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The competition attracts children up to age 12 who are hospitalized in national health facilities or who are undergoing treatment in day hospitals. The current exhibition, which will travel through Portuguese hospitals in the coming year, is geared to the general public and health professionals. We also wish to get the attention of the hospital management boards, alerting them to the need for institutional commitment so that they create conditions that promote comprehensive pain management in children and adolescents. Over the past 25 years, scientific research has brought to light the long-term consequences of undertreated pain in children. New therapeutic resources have emerged, and the effectiveness of a multimodal approach to managing pain has been demonstrated.

Sex pain drawings

Sex pain drawings

Markings in the neck and arm region on the pain drawing had excellent correlation to high values Sex pain drawings VAS-neck and VAS-arm, respectively. Indian Amateurs Archive. J Psychosom Res. Redhead Moms. The Gatchel method was dichotomized according to Takata and Hirotani Table 2 Textbook of pain. Amateur Shemales.

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Introduction: Pain drawings have been frequently used in the preoperative evaluation of spine patients.

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Pain drawings have been frequently used in the preoperative evaluation of spine patients. Until now most investigations have focused on low back pain patients, even though pain drawings are used in neck pain patients as well. The aims of this study were to investigate the pain drawing and its association to preoperative demographics, psychological impairment, and pain intensity.

We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease. The pain drawing was evaluated according to four established methods, now modified for cervical conditions.

Pain drawing results were not affected by age, sex, smoking, and employment status. Patients with markings in the head region had higher score on HADS-depression.

Pain drawings have been a common tool, allowing patients to communicate pain without the necessity of an elaborate language for quite some time. As early as Palmer 1 wrote about pain drawings and how to distinguish between functional and organic pain. Since then pain drawings have been analysed in order to see if we in fact can draw any conclusions about the different ways patients fill in the pain drawings. Several methods of assessing the pain drawings have been developed, and these assessment methods have been compared to psychological scales 2—11 , radiology methods 12—16 , and treatment outcome 17— Until now most investigations have focused on low back pain patients, even though pain drawings are frequently used in neck pain patients as well.

The most commonly affected nerve root is the C7, secondly the C6. The symptoms are neck pain with arm pain in the same distribution area as the affected nerve To our knowledge, a thorough study of the role of pain drawings in preoperative assessment for cervical degenerative disc disease DDD has not been done.

This study was designed to evaluate whether pain drawings of neck pain patients are affected by: 1 age, sex, smoking, and employment status; 2 anxiety and depression; and 3 pain intensity. This study was a post hoc analysis of a prospective randomized controlled trial RCT of patients from three hospitals in Sweden during through Inclusion and exclusion criteria as well as two-year results have been published previously Patient informed consent was obtained before randomization.

The test consists of a front and back outline drawing of the human body. The patients indicate the distribution and the character of their present pain using six different symbols: dull, burning, numbness, stabbing or cutting, pins and needles, and cramping Appendix 1.

Three spinal surgeons scored the pain drawings independently. The evaluation methods have been validated for the cervical spine unpublished observation. A score of two points or less was regarded as normal Appendix 2. The penalty point system by Ransford was modified to the cervical spine and is henceforth referred to as the modified Ransford method. Possible neurogenic PN —the pain drawing shows some aberrations from a classic nerve root syndrome.

Non-neurogenic NN —the pain has a distribution that could not be explained by radiculopathy. Possible non-neurogenic PNN —the pain drawing shows very little resemblance with a nerve root pain and is therefore hard to categorize into the other groups above.

The pain drawing was divided by bilaterally symmetrical grids with small boxes of approximately equal area. The grid over the human figure was copied onto a transparent plastic template and placed over each completed pain drawing for scoring. The number of boxes filled in by markings was counted. The method was modified for cervical use; hence the pain drawing was divided into the following five regions: neck, head, upper trunk scapula region , upper arm, and lower arm.

Markings on the elbow or wrist non-contiguous with neck or arm pain were disregarded because they may indicate joint problems We used a transparent plastic template with the human figure containing the boundaries placed over each completed pain drawing for scoring Appendix 1.

