Pain Drawings Help to Distinguish Between Somatic and Somatoform Pain

Aims: Pain drawing (PD) is a common method in the assessment of pain patients. Our aim was to find graphic criteria which help to distinguish between somatic and somatoform pain disorder.

Methods: PDs from 49 patients with somatic pain and 62 with somatoform pain were analyzed by an investigator, who was blinded regarding the patients diagnosis, according to a set of 30 numeric or binary pattern-criteria. Each criterion was individually tested for significance with regard to the two pain groups by using logistic regression methods (chi-square test). If the criteria were frequent (occurring > 26%), we also calculated multivariate analyses adjusted for age, sex, pain duration, pain severity, and perceived mood.

Results: The chi-square test revealed 13 drawing criteria significantly indicating a somatoform pain disorder (all p-values <0.001). In the multivariate analyses of the frequent criteria 8 drawing criteria had OR >3 (3.72–53.95).These criteria were characterized by significant differences in style, selection, size, distribution as well as in frequency of drawing signs. Specific combinations of marks (e.g. number and size of the marks in combination with symmetric aspects) had further high predicting impact.

Conclusion: PD is a simple and low-cost technique which helps to differentiate between somatoform-functional pain and somatic-nociceptive pain disorders in clinical practice

Pain - drawings - somatoform