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Comparative Study
. 2012 Dec 20:13:257.
doi: 10.1186/1471-2474-13-257.

Pain drawings in somatoform-functional pain

Niklaus Egloff  1 , Rafael J A Cámara, Roland von Känel, Nicole Klingler, Elizabeth Marti, Marie-Louise Gander Ferrari
Affiliations
Comparative Study

Pain drawings in somatoform-functional pain

Niklaus Egloff et al. BMC Musculoskelet Disord. .

Abstract

Background: Pain drawings are a diagnostic adjunct to history taking, clinical examinations, and biomedical tests in evaluating pain. We hypothesized that somatoform-functional pain, is mirrored in distinctive graphic patterns of pain drawings. Our aim was to identify the most sensitive and specific graphic criteria as a tool to help identifying somatoform-functional pain.

Methods: We compared 62 patients with somatoform-functional pain with a control group of 49 patients with somatic-nociceptive pain type. All patients were asked to mark their pain on a pre-printed body diagram. An investigator, blinded with regard to the patients' diagnoses, analyzed the drawings according to a set of numeric or binary criteria.

Results: We identified 13 drawing criteria pointing with significance to a somatoform-functional pain disorder (all p-values ≤ 0.001). The most specific and most sensitive criteria combination for detecting somatoform-functional pain included the total number of marks, the length of the longest mark, and the presence of symmetric patterns. The area under the ROC-curve was 96.3% for this criteria combination.

Conclusion: Pain drawings are an easy-to-administer supplementary technique which helps to identify somatoform-functional pain in comparison to somatic-nociceptive pain.

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Figures

Figure 1
Figure 1
Flow-chart of patients selected for analysis. This figure illustrates the recruitment process
Figure 2
Figure 2
Typical drawing marks. Index of the discussed drawing marks
Figure 3
Figure 3
Typical PDs from patients with somatic-nociceptive pain. Pictures a-c show orthopedic trauma pain. Pictures d-f are examples for degenerative pain caused by arthralgia. Typically, somatic-nociceptive pain is well localised
Figure 4
Figure 4
Typical PDs from patients with somatoform-functional pain. Picture a-g show pain drawings of patients with a-g medically inexplicable pain syndromes. Somatoform-functional pain is typically associated with symmetric patterns, long lines, and a higher number of marks
Figure 5
Figure 5
ROC-curve of the best pain-drawing criteria group. This receiver operating characteristic (ROC) curve illustrates the sensitivity and specificity of the combination of pain-drawing criteria with the highest diagnostic accuracy (total number of marks, length of the longest mark, and presence of symmetric pain zones). Virtually each possible cut-point is plotted against specificity (x axis) and sensitivity (y axis). The cut-off of 457.5 generated 93.9% specificity and 90.3% sensitivity, which represents the mathematical optimum of correctly diagnosed cases
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