J Korean Soc Spine Surg.  2007 Dec;14(4):249-255.

Pain Drawing in the Assessment of Nerve Root Compression in the Degenerative Spondylosis

• Kim JR
• Park CH
• Ahn JC
• Ahn MW
• Yoon HK

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To explore the pattern of pain distribution in HNP and spinal stenosis with or without degenerative spondylolisthesis (DS), and to evaluate the diagnostic value of pain drawings in predicting the presence of a painful nerve root. SUMMARY OF LITERATURE REVIEW: The usefulness of pain drawing as a tool to predict the presence of painful nerve root compression is unclear.
MATERIALS AND METHODS
Fifty-seven patients (27 HNP, 21 pure spinal stenosis, and 9 spinal stenosis with DS) with leg pain were recruited. The presence of painful nerve root compression was judged based on MRI and clinical findings. Each grid of the pain drawing is assigned an area code, and discriminant analysis was performed to explore indications of painful nerve root. Diagnostic values were evaluated by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
RESULTS
Pain distribution was characterized by a dermatomal pattern in HNP and variable in the spinal stenosis group. Paresthesia on the sole was extracted as a discriminant factor indicating painful compression of the S1 nerve root. In HNP, the sensitivity, specificity, PPV, and NPV of this factor were 62%, 100%, 100%, and 74% respectively. In the spinal stenosis group, they were 80%, 56%, 27%, and 93%, respectively.
CONCLUSIONS
The pain drawing can help assess painful nerve root compression as well as confirm the pattern of pain distribution.

Keyword

Lumbar spine; Spinal stenosis; Disc herniation; Radicular pain; Pain drawing

MeSH Terms

Humans
Leg
Magnetic Resonance Imaging
Paresthesia
Radiculopathy*
Retrospective Studies
Sensitivity and Specificity
Spinal Stenosis
Spondylolisthesis
Spondylosis*

Figure

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  Fig. 1. The form of pain drawing used in this study

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  Fig. 2. Pain drawing according to pain distribution pattern (A) focal type (B) wide type (C) dermatomal type

Reference

1). Zileli B, Ertekin C, Zileli M, Yunten N. Diagnostic value of electrical stimulation of lumbosacral roots in lumbar spinal stenosis. Acta Neurol Scand. 2002; 105:221–227.

2). Ransford AO, Cairns D, Mooney V. The pain drawing as an aid to the psychologic evaluation of patients with low-back pain. Spine. 1976; 1:127–134.

3). Hildebrandt J, Franz CE, Choroba-Mehnen B, Temme M. The use of pain drawings in screening for psychological involvement in complaints of low-back pain. Spine. 1988; 13:681–685.

4). Schwartz DP, DeGood DE. Global appropriateness of pain drawings: blind ratings predict pattern of psychological distress and litigation status. Pain. 1984; 19:383–388.

5). Von Baeyer CL, Bergstrom KJ, Brodwin MG, Brodwin SK. Invalid use of pain drawings in psychological screening of back pain patients. Pain. 1983; 16:103–107.

6). Kim HT, Park BH, Chun DW, Lee HS, Jeon HB. The use of pain drawing in low back disorder. J Korean Soc Spine Surg. 1994; 1:93–101.

7). Ohnmeiss DD, Vanharanta H, Guyer RD. The association between pain drawings and computed tomographic/disco-graphic pain responses. Spine. 1995; 20:729–733.

8). Leavitt F, Garron DC. Psychological disturbance and pain report differences in both organic and non-organic low back pain patients. Pain. 1979; 7:187–195.

9). Mann NH 3rd, Brown MD, Herz DB, Enger I, Tomp-kins J. Initial-impression diagnosis using low-back pain patient pain drawings. Spine. 1993; 18:41–53.

10). Margolis RB, Chibnall JT, Tait RC. Test-retest reliabil-ity of the pain drawing instrument. Pain. 1988; 33:49–51.

11). Margolis RB, Tait RC, Krause SJ. A rating system for use with patient drawings. Pain. 1986; 24:57–65.

12). Uden A, Landin LA. Pain drawing and myelography in sciatic pain. Clin Orthop Relat Res. 1987; 216:124–130.

13). Vucetic N, Maattanen H, Svensson O. Pain and pathology in lumbar disc hernia. Clin Orthop Relat Res. 1995; 320:65–72.