Relationship of pain drawings to invasive tests assessing intervertebral disc pathology

Abstract

It has been found that the pain patterns in pain drawings are related to the presence of herniated disc identified by myelography. The purpose of this study was to determine whether the pattern of pain in the drawings or the type of pain indicated (aching, burning, numbness, pins and needles, stabbing) was related to the presence of symptomatic disc pathology identified by CT/discography. In a subgroup of patients who underwent myelography, the relationship of the drawings to myelographic findings was also investigated. Pain drawings were completed by 187 patients with low back and/or radicular pain who were undergoing CT/discography. The drawings were scored in two ways, first by the system described by Ransford and secondly by visual inspection. They were classified as being indicative, or not, of disc pathology. The CT/discograms were classified as disrupted, or not, and the pain responses were recorded upon injection of each disc, based on the similarity of the pain provoked to clinical symptoms. Among the 133 patients with discogenic pain confirmed by discography, 110 (82.7%) had pain drawings that were classified as indicative. Among the 45 patients without discogenic pain, 29 (64.4%) had pain drawings classified as non-indicative. Patients with discogenic pain used more symbols indicating burning pain and aching pain than did non-discogenic pain patients. Our results confirmed those reported earlier by Udén, who found a relationship between the pattern of pain in the drawings and myelographic findings. Pain drawings may be helpful in the diagnosis of symptomatic disc pathology.