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Background and Aims: Pain drawings are commonly used in the clinical assessment of people with cervical radiculopathy. This study aimed to assess (1) the agreement of clinical interpretation of pain drawings and MRI findings in identifying the affected level of cervical radiculopathy, (2) the agreement of these predictions based on the pain drawing among four clinicians from two different professions (i.e., physiotherapy and surgery) and (3) the topographical pain distribution of people presenting with cervical radiculopathy (C4–C7). Methods: Ninety‐eight pain drawings were obtained from a baseline assessment of participants in a randomized clinical trial, in which single‐level cervical radiculopathy was determined using MRI. Four experienced clinicians independently rated each pain drawing, attributing the pain distribution to a single nerve root (C4–C7). A post hoc analysis was performed to assess agreement. Outcome measures: Percentage agreement and kappa values were used to assess the level of agreement. Topographic pain frequency maps were created for each cervical radiculopathy level as determined by MRI. Results: The radiculopathy level determined from the pain drawings showed poor overall agreement with MRI (mean = 35.7%, K = −0.007 to 0.139). The inter‐clinician agreement ranged from fair to moderate (K = 0.212–0.446). Topographic frequency maps revealed that pain distributions were widespread and overlapped markedly between patients presenting with different levels cervical radiculopathy. Conclusion: This study revealed a lack of agreement between the segmental level affected determined from the patient's pain drawing and the affected level as identified on MRI. The large overlap of pain and non‐dermatomal distribution of pain reported by patients likely contributed to this result. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular disorders (TMD) are characterised by complex symptomatology and their assessment can be enhanced using pain drawings (PD). Objectives: To evaluate the location and extent of pain in people TMD using digital PD, and to explore their association with clinical features. Reliability of pain extent and pain location using PD was also assessed. Methods: Forty volunteers with TMD completed two consecutive digital PDs. Clinical features were captured from self‐reported questionnaire. Additionally, secondary hyperalgesia was measured using the pressure pain threshold (PPT). The correlation between pain extent and clinical features was investigated using Spearman rank correlation coefficients. Reliability of pain extent was evaluated using intraclass correlation coefficient (ICC) and Bland‐Altman plots. The Jaccard index was computed to assess the reliability of pain location. Results: Analysis of the PDs indicated that people with TMD commonly experience pain in other body regions including the neck, the shoulder and the low back. Except for PPT and pain catastrophising, all other clinical features were significantly correlated with pain extent. The ICCs of pain extent for all body charts were very high (ICCs 95% CI from 0.73 to 0.96), and Bland‐Altman plots showed mean biases close to zero with narrow limits of agreement. The reliability of pain location was also supported by Jaccard index mean scores above 0.68. Conclusions: People with TMD showed widespread pain, and pain extent was associated with pain intensity, neck and headache‐related disability, depression, anxiety, hyperventilation and central sensitivity. The reliability of measuring pain extent and pain location was confirmed. [ABSTRACT FROM AUTHOR]

Objective. Our aims were 1) to investigate whether perceived pain extent, assessed from the pain drawing, relates to clinical, psychological, and psychophysical outcomes in women with carpal tunnel syndrome (CTS); 2) to assess differences in pain extent depending on the presence of median or extramedian symptoms; and 3) to investigate differences in pain extent according to severity (minimal, moderate, or severe) or laterality (unilateral or bilateral) of CTS. Methods. One hundred forty (N�0) women with CTS completed pain drawings, which were subsequently digitized, allowing pain extent to be calculated. Clinical features including pain intensity (numerical pain rating scale, 0�) and disability (Boston Carpal Tunnel Questionnaire), psychological features including depression (Beck Depression Inventory), and psychophysical variables (pressure pain and thermal pain thresholds) were assessed. Spearman rho correlation coefficients were used to reveal the correlations between pain extent and other outcomes. Differences in pain extent according to severity (minimal, moderate, severe) or laterality (unilateral, bilateral) and the presence of extramedian symptoms were also evaluated. Results. No significant associations were identified between pain extent and clinical, psychological, or psychophysical outcomes. Women with extramedian symptoms (88%) exhibited a larger (P<0.001) pain extent (total: 24.2%613.5%) than women with median symptoms (12%; total: 12.2%66.9%). Pain extent was not significantly different depending on the severity or laterality of the symptoms. Conclusions. Pain extent in the upper extremity was not associated with clinical, psychological, or psychophysical variables and was not related to the severity or laterality of the symptoms in women with CTS. [ABSTRACT FROM AUTHOR]

