The Spatial Extent of Pain Is Associated with Pain Intensity, Catastrophizing and Some Measures of Central Sensitization in People with Frozen Shoulder

The aim of this cross-sectional study was to explore the spatial extent of pain and its association with clinical symptoms, psychological features, and pain sensitization in people with frozen shoulder (FS). Forty-eight individuals with FS completed pain drawings (PDs) and reported their clinical symptoms including pain intensity (Visual Analogue Scale) and shoulder disability (Shoulder Pain and Disability Index). Moreover, pain sensitization measurements (pressure pain thresholds, temporal summation, conditioned pain modulation, and Central Sensitization Inventory (CSI)) were assessed. Psychological features were assessed by Pain Catastrophizing Scale (PCS) and Pain Vigilance and Awareness Questionnaire. Pain frequency maps were generated, Margolis rating scale was used for pain location, and Spearman correlation coefficients were computed. The mean (SD) pain extent was 12.5% (6.7%) and the most common painful area was the anterolateral shoulder region (100%). Women presented a more widespread pain distribution compared with men. Significant positive associations were obtained between pain extent and current pain intensity (rs = 0.421, p < 0.01), PCS (rs = 0.307, p < 0.05) and CSI (rs = 0.358, p < 0.05). The anterolateral region of the shoulder was the most common painful area in people with FS. Women with FS presented more extended areas of pain; and a more widespread distribution of pain was correlated with higher levels of pain, pain catastrophizing and pain sensitization.

Comparison of Pain Location and Extent Between Adults with Ankylosing Spondylitis-related Inflammatory versus Chronic Nonspecific Low Back Pain

Introduction: Pain among adults with ankylosing spondylitis-related inflammatory low back pain (AS-ILBP) is not well-characterized, and individuals with AS-ILBP are frequently misdiagnosed with chronic nonspecific low back pain (CNSLBP). This study digitally quantifies and compares the location and extent of pain between adults with AS-ILBP and those with CNSLBP and examines the relationship between the pain extent and functional, psychological, and condition-specific factors in those with AS-ILBP. Methodology: The location and extent of pain in adults with AS-ILBP (n = 27) or CNSLBP (n = 22) was quantified using a digital pain drawing analysis. Relationships between pain extent and perceived pain intensity and disability, pain-related cognitive factors (back beliefs, fear of movement, pain catastrophizing, pain coping, and self-efficacy), psychological distress, and AS-specific features were examined in those with AS-ILBP. Result: Pain extent in the dorsal region of the body was greater in those with AS-ILBP than in CNSLBP (P < 0.05). In AS-ILBP, the most prevalent pain location was the lumbar region (88.9%), followed by the buttock (70.4%); the frequencies of reported pain in these regions were similar between groups (P > 0.05). The AS-ILBP group more frequently reported pain in the thoracic (70.4%) and cervical (51.8%) regions (P < 0.05). In the AS-ILBP group, larger pain extent was moderately associated with negative back beliefs (rs = –0.44 to –0.41, P < 0.05) and lower self-efficacy (rs = –0.58 to –0.42, P < 0.05), but not with any of functional outcomes. Larger pain extent was associated with higher disease activity (P < 0.05). Conclusion: Adults with AS-ILBP perceive larger pain extent in spinal regions and the degree of pain extent is associated with negative back beliefs, lower self-efficacy, and higher disease activity. Pain drawings may assist in the differential diagnosis of CNSLBP and AS-ILBP. Further, they may aid psychological screening in adults with AS-ILBP.

POS1444 ADOPTION OF DIGITAL MANIKINS TO SELF-REPORT PAIN: A SYSTEMATIC REVIEW

Background:Chronic pain is common in rheumatic and musculoskeletal conditions, and a major driver of disability worldwide. Knowledge gaps exist with respect to correct estimates of chronic pain [1], what causes it and how best to manage it [2]. To address this, researchers need validated methods to measure pain in large, representative populations. Though many authors have recognised the potential benefits of paper-based and digital pain manikins [3]–[5], it is unknown to what extent studies have adopted digital manikins as a data collection tool.Objectives:The objective of our review was to identify and characterise published studies that have used digital pain manikins as a data collection tool.Methods:We systematically searched six electronic databases, including Medline, CINAHL, Embase, Scopus, IEEE Xplore digital library, ACM Digital Library, on 3-4 of November 2020 by using a pre-defined search strategy. We included a study in our review if it used a digital manikin for self-reporting any pain aspect (e.g., intensity, type) by people suffering from pain, and if its full text was published in English. We conducted this review by following the PRISMA reporting guidelines and conducted a descriptive synthesis of findings, including manikin-derived outcome measures.Results:Our search yielded 4,685 unique studies. After full text screening of 705 articles, we included 14 studies in our review. Most articles were excluded because they used either paper-based manikins or didn’t include enough details to determine that the manikin was digital (n=386). The majority of included studies were published in Europe (n=11). Most studies collected data on a manikin once (n=11); from people with pain conditions (n=9); and in clinical settings (n=9). There was only one study that collected digital pain manikin data in a large sized (i.e., ~20,000) population-based survey.In most studies participants shaded any painful area on manikin (n=9) and did not enable participants to record location-specific pain aspects (n=11). None of the manikins enabled participants to record location-specific pain intensity. Pain distribution (i.e. number or percentage of pre-defined body areas or locations experiencing pain) and pain extent (i.e. number or percentage of shaded pixels) were commonly used manikin-derived outcome measures. In six studies, a heat map was used to summarise the extent of pain across the population.Conclusion:Digital pain manikins have been available since the 1990s but their adoption in research has been slow. Few manikins enabled location-specific pain recording suggesting that the digital nature of the manikin is not yet fully utilised. Future development of a validated digital pain manikin supporting self-reporting of the location and intensity of pain, usable across any device and screen size, may increase uptake and value.References:[1]S. E. E. Mills, K. P. Nicolson, and B. H. Smith, “Chronic pain: a review of its epidemiology and associated factors in population-based studies,” Br. J. Anaesth., vol. 123, no. 2, pp. e273–e283, Aug. 2019.[2]D. B. Reuben et al., “National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain,” Ann. Intern. Med., vol. 162, no. 4, p. 295, Feb. 2015.[3]R. Waller, P. Manuel, and L. Williamson, “The Swindon Foot and Ankle Questionnaire: Is a Picture Worth a Thousand Words?,” ISRN Rheumatol., vol. 2012, pp. 1–8, 2012.[4]M. Barbero et al., “Clinical Significance and Diagnostic Value of Pain Extent Extracted from Pain Drawings: A Scoping Review,” Diagnostics, vol. 10, no. 8, p. 604, Aug. 2020.[5]S. M. Ali, W. J. Lau, J. McBeth, W. G. Dixon, and S. N. van der Veer, “Digital manikins to self-report pain on a smartphone: A systematic review of mobile apps,” Eur. J. Pain, vol. 25, no. 2, pp. 327–338, Feb. 2021.Disclosure of Interests:None declared

