Review Question - QID 214054

Of the above statements about pain diagrams, the most accurate is that is is a convenient screening tool to identify patients with an increased likelihood of pain sensitization, psychosocial load, and utilizing pain management resources.

Many epidemiological studies have demonstrated associations between body pain and psychosocial factors including anxiety, depression, somatization, sleep, healthcare utilization, disability, and socioeconomic status. Patients with chronic widespread pain have increased pain sensitization (i.e. neuropathic pain), anxiety, psychosocial stressor loads, and utilize more pain management strategies. Hence, this tool is increasingly being utilized as a screening tool to help identify chronic pain patients with these important problems.

Furman et al. investigated induced lumbosacral radicular symptom referral patterns. They reported that although the symptom distribution occasionally followed the expected dermatomal maps, most often the referral was outside of the patterns expected for each level. They highlighted that the most common symptom referral pattern for levels L3-S1 was the buttock, the posterior thigh, and the posterior calf due to nerve root segmental irritation.

Visser et al. investigated the utility of pain diagrams in screening for increased pain sensitization, psycho-social load, and utilization of pain management strategies. They reported that patients with chronic widespread pain (as demonstrated in the diagram) exhibited high sensitization, anxiety, depression, and utilized more pain management strategies. They concluded that pain diagrams are a valid and convenient screening tool to identify patients with an increased likelihood of pain sensitization, psycho-social load, and utilizing pain management resources.

Parkin-Smith et al. reviewed chronic spinal pain management. They highlighted that the process of pain management starts with motivated, energetic health care practitioners with an interest in chronic pain management to take the reins and begin planning for such community-based, primary care services. They concluded that the primary challenge is ensuring early access of patients with chronic spinal pain to care, coordinated practitioner teamwork and the application of the correct level of care individualized to the patient.

Figure A depicts a pain diagram highlighting chronic widespread pain.

Incorrect Answers:
Answer 1 and 2: The level of pain depicted on the diagram usually correlates positively with the level of anxiety and depression.
Answer 3 and 5: Pain diagrams are neither sensitive nor specific in identifying patients who will or will not benefit from surgery.