Background Pain drawings ( PD) are frequently used in research to illustrate the pain response to pain provocation tests. However, there is a lack of data on the reliability in defining the extent and location of pain. We investigated the test-retest reliability in reporting an acute painful sensation induced by a pain provocation test using a novel approach for PD acquisition and analysis in healthy volunteers. Methods Forty healthy volunteers participated. Each participant underwent 2 upper limb neurodynamic tests 1 ( ULNT1), once to the point of pain onset ( PO) and once until the point of submaximal pain ( SP). After each ULNT1, participants completed 2 consecutive PD with an interval of 1 minute. Custom software was used to quantify the pain extent and analyze the pain overlap. The test-retest reliability of pain extent was examined using Intraclass Correlation Coefficient ( ICC 2,1) and Bland-Altman plots. Pain location reliability was examined using the Jaccard similarity coefficient ( JSC). Results The ICC values for PO and SP were 0.98 (95% CI: 0.96-0.99) and 0.97 (95% CI: 0.95-0.98), respectively. The mean difference and 95% limits of agreement (± 1.96 SD) in the Bland-Altman plots were 14 pixels (−1080;1110) for PO, and 145 (−1610;1900) for SP. The median JSCs (Q1;Q3) were 0.73 (0.64;0.80) for PO and 0.76 (0.65;0.79) for SP. Conclusions Pain drawings is a reliable instrument to investigate pain extent and pain location in healthy individuals experiencing an acute painful sensation induced by a pain provocation test. [ABSTRACT FROM AUTHOR]

The current scoping review aimed to map current literature investigating the relationship between pain extent extracted from pain drawings with clinical, psychological, and psycho-physiological patient-reported outcome measures in people with pain. Electronic databases were searched for cross-sectional cohort studies that collected pain drawings using digital technology or a pen-on-paper approach and assessed for correlations between pain extent and clinical, psychological or psycho-physical outcomes. Data were extracted by two different reviewers. The methodological quality of studies was assessed using the Newcastle–Ottawa Quality Assessment Scale. Mapping of the results included: 1, description of included studies; 2, summary of results; and 3, identification of gaps in the existing literature. Eleven cross-sectional cohort studies were included. The pain disorders considered were heterogeneous, ranging from musculoskeletal to neuropathic conditions, and from localized to generalized pain conditions. All studies included pain and/or pain-related disability as clinical outcomes. Psychological outcomes included depression and anxiety, kinesiophobia and catastrophism. Psycho-physical measures included pressure or thermal pain thresholds. Ten studies were considered of high methodological quality. There was heterogeneity in the associations between pain extent and patient-reported outcome measures depending on the pain condition. This scoping review found that pain extent is associated with patient-reported outcome measures more so in patients presenting with musculoskeletal pain, e.g., neck pain or osteoarthritis, rather than for those with neuropathic pain or headache. [ABSTRACT FROM AUTHOR]

Pen-on-paper pain drawing are an easily administered self-reported measure that enables patients to report the spatial distribution of their pain. The digitalization of pain drawings has facilitated the extraction of quantitative metrics, such as pain extent and location. This study aimed to assess the reliability of pen-on-paper pain drawing analysis conducted by an automated pain-spot recognition algorithm using various scanning procedures. One hundred pain drawings, completed by patients experiencing somatic pain, were repeatedly scanned using diverse technologies and devices. Seven datasets were created, enabling reliability assessments including inter-device, inter-scanner, inter-mobile, inter-software, intra- and inter-operator. Subsequently, the automated pain-spot recognition algorithm estimated pain extent and location values for each digitized pain drawing. The relative reliability of pain extent analysis was determined using the intraclass correlation coefficient, while absolute reliability was evaluated through the standard error of measurement and minimum detectable change. The reliability of pain location analysis was computed using the Jaccard similarity index. The reliability analysis of pain extent consistently yielded intraclass correlation coefficient values above 0.90 for all scanning procedures, with standard error of measurement ranging from 0.03% to 0.13% and minimum detectable change from 0.08% to 0.38%. The mean Jaccard index scores across all dataset comparisons exceeded 0.90. The analysis of pen-on-paper pain drawings demonstrated excellent reliability, suggesting that the automated pain-spot recognition algorithm is unaffected by scanning procedures. These findings support the algorithm's applicability in both research and clinical practice. [ABSTRACT FROM AUTHOR]