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Pain Pract. 2016 Jan;16(1):31-7. doi: 10.1111/papr.12263. Epub 2014 Dec 3.

Chronic Widespread Pain Drawn on a Body Diagram is a Screening Tool for Increased Pain Sensitization, Psycho-Social Load, and Utilization of Pain Management Strategies.

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Pain Medicine Unit, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
Pharmacology and Anaesthesiology Unit, University of Western Australia, Perth, Western Australia, Australia.
Southern Regional Medical Group, Albany, Western Australia, Australia.
School of Physiotherapy, Curtin University of Technology, Bentley, Western Australia, Australia.
Biostatistics, School of Occupational Therapy and Social Work, Curtin University of Technology, Bentley, Western Australia, Australia.


The aim of this study was to investigate the hypothesis that chronic widespread pain, (CWP) drawn by patients on a body diagram, could be used as a screening tool for increased pain sensitization, psycho-social load, and utilization of pain management strategies. The triage questionnaires of 144 adults attending a chronic pain outpatients' clinic were audited and the percentage pain surface area (PPSA) drawn on their body diagrams was calculated using the "rule of nines" (RON) method for burns area assessment. Outcomes were measured using the painDETECT Questionnaire (PD-Q) and other indices and compared using a nonrandomized, case-control method. It was found that significantly more subjects with CWP (defined as a PPSA ≥ 20%) reported high (≥ 19) PD-Q scores (suggesting pain "sensitization" or neuropathic pain) (P = 0.0002), "severe" or "extremely severe" anxiety scores on the Depression, Anxiety and Stress Scale-21 Items Questionnaire (P = 0.0270), ≥ 5 psycho-social stressors (P = 0.0022), ≥ 5 significant life events (P = 0.0098), and used ≥ 7 pain management strategies (PMS) (P < 00001), compared to control subjects with a lower PPSA. A Widespread Pain Index score ≥ 7 (OR = 11.36), PD-Q score ≥ 19 (OR = 4.46) and use of ≥ 7 PMS (OR = 5.49) were independently associated with CWP. This study demonstrates that calculating PPSA on a body diagram (using the RON method) is a valid and convenient "snapshot" screening tool to identify patients with an increased likelihood of pain sensitization, psycho-social load, and utilizing pain management resources.


anxiety; fibromyalgia; neuropathic pain; pain diagram; pain drawings; painDETECT; psycho-social load; widespread pain

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