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      Computer-aided surface estimation of pain drawings – intra- and inter-rater reliability

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          Pain drawings are often utilized in the documentation of pain conditions. The aim here was to investigate intra- and inter-rater reliability of area measurements performed on pain drawings consecutively, using the computer program Quantify One. Forty-eight patients with chronic nonmalignant pain had shaded in their experienced pain on the front and back views of a pain drawing. The templates were scanned and displayed on a 17-inch computer screen. Two independent examiners systematically encircled the shaded-in areas of the pain drawings with help of a computer mouse, twice each on two separate days, respectively. With this method it is possible to encircle each marked area and to obtain immediate details of its size. The total surface area (mm 2) was calculated for each pain drawing measurement. Each examiner measured about 2400 areas, and as a whole, the number of areas measured varied only by 3%. The intra-rater reliability was high with intraclass correlation coefficients 0.992 in Examiner A and 0.998 in Examiner B. The intra-individual absolute differences were small within patients within one examiner as well as between the two examiners. The inter-rater reliability was also high. Still, significant differences in the absolute mean areas (13%) were seen between the two examiners in the second to fourth measurement sessions, indicating that one of the examiners measured systematically less. The measurement error was ≤10%, indicating that use of the program would be advantageous both in clinical practice and in research, but if repeated, preferably with the same examiner. Since pain drawings with this method are digitized, high quality data without loss of information is possible to store in electronic medical records for later analysis, both regarding precise location and size of pain area. We conclude that the computer program Quantify One is a reliable method to calculate the areas of pain drawings.

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          Most cited references 15

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          The use of the pain drawing as a screening measure to predict psychological distress in chronic low back pain.

          The ability of three new methods of scoring the Pain Drawing to predict psychological distress in two cohorts of 100 patients with chronic low back pain was investigated. Patients completed a Pain Drawing and questionnaire measures of psychological distress and were given a standard physical examination. The two cohorts were significantly different on all variables (except for disability). The relationship between the three new scoring systems and measures of distress, physical factors, and disability was investigated. The new scoring methods had high reliability. Pain Sites was a more accurate predictor of distress, but was unable to do so with sufficient specificity/sensitivity. Body Map did not correlate with physical/disability measures. Using the new scoring systems, it was not possible to identify distressed patients with sufficient sensitivity/specificity, nor to differentiate between organic and nonorganic pain patterns.
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            The cartography of pain: the evolving contribution of pain maps.

            Pain maps are nowadays widely used in clinical practice. This article aims to critically review the fundamental principles that underlie the mapping of pain, to analyse the evolving iconography of pain maps and their sometimes straightforward and sometimes contentious nature when used in the clinic, and to draw attention to some more recent developments in mapping pain. It is concluded that these maps are intriguing and evolving cartographic tools which can be used for depicting not only the spatial features but also the interpretative or perceptual components and accompaniments of pain.
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              Extent measurement in localised low-back pain: a comparison of four methods.

               P Bryner (1994)
              Seventeen drawings of localised low-back pain were analysed by two assessors using 4 systems. Three were grid-based systems and one was by computer. The mean area or 'extent' was calculated to be 7.7%, 4.7%, 3.6% and 2.3% of the body outline using 45, 200, 560 and 61,102 section analyses, respectively. The computer-assisted method provided a significantly lower estimate of pain extent than the grid-based assessments as expected. Analysis of variance showed that the method of analysis provided greater source of variation than raters (P < 0.0001). Inter-rater reliability was high using all 4 systems calculated using intraclass correlation and the kappa statistic. Correlation coefficients of extent between the systems varied from 0.46 to 0.94. Correlation was highest between systems of adjacent magnitude of sections. It is concluded that grid-based assessment of small areas overestimates the actual area of pain and this may account for the lack of sensitivity to change in clinical status.

                Author and article information

                J Pain Res
                Journal of Pain Research
                Dove Medical Press
                15 May 2011
                : 4
                : 135-141
                [1 ]Rehabilitation and Research Centre for Torture Victims, Copenhagen K, Denmark;
                [2 ]Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
                Author notes

                These authors contributed equally to this study

                Correspondence: Ann L Persson, Rehabilitation and Research Centre for Torture Victims, PO 2107, DK-1014 Copenhagen K, Denmark, Tel +45 33 760 600, Fax +45 33 760 510, Email ap@ 123456rct.dk
                © 2011 Persson et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.



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