Carnes Dawn, Ashby Deborah, Underwood Martin
Institute of Health Sciences Education, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK.
Clin J Pain. 2006 Jun;22(5):449-57. doi: 10.1097/01.ajp.0000208245.41122.ac.
The use of pain drawings to identify the psychologic "state" of patients has been advocated. They are used for psychologic screening before considering treatments, such as surgery. For pain drawings to be clinically useful as a psychologic screen they need good positive and negative predictive values. We systematically reviewed the literature that directly compared pain drawing scoring systems with measures of psychologic state.
We searched 12 medical and social science databases, using key words and their derivatives. Nineteen articles were suitable for analysis. The majority focused on low back pain (79%) in secondary or tertiary care (90%). Pain drawings were evaluated against psychologic tools testing: somatization, depression, anxiety, and distress.
Three studies concluded that the association between pain drawings and psychologic state was sufficient for clinical use; of these only 1 showed reasonable sensitivity and specificity data. Six reported a statistical association and 10/19 studies reported inconclusive results and weak association. The pooled median sensitivity score was 56% (range 24% to 93%), specificity 79.5% (range 44% to 91%), positive predictive value 71.5% (range 28% to 94%), and negative predictive value 88% (range 35% to 100%). The predictive data were too low, wide-ranging, and inconsistent to accept the pain drawing as a clinical diagnostic tool to predict psychologic state.
We conclude that the available data do not support the assumption that unusual pain drawings or extensive marking indicate disturbed psychologic state. There is no high quality evidence to support pain-drawing use as a psychologic assessment tool; therefore, pain drawings are not recommended for this purpose.
有人主张使用疼痛图来识别患者的心理“状态”。在考虑进行手术等治疗之前，它们被用于心理筛查。为了使疼痛图在临床上作为一种心理筛查工具发挥作用，它们需要有良好的阳性和阴性预测价值。我们系统地回顾了直接将疼痛图评分系统与心理状态测量方法进行比较的文献。
我们使用关键词及其衍生词搜索了12个医学和社会科学数据库。19篇文章适合进行分析。大多数研究聚焦于二级或三级医疗机构中90%的腰痛患者（79%）。根据心理测试工具对疼痛图进行评估：躯体化、抑郁、焦虑和痛苦。
三项研究得出结论，疼痛图与心理状态之间的关联足以用于临床；其中只有一项研究显示了合理的敏感性和特异性数据。六项研究报告了统计学关联，19项研究中有10项报告结果不明确且关联较弱。汇总后的中位敏感性评分为56%（范围为24%至93%），特异性为79.5%（范围为44%至91%），阳性预测值为71.5%（范围为28%至94%），阴性预测值为88%（范围为35%至100%）。这些预测数据过低、范围过宽且不一致，无法将疼痛图作为预测心理状态的临床诊断工具接受。
我们得出结论，现有数据不支持异常疼痛图或广泛标记表明心理状态紊乱这一假设。没有高质量的证据支持将疼痛图用作心理评估工具；因此，不建议为此目的使用疼痛图。
