 patients. Acta Orthop Scand. 1996; 67(5):470-2. DOI: 10.3109/17453679608996670. View

Aprill C, Dwyer A, Bogduk N . Cervical zygapophyseal joint pain patterns. II: A clinical evaluation. Spine (Phila Pa 1976). 1990; 15(6):458-61. DOI: 10.1097/00007632-199006000-00005. View

Mayer T, Gatchel R, Kishino N, Keeley J, Capra P, Mayer H . Objective assessment of spine function following industrial injury. A prospective study with comparison group and one-year follow-up. Spine (Phila Pa 1976). 1985; 10(6):482-93. DOI: 10.1097/00007632-198507000-00002. View

Bertilson B, Grunnesjo M, Johansson S, Strender L . Pain drawing in the assessment of neurogenic pain and dysfunction in the neck/shoulder region: inter-examiner reliability and concordance with clinical examination. Pain Med. 2007; 8(2):134-46. DOI: 10.1111/j.1526-4637.2006.00145.x. View

Ohnmeiss D . Repeatability of pain drawings in a low back pain population. Spine (Phila Pa 1976). 2000; 25(8):980-8. DOI: 10.1097/00007632-200004150-00014. View

Pande K, Tripathi S, Kanoi R . Limited clinical utility of pain drawing in assessing patients with low back pain. J Spinal Disord Tech. 2005; 18(2):160-2. DOI: 10.1097/01.bsd.0000146762.44281.6d. View

10.

Mooney V, Cairns D, Robertson J . A system for evaluating and treating chronic back disability. West J Med. 1976; 124(5):370-6. PMC: 1130072. View

11.

Bertozzi L, Rosso A, Romeo A, Villafane J, Guccione A, Pillastrini P . The accuracy of pain drawing in identifying psychological distress in low back pain-systematic review and meta-analysis of diagnostic studies. J Phys Ther Sci. 2015; 27(10):3319-24. PMC: 4668192. DOI: 10.1589/jpts.27.3319. View

12.

Ohnmeiss D, Vanharanta H, Ekholm J . Relation between pain location and disc pathology: a study of pain drawings and CT/discography. Clin J Pain. 1999; 15(3):210-7. DOI: 10.1097/00002508-199909000-00008. View

13.

Jamison R, Fanciullo G, Baird J . Usefulness of pain drawings in identifying real or imagined pain: accuracy of pain professionals, nonprofessionals, and a decision model. J Pain. 2004; 5(9):476-82. DOI: 10.1016/j.jpain.2004.08.004. View

14.

Vucetic N, Maattanen H, Svensson O . Pain and pathology in lumbar disc hernia. Clin Orthop Relat Res. 1995; (320):65-72. View

15.

Reis F, Guimaraes F, Nogueira L, Meziat-Filho N, Sanchez T, Wideman T . Association between pain drawing and psychological factors in musculoskeletal chronic pain: A systematic review. Physiother Theory Pract. 2018; 35(6):533-542. DOI: 10.1080/09593985.2018.1455122. View

16.

Boudreau S, Badsberg S, Christensen S, Egsgaard L . Digital Pain Drawings: Assessing Touch-Screen Technology and 3D Body Schemas. Clin J Pain. 2015; 32(2):139-45. DOI: 10.1097/AJP.0000000000000230. View

17.

Ohlund C, Eek C, Palmbald S, Areskoug B, Nachemson A . Quantified pain drawing in subacute low back pain. Validation in a nonselected outpatient industrial sample. Spine (Phila Pa 1976). 1996; 21(9):1021-30; discussion 1031. DOI: 10.1097/00007632-199605010-00005. View

18.

Krause S, Backonja M . Development of a neuropathic pain questionnaire. Clin J Pain. 2003; 19(5):306-14. DOI: 10.1097/00002508-200309000-00004. View

19.

Hildebrandt J, Franz C, Temme M . The use of pain drawings in screening for psychological involvement in complaints of low-back pain. Spine (Phila Pa 1976). 1988; 13(6):681-5. View

20.

Takata K, Hirotani H . Pain drawing in the evaluation of low back pain. Int Orthop. 1995; 19(6):361-6. DOI: 10.1007/BF00178350. View