Assessment of neuropathic pain after spinal cord injury using quantitative pain drawings

Study design Clinimetric cross-sectional cohort study in adults with paraplegic spinal cord injury (SCI) and neuropathic pain (NP). Objective To assess the reliability of standardized quantitative pain drawings in patients with NP following SCI. Setting Hospital-based research facility at the Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland. Methods Twenty individuals with chronic thoracic spinal cord injury and neuropathic pain were recruited from a national and local SCI registry. A thorough clinical examination and pain assessments were performed. Pain drawings were acquired at subsequent timepoints, 13 days (IQR 7.8–14.8) apart, in order to assess test-retest reliability. Results The average extent [%] and intensity [NRS 0–10] of spontaneous NP were 11.3% (IQR 4.9–35.8) and 5 (IQR 3–7), respectively. Pain extent showed excellent inter-session reliability (intraclass correlation coefficient 0.96). Sensory loss quantified by light touch and pinprick sensation was associated with larger pain extent (rpinprick = −0.47, p = 0.04; rlight touch = −0.64, p < 0.01). Conclusion Assessing pain extent using quantitative pain drawings is readily feasible and reliable in human SCI. Relating information of sensory deficits to the presence of pain may provide distinct insights into the interaction of sensory deafferentation and the development of neuropathic pain after SCI.

Profiling the Extent and Location of Pain in Migraine and Cervicogenic Headache: A Cross-sectional Single-Site Observational Study

Objectives The primary aim was to quantify and compare the location and extent of pain in people with either episodic migraine, chronic migraine, or cervicogenic headache. A secondary aim was to examine the associations between pain extent and headache features, quality of life, and psychological distress for each headache type. Design A cross-sectional, single-site, observational study. Setting Headache outpatient clinic. Subjects From a sample of 390 patients, 114 patients with migraine or cervicogenic headache (48 episodic migraine, 30 chronic migraine, 36 cervicogenic headache) were eligible for the study. Methods Pain location and extent were determined using a novel approach for digital pain drawing acquisition and analysis. Headache features included intensity and history duration. Quality of life was measured using the SF-36 and psychological distress using the Hospital Anxiety and Depression Scale. Results Overall, pain was most frequently reported in the frontal and temporal regions in patients with either episodic or chronic migraine, whereas pain was most frequent in the suboccipital region in patients with cervicogenic headache. A larger pain extent was moderately correlated with higher headache intensity (rs = 0.53, P = 0.003) and poorer quality of life (rs ranged from –0.36 to –0.40, P &lt; 0.05) in patients with chronic migraine, whereas pain extent was associated with longer headache duration in those with cervicogenic headache (rs = 0.35, P = 0.04). No correlation was found between pain extent and psychological features for any headache type (P &gt; 0.05). Conclusions Despite some differences, there was a large symptomatic overlap between headache types, highlighting the limitations of using pain location in the differential diagnosis of headache.

Clinical Significance and Diagnostic Value of Pain Extent Extracted from Pain Drawings: A Scoping Review

The current scoping review aimed to map current literature investigating the relationship between pain extent extracted from pain drawings with clinical, psychological, and psycho-physiological patient-reported outcome measures in people with pain. Electronic databases were searched for cross-sectional cohort studies that collected pain drawings using digital technology or a pen-on-paper approach and assessed for correlations between pain extent and clinical, psychological or psycho-physical outcomes. Data were extracted by two different reviewers. The methodological quality of studies was assessed using the Newcastle–Ottawa Quality Assessment Scale. Mapping of the results included: 1, description of included studies; 2, summary of results; and 3, identification of gaps in the existing literature. Eleven cross-sectional cohort studies were included. The pain disorders considered were heterogeneous, ranging from musculoskeletal to neuropathic conditions, and from localized to generalized pain conditions. All studies included pain and/or pain-related disability as clinical outcomes. Psychological outcomes included depression and anxiety, kinesiophobia and catastrophism. Psycho-physical measures included pressure or thermal pain thresholds. Ten studies were considered of high methodological quality. There was heterogeneity in the associations between pain extent and patient-reported outcome measures depending on the pain condition. This scoping review found that pain extent is associated with patient-reported outcome measures more so in patients presenting with musculoskeletal pain, e.g., neck pain or osteoarthritis, rather than for those with neuropathic pain or headache.