1. 2020;23;E231-E240Can People with Chronic Neck Pain Recognize Their Own Digital Pain Drawing?
   Experimental Study
   Deepa Abichandani, MSc, Marco Barbero, PhD, Corrado Cescon, PhD, Alberto Gallace, PhD, David Punt, PhD, Enrique Sanchis-Sanchez, PhD, and Deborah Falla, PhD.

BACKGROUND: Although the reliability of pain drawings (PDs) has been confirmed in people with chronic pain, there is a lack of evidence about the validity of the PD, that is, does the PD accurately represent the pain experience of the patient?

OBJECTIVES: We investigate whether people with chronic neck pain (CNP) can recognize their own PD to support the validity of the PD in reporting the experience of pain. Moreover, we examined the association between their ability to recognize their own PD with their levels of pain intensity and disability and extent of psychosocial and somatic features.

STUDY DESIGN: Experimental.

SETTING: University Laboratory.

METHODS: Individuals with CNP completed their PD on a digital body chart, which was then automatically modified with specific dimensions using a novel software, providing an objective range of distortion and eliminating errors, which could potentially occur in manually controlled visual-subjective based methods. Following a 10-minute break listening to music, a series of 20 PDs were presented to each patient in a random order, with only 2 being their original PD. For each PD, the patients rated its likeliness to their own original PD on a scale from 0 to 100, with 100 representing “this is my pain.”

RESULTS: Overall, the patients rated their original PD with a median score of 92% similarity, followed by 91.8% and 89.5% similarity when presented with a PD scaled down to 75% and scaled up by 150% of the original size, respectively; these scores were not significantly different to the ratings given for their original PD. The PD with horizontal translation by 40 pixels (8%) and vertical translation by 70 pixels (12.8%) were rated as the most dissimilar to their original PD; these scores were significantly different to their original PD scores. The Spearman correlation coefficient revealed a significant negative association between their ability to recognize their original PD and their Modified Somatic Perceptions Questionnaire scores.

LIMITATIONS: The patients in the study presented with relatively mild CNP, and the results may not be generalized to those with more severe symptoms.

CONCLUSIONS: People with CNP are generally able to identify their own PD but that their ability to recognize their original PD is negatively correlated with the extent of somatic awareness.

KEY WORDS: Chronic pain, perception, pain drawings, somatic awareness