Digital Pain Drawings Can Improve Doctors' Understanding of Acute Pain Patients: Survey and Pain Drawing Analysis

Abstract

Background: Pain drawings (PDs) are an important tool to evaluate, communicate, and objectify pain. In the past few years, there has been a shift toward tablet-based acquisition of PDs, and several studies have been conducted to test the usefulness, reliability, and repeatability of electronic PDs. However, to our knowledge, no study has investigated the potential role of electronic PDs in the clinical assessment and treatment of inpatients in acute pain situations.

Objective: The aim of this study was to evaluate whether knowledge of the patients' electronic PD has the potential to improve the doctors' understanding of their patients and to influence their clinical decision making. Furthermore, we sought to identify differences between electronic PDs of patients and their treating pain specialists in an acute pain situation and to find those specific characteristics derived from the PDs that had the largest impact on doctors' understanding.

Methods: We obtained electronic PDs from 47 inpatients in acute pain situations before their consultation with a pain specialist on a tablet personal computer with a stylus. Before looking at their patients' drawings, these specialists drew their own conception of the patients' pain after anamnesis and physical examination. Patients' drawings were then revealed to the doctors, and they were asked to evaluate how much the additional information improved their understanding of the case and how much it influenced their clinical decision on an 11-point Likert scale (0="not at all" and 10="very much"). Similarities and differences of patients' and doctors' PDs were assessed by visual inspection and by calculating Jaccard index and intraclass correlation coefficient (ICC) of the pain area and the number of pain clusters. Exploratory analyses were conducted by means of correlation tables to identify specific factors that influenced doctors' understanding.

Results: Patients' PDs significantly improved the doctors' understanding (mean score 4.81, SD 2.60, P<.001) and to a lesser extent their clinical decision (mean 2.68, SD 1.18, P<.001). Electronic PDs of patients and doctors showed fair to good similarity for pain extent (r=.454, P=.001) and widespreadness (P=.447, r=.002) were important factors helping doctors to understand their patients.

Conclusions: In a clinical setting, electronic PDs can improve doctors' understanding of patients in acute pain situations. The ability of electronic PDs to visualize differences between doctors' and patients' conception of pain has the potential to improve doctor-patient communication.

Keywords: acute pain; app; eHealth; manikins; pain drawing; symptom drawing; tablet computers.

Figure 1

Graphical user interface of the SymptomMapper app that was used in our study. Its drawing module allows for quick and easy data entry without previous training, a crucial prerequisite when studying patients in acute pain situations. Sides are emphasized by the words left (“links”) and right (“rechts”). Doctors and patients used the same app for their pain drawings.

Figure 2

Impact of knowing patients’ pain drawings (PDs) on understanding of the pain and clinical decision making as rated by the doctors. Patients’ PDs significantly improved the doctors’ understanding of the pain and to a lesser but still significant extent influenced their clinical decision.

Figure 3

Descriptive comparison of patients’ (top line) and doctors’ (lower line) perception of pain in our final sample of 47 acute pain patients. Average pain distribution thresholded at 10% overlap between patients.

Figure 4

A comparison of patients’ and doctors’ pain drawings (PDs) for individual patients, in which knowledge of the PD led to strong improvement of the doctor’s understanding of the patient. CD: impact on clinical decision; UP: understanding of the patient.

Figure 5

Factors with the potential to influence doctors’ understanding of the patients. The left image shows correlations of pain drawing characteristics extracted from the patients’ drawings, whereas the right image is based on absolute differences of those characteristics between patients’ and doctors’ drawings. Correlation strength is encoded in color brightness and circle size. Blue color indicates positive values and red color indicates negative values. Both the areas of pain (in percent body area) and the widespread pain index (WPI) showed significant correlations with the doctors’ understanding of pain. VAS: visual analog scale.