Presented at the 2013 AAPM Annual Meeting« Back

Does the Pain Drawing Tell Us More Than Just Where Pain Is?

Gabriel Tan, PhD ABPP, psygt@nus.edu.sg¹, (1) National University of Singapore, Singapore

Introduction: Chronic pain is highly comorbid with many psychiatric conditions and may reduce responsiveness to psychiatric treatment. Asking pain patients to indicate on a blank human figure the location(s) of their pain(s) has been widely used in pain assessment. However, it is not known if pain location and pain extent (pain locations quantified) would contribute to depression over and above pain intensity. Methods: Archival data from a convenience sample of 75 chronic pain patients seen at a multidisciplinary pain management program were analyzed to assess their relationships to pain drawing, depression, and selected pain-related variables. Results: Total pain extent score was significantly associated with depression (p<0.001) but not pain intensity (p=0.59), suggesting that pan intensity and pain extent may be associated with depression via different routes. Endorsement of Arms/Hands pain was significantly associated with increased depression score (p<.01) and this relationship holds even after controlling for pain intensity (p<.05). Depression score was significantly higher for those who reported pain in more than 2 locations (p<.01). Conclusions: In addition to identifying location of pain, pain drawings were found to contribute towards patient’s depression over and above pain intensity. For instance, pain in Arms/Hands as well as pain in more than 2 locations was associated with increased depression. Given the high prevalence of chronic pain among patients with depressive disorders, having patients complete a simple pain drawing could potentially provide useful information that could facilitate treatment. References: 1) Margolis, R. B., Tait, R. C., Krause, S. J. (1986). A rating system for use with patient pain drawings. Pain, 24, 57–65. 2) Chan, C. W., Goldman, S., Ilsstrupm D. M., Kunselman, A. R., & O’Neil, P. I. (1993). The pain drawing and Waddell’s nonorganic physical signs in chronic low-back pain. Spine, 18, 1717-1722. 3) Ransford, A. O., Cairns D, Mooney, V. (1976). The pain drawing as an aid to the psychological evaluation of patients with low back pain. Spine, 1, 1–127. 4) Uden, A., Astrom, M., & Bergenudd, H. (1988). Pain drawings in chronic pain. Spine, 13, 389-392. 5) Voorhies, R.M, Jiang, X., & Thomas, N. (2006). Predicting outcome in the surgical treatment of lumbar radiculopathy using the Pain Drawing Score, McGill Short Form Pain Questionnaire, and risk factors including psychosocial issues and axial joint pain. The Spine Journal 7: 516-524, September/October 2007.

Funding: None