Validity of pain drawings for predicting psychological status outcome in patients with recurrent or chronic low back pain

The authors conducted this study with the aims of investigating the connection between baseline pain drawings and future psychological status, and estimating the prognostic value of pain drawing assessment for predicting somatization, distress, and depression at one-year follow-up, in patients with individuals or chronic low back pain (RCLBP). They conducted a multi-center prospective cohort study of 138 patients with RCLBP. Participating individuals completed at baseline and one-year follow-up: a blank pain drawing; the Modified Somatic Perceptions Questionnaire; modified Zung Depression Scale; and Distress and Risk Assessment Method. Pain drawings were analyzed quantitatively using the Pain Sites Score (PSS) and Simple Body Region (SBR) method. The association between baseline pain drawing assessment and one-year psychological status was estimated using correlation and Relative Risk (RR) statistics. They procured complete data from 81 patients (59%). Psychological status and pain drawings did not vary significantly between completers and non-completers. Pain drawing area at baseline was associated with depression and somatization at one-year follow-up (Spearman’s Rho 0.25, P=0.022; 0.31 P=0.006, respectively). Stronger associations resulted from analyses using the PSS, compared with the SBR. Patients with abnormal PSS pain drawings at baseline had significantly greater RR of depression (RR 6.1, 95% CI 1.1, 33.5), somatization (RR 4.1, 95% CI 1.7, 9.9) and distress (RR 6.8, 95% CI 1.9, 25.3) at one-year follow-up.

The authors concluded that their results offer the first evidence that abnormal baseline pain drawings predict increased risk of abnormal psychological states or poor psychological outcome at one-year follow-up, in individuals with RCLBP.