Journal of Pain Research (Jun 2016)

The pain drawing as an instrument for identifying cervical spine nerve involvement in chronic whiplash-associated disorders

  • Bernhoff G,
  • Landén Ludvigsson M,
  • Peterson G,
  • Bertilson BC,
  • Elf M,
  • Peolsson A

Journal volume & issue
Vol. 2016, no. Issue 1
pp. 397 – 404

Abstract

Read online

Gabriella Bernhoff,1 Maria Landén Ludvigsson,1,2 Gunnel Peterson,1,3 Bo Christer Bertilson,4,5 Madeleine Elf,6 Anneli Peolsson1 1Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, 2Rehab Väst, County Council of Östergötland, Östergötland, 3Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, 4Musculoskeletal Functions and Pain, Division of Family Medicine, NVS, Karolinska Institutet, 5Academic Primary Health Care Center, Stockholm County Council, 6Kista Rygg and Idrottsklinik, Kista, Sweden Objective: The aim of the study was to investigate the psychometric properties of a standardized assessment of pain drawing with regard to clinical signs of cervical spine nerve root involvement.Design: This cross-sectional study included data collected in a randomized controlled study.Patients: Two hundred and sixteen patients with chronic (≥6 months) whiplash-associated disorders, grade 2 or 3, were included in this study.Methods: The validity, sensitivity, and specificity of a standardized pain drawing assessment for determining nerve root involvement were analyzed, compared to the clinical assessment. In addition, we analyzed the interrater reliability with 50 pain drawings.Results: Agreement was poor between the standardized pain drawing assessment and the clinical assessment (kappa =0.11, 95% CI: −0.03 to 0.20). Sensitivity was high (93%), but specificity was low (19%). Interrater reliability was good (kappa =0.64, 95% CI: 0.53 to 0.76).Conclusion: The standardized pain drawing assessment of nerve root involvement in chronic whiplash-associated disorders was not in agreement with the clinical assessment. Further research is warranted to optimize the utilization of a pain/discomfort drawing as a supportive instrument for identifying nerve involvement in cervical spinal injuries. Keywords: pain drawing, cervical vertebrae, diagnostic self-evaluation, radiculopathy, reproducibility of results, whiplash injuries

Keywords