The scoring by body surfaces by Ohnmeiss is henceforth referred to as the modified Ohnmeiss method. Every item scores on a four-point scale from 0 to 3, resulting in a maximum score of It is a validated tool in medical practice for screening psychological distress in non-psychiatric patient populations 31 , The patients were asked to make a vertical mark on the line to show the location that best represented the pain they had experienced during the last week.

The patients received separate VAS for neck and arm pain. The Gatchel method was dichotomized according to Takata and Hirotani Table 2 The lower third, together with the medium values, was classified as low-VAS. To avoid over-fitted models, only four predictors were used: age, sex, smoking, and employment status.

A logistic regression model was fitted with NN as outcome, and the four mentioned predictors as independent variables. Since there were three independent observers there are three values per patient. Therefore, a random effects logistic regression was run in this case, with the patient as a random intercept. From these models, odds ratios OR , confidence intervals CI , and P values were extracted for each predictor.

In the modified Ohnmeiss method there was an imbalance with a small number of patients in one group out of two in every region. Such a distribution makes logistic regression with four different variables unreliable, and it was therefore not carried out.

The endpoint mean for the N group was subtracted from the endpoint mean in the NN group. For the modified Ohnmeiss method, the comparison was instead between groups 0 no pain markings and 1 with pain markings separately for each body surface region. The endpoint mean for the group 0 was subtracted from the endpoint mean in group 1. Positive values correspond to larger values for the NN group or, for modified Ohnmeiss, for group 1.

The target parameter was the difference in means. Finally, some dichotomous endpoints were compared to dichotomized pain drawing results. This comparison was made using the Fisher exact test. Hence only patients without missing values for the variables used in the analysis at hand were included. Consequently, the populations the various analyses were based on are not the same. All statistical analyses were performed in R 37 , version 3.

Of the patients included in the RCT, 20 patients had missing data for pain drawings. One pain drawing was incorrectly given after the operation. None of the chosen preoperative demographic factors age, sex, smoking, and employment status were related to a NN pain drawing in any of the three assessment methods Table 3.

The HADS-t value was also lower if there were markings in the upper arm, but the value was higher if there were markings in the region of the head, neck, and lower arm Table 4. HADS per method result for the totality of all observers.

Entries are median min, max. These findings were also supported by the analysis with the dichotomized HADS. Results from method comparison. Difference in means presented for each method. The endpoint mean for the N group is subtracted from the endpoint mean in the NN group. For the modified Ohnmeiss method, the endpoint mean for the group 0 no markings was subtracted from the endpoint mean in group 1 with markings.

Most of the patients who marked pain in the neck region on the pain drawing were also in the high-VAS-neck group OR, 2. There was no association between high-VAS-arm values and markings in the upper arm region Table 6. This study documents for the first time the effect of anxiety and depression on cervical pain drawings. Interestingly for cervical spine patients, age, sex, smoking, and employment status were not associated with non-neurogenic pain drawings.

Only few studies relate pain drawings to anxiety and depression 8 , 9 , The HADS values in our study were very low in general, in both the neurogenic and non-neurogenic groups, implying that surgeon selection was a possible reason for the HADS values being lower than anticipated. Still, there were 39 patients with a value of 10 points or more in either anxiety or depression score. In this study, four different assessment methods for pain drawings were applied, all of which had different characteristics.

The method by Ransford emphasizes arrows, circled areas, explanatory notes, as well as generalized pain and strange pain patterns. In our study those features seemed to have a correlation to higher HADS values. In our study these features were not related to anxiety, depression, or pain. Since these were associated with more anxiety and depression, as measured with HADS, the greater sensitivity of the modified Ransford method to HADS was probably due to this particular feature.

The modified Ohnmeiss method predicts even surgical treatment outcome for cervical spine patients unpublished observation. There is no consensus about the interpretation of pain drawings. There are articles with and without associations when similar comparisons were made.

