title: Validity of pain drawings for predicting psychological status outcome in patients with recurrent or chronic low back pain.
abstract: OBJECTIVE
  To investigate the association between baseline pain drawings and future psychological status, and estimate the prognostic value of pain drawing assessment for predicting somatization, distress, and depression at one-year follow-up, in patients with recurrent or chronic low back pain (RCLBP).
  
  
  METHODS
  This was a multi-center prospective cohort study of 138 patients with RCLBP. Participating patients completed at baseline and one-year follow-up: a blank pain drawing; the Modified Somatic Perceptions Questionnaire; modified Zung Depression Scale; and Distress and Risk Assessment Method. Pain drawings were analyzed quantitatively using the Pain Sites Score (PSS) and Simple Body Region (SBR) method. The association between baseline pain drawing assessment and one-year psychological status was estimated using correlation and Relative Risk (RR) statistics.
  
  
  RESULTS
  We obtained complete data from 81 patients (59%). Psychological status and pain drawings did not differ significantly between completers and non-completers. Pain drawing area at baseline was associated with depression and somatization at one-year follow-up (Spearman's Rho 0.25, P = 0.022; 0.31 P = 0.006, respectively). Stronger associations resulted from analyses using the PSS, compared with the SBR. Patients with abnormal PSS pain drawings at baseline had significantly greater RR of depression (RR 6.1, 95% CI 1.1, 33.5), somatization (RR 4.1, 95% CI 1.7, 9.9) and distress (RR 6.8, 95% CI 1.9, 25.3) at one-year follow-up.
  
  
  CONCLUSIONS
  These results provide the first evidence that abnormal baseline pain drawings predict greater risk of abnormal psychological states or poor psychological outcome at one-year follow-up, in patients with RCLBP.
authors: Centre for Musculoskeletal Outcomes Research, Orthopaedic Surgery Section, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors: J H
authors: JH
authors: Abbott
authors: School of Physiotherapy, University of Otago, Dunedin, New Zealand.
authors: Megan
authors: M
authors: Foster
authors: School of Physiotherapy, University of Otago, Dunedin, New Zealand.
authors: Lucien
authors: L
authors: Hamilton
authors: School of Physiotherapy, University of Otago, Dunedin, New Zealand.
authors: Michael
authors: M
authors: Ravenwood
authors: School of Physiotherapy, University of Otago, Dunedin, New Zealand.
authors: Nicholas
authors: N
authors: Tan
keywords: Low back pain; Pain drawing; Patient examination; Prognosis; Psychological state