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Specifically, pain drawing is a technique that has been used since the 1940s in the
assessment of patients [34], and is considered to be a simple self-assessment method,
originally proposed in back pain assessment by [43] as a visual aid tool to enable the
recording of the spatial location and type of pain that a patient is suffering from.
One of the main advantages of this method is that it improves the communication
between a clinician and the patient. Indeed, spoken description of pain by a patient to
the clinician might not be sufficient due to educational, language, and experience
differences that might occur amongst them [33]. By using pain drawings though, this
two-way communication is improved by providing a common framework based on
which the patient describes the pain by marking it on the pain diagram, and the clini-
cian interprets it by examining it, enabling them in that way to overcome the afore-
mentioned differences. This topographical representation of pain therefore, is very
useful in summarizing patients' description of the location and type of pain, in an
interpretable way for the clinician, and makes it possible to determine whether pain is
of organic or non-organic nature [49].
In addition to improving communication, many more benefits of pain drawings
have been described in the literature. [34] cites in her work results of studies that
demonstrate consistency of patients in completing drawings, even with elderly sub-
jects, whereas [19] highlight their importance in corresponding to imaging tests, as
well as in being able to help clinicians to categorize patients into diagnostic groups
(e.g. osteoporosis, tumor) based on their pain drawings. Moreover, in overall, pain
drawings are considered to be economic and simple to complete, and can also be used
to monitor change in a patient's pain situation as cited by [47].
As a result, based on their ability to help identify patient diagnostic groups, pain
drawings have been used in various ways, including diagnosis of lumbar disc disease,
evaluation of changes in pain, as well as prediction of treatment outcome [34]. To this
end, because of the several uses of drawings, the need for different methods of inter-
preting them has also been identified. However, no standard method for filling them
out and scoring them currently exists. According to some protocols, patients might be
asked to mark or shade those body areas where they feel pain [17]. Slight variations
of this technique also exist where the patient instead of marking or shading the pain
within the outline of a blank human diagram, he or she might be asked to respond to a
pre-shaded drawing, a technique that has as an advantage the controlling of the defini-
tion of the body area pre-shaded, something that should be easy for the patient to
recognize and should be where most of the symptoms tend to occur [24]. Neverthe-
less, traditionally, according to [45], in earliest uses of pain drawings the patient
would fill them out by marking the location of the pain on a blank diagram using a
symbol without mentioning any sensation (pain, burning, etc.) description, as it was
the clinician's responsibility to identify it through the pain discussion. More recently
though, the patient is asked to also indicate their pain sensation on the drawing, with
the most common way of doing it being the use of a specific symbol indicating vari-
ous sensation types, as shown in fig. 6.
Similarly, there is no gold standard regarding pain sensation types that could be
used to describe pain on the drawing. [47] cite in their study that there is a range of
sensation types which have been used in literature, including [7] use of pins and nee-
dles, burning, stabbing, and deep ache in their pain drawings, and [51] use of dull,
burning, numb, stabbing or cutting, tingling or pins and needles, and cramping in
their drawings. Accordingly, [34] uses aching, numbness, pins and needles, burning,
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