Pain Drawing in the Assessment of Nerve Root Compression in the Degenerative Spondylosis

Jeong Rae Kim; Chul Hyun Park; Jong Chul Ahn; Myun Whan Ahn; Hyun Kook Yoon

doi:10.4184/jkss.2007.14.4.249

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Kim, Park, Ahn, Ahn, and Yoon: Pain Drawing in the Assessment of Nerve Root Compression in the Degenerative Spondylosis

Original Article

Journal of Korean Spine Surg 2007;14(4):249-255.

Published online: 21 February 2007

DOI: https://doi.org/10.4184/jkss.2007.14.4.249

Pain Drawing in the Assessment of Nerve Root Compression in the Degenerative Spondylosis

Jeong Rae Kim, M.D., Chul Hyun Park, M.D., Jong Chul Ahn, M.D., Myun Whan Ahn, M.D., Hyun Kook Yoon, M.D.

Department of Orthopedic Surgery, College of Medicine, Yeungnam University, Daegu, Korea

Address reprint requests to Myun-Whan Ahn, M.D. Department of Orthopedic Surgery, College of Medicine, Yeungnam University Daemyungdong 317-1, Namgu, Daegu, Korea Tel: 82-53-620-3643, Fax: 82-53-628-4020, E-mail: mwahn@med.yu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study.

Objectives

To explore the pattern of pain distribution in HNP and spinal stenosis with or without degenerative spondylolisthesis (DS), and to evaluate the diagnostic value of pain drawings in predicting the presence of a painful nerve root.

Summary of Literature Review

The usefulness of pain drawing as a tool to predict the presence of painful nerve root compression is unclear.

Materials and Methods

Fifty-seven patients (27 HNP, 21 pure spinal stenosis, and 9 spinal stenosis with DS) with leg pain were recruited. The presence of painful nerve root compression was judged based on MRI and clinical findings. Each grid of the pain drawing is assigned an area code, and discriminant analysis was performed to explore indications of painful nerve root. Diagnostic values were evaluated by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results

Pain distribution was characterized by a dermatomal pattern in HNP and variable in the spinal stenosis group. Pares-thesia on the sole was extracted as a discriminant factor indicating painful compression of the S1 nerve root. In HNP, the sensitivity, specificity, PPV, and NPV of this factor were 62%, 100%, 100%, and 74% respectively. In the spinal stenosis group, they were 80%, 56%, 27%, and 93%, respectively.

Conclusions

The pain drawing can help assess painful nerve root compression as well as confirm the pattern of pain distribution.

Keywords: Lumbar spine, Spinal stenosis, Disc herniation, Radicular pain, Pain drawing

REFERENCES

1). Zileli B, Ertekin C, Zileli M, Yunten N. Diagnostic value of electrical stimulation of lumbosacral roots in lumbar spinal stenosis. Acta Neurol Scand. 2002; 105:221–227.

2). Ransford AO, Cairns D, Mooney V. The pain drawing as an aid to the psychologic evaluation of patients with low-back pain. Spine. 1976; 1:127–134.

3). Hildebrandt J, Franz CE, Choroba-Mehnen B, Temme M. The use of pain drawings in screening for psychological involvement in complaints of low-back pain. Spine. 1988; 13:681–685.

4). Schwartz DP, DeGood DE. Global appropriateness of pain drawings: blind ratings predict pattern of psychological distress and litigation status. Pain. 1984; 19:383–388.

5). Von Baeyer CL, Bergstrom KJ, Brodwin MG, Brodwin SK. Invalid use of pain drawings in psychological screening of back pain patients. Pain. 1983; 16:103–107.

6). Kim HT, Park BH, Chun DW, Lee HS, Jeon HB. The use of pain drawing in low back disorder. J Korean Soc Spine Surg. 1994; 1:93–101.

7). Ohnmeiss DD, Vanharanta H, Guyer RD. The association between pain drawings and computed tomographic/disco-graphic pain responses. Spine. 1995; 20:729–733.

8). Leavitt F, Garron DC. Psychological disturbance and pain report differences in both organic and non-organic low back pain patients. Pain. 1979; 7:187–195.

9). Mann NH 3rd, Brown MD, Herz DB, Enger I, Tomp-kins J. Initial-impression diagnosis using low-back pain patient pain drawings. Spine. 1993; 18:41–53.

10). Margolis RB, Chibnall JT, Tait RC. Test-retest reliabil-ity of the pain drawing instrument. Pain. 1988; 33:49–51.

11). Margolis RB, Tait RC, Krause SJ. A rating system for use with patient drawings. Pain. 1986; 24:57–65.

12). Uden A, Landin LA. Pain drawing and myelography in sciatic pain. Clin Orthop Relat Res. 1987; 216:124–130.

13). Vucetic N, Maattanen H, Svensson O. Pain and pathology in lumbar disc hernia. Clin Orthop Relat Res. 1995; 320:65–72.

Figures and Tables%

Fig. 1.

The form of pain drawing used in this study

Fig. 2.

Pain drawing according to pain distribution pattern (A) focal type (B) wide type (C) dermatomal type

Table 1.

Patient distribution with relation to disease entities & anatomical level

	Disease		L3-4	L4-5	L5-S1	Multilevel	Total
HNP		case number affected nerve root	2 L4 root	12 L5 root	13 S1 root	0	27
Spinal	Pure	case number	0	6	5	10	21
Spinal	stenosis	affected nerve root	L4 root	L5 root	S1 root
stenosis		case number
group*	DS^†	case number affected nerve root	0	7 L5 root	0	2	9
Total			2	25	18	12	57

Spinal stenosis group*: Spinal stenosis with or without degenerative spondylolisthesis DS

^† : degenerative spondylolisthesis

Table 2.

Pain distribution pattern with relation to the disease entities

Disease	Pain distribution pattern
Disease	Focal	Wide	Dermatomal	Total
HNP	5	16	16	27
Spinal stenosis group*	8	14	18	30

Spinal stenosis group* : Spinal stenosis with or without degenerative spondylolisthesis (Pearson chi-square test : P=0.04)

Table 3.

Numbness on the sole with relation to MRI examination in HNP

Numbness on the sole	Compressed level based on MRI examination
Numbness on the sole	Lumbar	Sacral	Total
Absent	14	15	19
Present	10	18	18
Total	14	13	27

(Fisher's exact test : P=0.0005)

Table 4.

Numbness on the sole with relation to MRI examination in the spinal stenosis group*

Numbness on the sole	Compressed level based on MRI examination
Numbness on the sole	Lumbar	Sacral	Total
Absent	14	1	15
Present	11	4	15
Total	25	5	30

Spinal stenosis group* : Spinal stenosis with or without degenerative spondylolisthesis (Fisher's exact test : P=0.33)

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