Abstract
Background and Significance: Pain drawings could be a means of easily identifying sub-groups of patients who might benefit from different treatment approaches. In particular it has been suggested that they can be used to identify the psychological ‘state’ of patients in terms of distress, depression, somatisation and anxiety.
Purpose/Hypothesis: To systematically appraise data from the literature about the validity and reliability of using pain drawings to evaluate psychological ‘state’.
Method: We searched 12 medical and social science databases, using key words and their derivatives; pain; drawings; diagrams; vis(z)ualisation; body mapping; mannequins and homunculi. We appraised studies directly evaluating the utility of pain drawings and psychological state.
Results: We selected 19 for final inclusion. The majority of studies reviewed focused on low back pain (79%) and secondary and tertiary care (90%). Pain drawings were evaluated against psychological tools testing personality (MMPI), somatisation (MSPQ, IBQ) and psychological states such as depression (Zung) anxiety (SF36) and distress (GHQ).
11/19 studies reported inconclusive results, 8/19 showed a statistical association between drawings and the psychological assessment tool. However the more clinically relevant, sensitivity data ranged from 24–93%, specificity 44–91%, positive predictive values 28–93%, and negative predictive values 35–92%. The range of this data is too wide to be acceptable clinically as predictive of psychological state.
Conclusions: There is insufficient evidence to support the assumption that unusual pain drawings indicate a disturbed psychological state, therefore pain-drawing use as a psychological assessment tool is not recommended.
Correspondence should be addressed to SBPR c/o Royal college of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN
