Exploring the association between patient-drawn pain diagrams and psychological and physical health variables: A large-scale study of patients with low back pain.

IF 3.5 2区 医学 Q1 ANESTHESIOLOGY
Steen Harsted, Natalie H S Chang, Casper Nim, James J Young, David T McNaughton, Søren O'Neill
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Abstract

Background: Despite the use of Patient-Drawn Pain Drawings (PDPDs) in clinical settings, their validity as indicators of psychological distress remains debated. We aimed to assess the association between PDPD areas and physical health and psychological variables.

Methods: This study analysed digitally-drawn PDPDs from 15,345 chronic low back pain (LBP) patients at a Danish outpatient hospital unit. We employed a novel quantitative approach to calculate four log-transformed geometric pain areas for each PDPD. We assessed six psychological constructs and seven physical health variables. Associations were modelled using multivariable linear regression.

Results: Increasing leg pain intensity (estimates from 0.12 to 0.25), disability (estimates from 0.3 to 0.14), and pain duration (estimates from 0.10 to 0.33) had the strongest associations with increasing pain areas. Conversely, increasing fear of movement (estimates from -0.02 to -0.05) and catastrophizing (estimates from -0.02 to -0.03) were associated with slight reductions in pain areas. Anxiety and depression had the weakest and most uncertain relationships to pain area size.

Conclusions: Increasing levels of leg pain intensity, pain duration, and pain-related disability were consistently associated with larger geometric pain areas in PDPDs. Conversely, the associations between the psychological constructs and the geometric pain areas exhibited varying directions and were notably weaker. Clinicians are encouraged to focus on the association of PDPDs with physical symptoms rather than psychological conditions during clinical assessments.

Significance statement: This large-scale study demonstrates that extensive pain areas in pain drawings drawn by LBP patients do not signify psychological distress. Our findings reveal that these pain representations are more closely linked to increased pain intensity, pain duration, and disability rather than being independently associated with psychological factors. Clinicians are encouraged to focus on the association of extensive pain areas with physical symptoms rather than psychological distress during clinical assessments.

探索患者绘制的疼痛图与心理和生理健康变量之间的关联:一项针对腰背痛患者的大规模研究。
背景:尽管患者绘制的疼痛图(PDPD)在临床中得到了广泛应用,但其作为心理困扰指标的有效性仍存在争议。我们旨在评估 PDPD 区域与身体健康和心理变量之间的关联:本研究分析了丹麦一家医院门诊部的 15,345 名慢性腰背痛(LBP)患者的数字绘制的 PDPD。我们采用了一种新颖的定量方法来计算每个 PDPD 的四个对数转换几何疼痛区域。我们评估了六个心理结构和七个身体健康变量。我们使用多变量线性回归法建立了相关模型:腿部疼痛强度的增加(估计值从 0.12 到 0.25)、残疾程度的增加(估计值从 0.3 到 0.14)以及疼痛持续时间的增加(估计值从 0.10 到 0.33)与疼痛面积的增加关系最为密切。相反,运动恐惧(估计值从-0.02到-0.05)和灾难化(估计值从-0.02到-0.03)的增加与疼痛面积的轻微减少有关。焦虑和抑郁与疼痛面积的关系最弱,也最不确定:结论:腿部疼痛强度、疼痛持续时间和疼痛相关残疾程度的增加与 PDPDs 的几何疼痛面积增大密切相关。相反,心理结构与几何疼痛面积之间的关系则表现出不同的方向,且明显较弱。我们鼓励临床医生在进行临床评估时,关注 PDPD 与躯体症状而非心理状况的关联:这项大规模研究表明,腰椎间盘突出症患者在疼痛图画中画出的大面积疼痛区域并不代表心理困扰。我们的研究结果表明,这些疼痛表征与疼痛强度、疼痛持续时间和残疾程度的增加密切相关,而不是与心理因素独立相关。我们鼓励临床医生在进行临床评估时,关注广泛疼痛区域与躯体症状的关联,而不是心理困扰。
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来源期刊
European Journal of Pain
European Journal of Pain 医学-临床神经学
CiteScore
7.50
自引率
5.60%
发文量
163
审稿时长
4-8 weeks
期刊介绍: European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.
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