title: Pain drawing in the assessment of neurogenic pain and dysfunction in the neck/shoulder region: inter-examiner reliability and concordance with clinical examination.
abstract: BACKGROUND
  The pain drawing (PD) has proven to have good inter-examiner reliability and high sensitivity in assessing neurogenic pain and dysfunction (NP) originating from the lower back. Studies on its use in the neck/shoulder region have not been found.
  
  
  OBJECTIVE
  To investigate inter-examiner reliability of a first impression assessment of NP in the neck/shoulder region using a simplified PD made by the patient. Also, to investigate concordance between first impression assessment and a final assessment based on a complete clinical examination.
  
  
  METHODS
  A clinical trial on 50 primary care patients with discomfort in the neck/shoulder region assessed by two independent examiners. One examiner was experienced in assessing the PD and the other was not. A first impression assessment was based solely on the PD. A final assessment was based on clinical examination also including history interviews, physical examinations, and possible radiological reports. NP was considered if at least two physical examination findings indicated neurological deficit in the area of discomfort. Concordance between the first impression assessment and the final assessment was calculated as sensitivity with the final assessment as the key.
  
  
  RESULTS
  Inter-examiner reliability based solely on the first impression assessment of the pain drawing reached 88% overall agreement and a sensitivity of 90%. Signs of NP were found in 92% of the patients according to the final assessment. Two thirds of the patients added to their pain drawing during the history interview.
  
  
  CONCLUSIONS
  First impression assessment of the PD seems to be a reliable, easily learned, and sensitive diagnostic method for assessing NP in the neck/shoulder region. NP may be greatly underestimated, especially as patients withhold symptoms of discomfort when they fill in the PD.
authors.affiliation: Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden. bo.bertilson@ki.se
authors.forename: Bo
authors.initials: B
authors.lastname: Bertilson
authors.forename: Marie
authors.initials: M
authors.lastname: Grunnesjö
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Johansson
authors.forename: Lars-Erik
authors.initials: LE
authors.lastname: Strender
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging; D009460:Neurologic Examination; D015588:Observer Variation; D018579:Patient Selection; D010361:Patients; D010808:Physical Examination; D011859:Radiography; D015203:Reproducibility of Results; D020069:Shoulder Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011795:Surveys and Questionnaires