Clinical Significance and Diagnostic Value of Pain Extent Extracted from Pain Drawings: A Scoping Review

Research output: Contribution to journalArticle


  • Marco Barbero
  • Marcos J Navarro-Santana
  • María Palacios-Ceña
  • Ricardo Ortega-Santiago
  • Corrado Cescon
  • César Fernández-de-Las-Peñas

Colleges, School and Institutes

External organisations

  • University of Applied Sciences and Arts of Southern Switzerland
  • Radiology Department
  • Physical Therapy Department
  • Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, U.K.
  • School of Sport
  • College of Life and Environmental Sciences, University of Birmingham


The current scoping review aimed to map current literature investigating the relationship between pain extent extracted from pain drawings with clinical, psychological, and psycho-physiological patient-reported outcome measures in people with pain. Electronic databases were searched for cross-sectional cohort studies that collected pain drawings using digital technology or a pen-on-paper approach and assessed for correlations between pain extent and clinical, psychological or psycho-physical outcomes. Data were extracted by two different reviewers. The methodological quality of studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Mapping of the results included: 1, description of included studies; 2, summary of results; and 3, identification of gaps in the existing literature. Eleven cross-sectional cohort studies were included. The pain disorders considered were heterogeneous, ranging from musculoskeletal to neuropathic conditions, and from localized to generalized pain conditions. All studies included pain and/or pain-related disability as clinical outcomes. Psychological outcomes included depression and anxiety, kinesiophobia and catastrophism. Psycho-physical measures included pressure or thermal pain thresholds. Ten studies were considered of high methodological quality. There was heterogeneity in the associations between pain extent and patient-reported outcome measures depending on the pain condition. This scoping review found that pain extent is associated with patient-reported outcome measures more so in patients presenting with musculoskeletal pain, e.g., neck pain or osteoarthritis, rather than for those with neuropathic pain or headache.


Original languageEnglish
JournalDiagnostics (Basel, Switzerland)
Issue number8
Publication statusPublished - 18 Aug 2020