Cultural differences may influence the results, Swedish studies being more consistent in reporting correlations between pain drawings and psychological impairment 3 , 17 as well as discriminating between neurogenic and non-neurogenic pain Since other studies from countries with different health care and insurance systems arrive at the same conclusion as the Swedish studies 2 , 4 , 6 , 7 , individual differences may be equally common within the same country 11 as between different cultures 9.

From this perspective, it seems to matter more which region is investigated, the lumbar spine or the cervical spine 38 , 40 , and if the patient has radiculopathy or not 12 , 13 , 15 , 40 , This analysis of anxiety and depression on pain drawings is relevant since there have been recent reports of high values on HADS being a negative predictor of surgical treatment outcome in cervical spine patients Based on this study, we suggest the pain drawing as a possible first assessment-screening instrument in helping clinicians to select patients who might need further psychological screening.

Compared to other patient-reported measurements and questionnaires, a pain drawing is very simple and quick, easy for the patient to understand, and also cheap.

It is an important complement in the communication with the patient as not everyone communicates well with words and a pain drawing can then be very helpful. We therefore hope for more future research on this topic.

One major limitation of this study is the homogeneous study population due to the clear inclusion criteria in the RCT this study was based on. Therefore, one should be cautious in generalizing these results to other diagnoses. We hereby accept the risk of making a type one error. Since we did not compute so many variables, we estimated that with a correction for multiple testing the results would be too conservative, hence at risk of a type two error.

Age, sex, smoking, and employment status did not predict markings on the pain drawing whether they are neurogenic or non-neurogenic in patients with cervical DDD with radiculopathy. Pain drawings assessed as non-neurogenic, according to the modified Ransford method, were associated with anxiety and depression. Pain markings in the head region on the pain drawing were associated with depression.

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Sex pain drawings

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Introduction: Pain drawings have been frequently used in the preoperative evaluation of spine patients. Until now most investigations have focused on low back pain patients, even though pain drawings are used in neck pain patients as well.

The aims of this study were to investigate the pain drawing and its association to preoperative demographics, psychological impairment, and pain intensity. Methods: We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease.

The pain drawing was evaluated according to four established methods, now modified for cervical conditions. Pain drawing results were not affected by age, sex, smoking, and employment status. Patients with markings in the head region had higher score on HADS-depression.

Therefore, the pain drawing can be a useful tool when interpreting the patients' pain in correlation to psychological impairment and pain location. Background: Knowledge about how to interpret pain-analyzing tools such as the pain drawing test and the visual analog scale VAS in cervical spine patients are sparse; hence, they have never been validated for this subgroup of patients.

The method of artificial disc replacement ADR has been developed as an alternative treatment to fusion surgery after decompression for cervical degenerative disc disease DDD with radiculopathy. Preserved motion of ADR devices aims to prevent immobilization side effects such as stiffness, dysphagia and adjacent segment pathology.

Long-term follow-ups of these devices compared with the gold standard treatment are needed to create future guidelines. Objectives: This thesis aims at 1 validating the pain drawing as an investigational tool for the cervical spine, 2 validating the VAS for the cervical spine regarding the measurement noise and the minimum clinically important difference MCID , 3 comparing ADR with fusion surgery at 5-years of follow-up regarding outcome and complications in a randomized controlled trial RCT as well as in the Swedish spine Swespine registry, and 4 investigating possible predictors to outcome after surgical treatment of cervical radiculopathy.

Methods: An RCT with patients undergoing surgery for cervical radiculopathy was performed. Results: Pain drawings interpreted with the simple body region method showed good inter-rater reliability in cervical spine patients.

Markings in the upper arm region on the pain drawing predicted surgical treatment outcome and markings in the head region predicted depression. In both the RCT and Swespine register the outcome after ADR surgery were comparable with fusion at 5 years of follow-up, except for an elevated risk regarding secondary surgery on the index level in the ADR group.

Preserved motion did not prevent adjacent segment pathology. High values of preoperative HADS scores were negative predictors of outcome. Preoperative mental distress affects long-term outcome much more than the allocated treatment, ADR or fusion surgery in patients with cervical radiculopathy. Please wait English Svenska Norsk.

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Sex pain drawings