Ep. 16 How to Draw Your Pain
In this episode, Dan and Juz focus on the importance of communicating and assessing pain through the use of pain diagrams, which help both clinicians and patients gain insights into the sources and amplification of their presentation. The hosts go through many different types of back, leg, and neck pain, discussing how this information contributes to goal setting and tracking progress in pain management. Unfortunately, the data on diagrams makes it seems as though they are useless - but that is if they are drawn in such a fashion. Pain diagrams when done with a clear, consistent key can provide a visual representation of the pathologies driving pain, allowing patients to turn the invisible, visible. Clinicians can then better identify underlying nociceptive and neuropathic components, and amplifying factors, so they can more effectively diagnose and treat. Listen to learn how to draw you pain better as a patient and provider.
Introduction: Bridging the Communication Gap
The episode "How to Draw Your Pain" from the chronic pain podcast "It's Not in Your Head" addresses a crucial aspect of patient-doctor interactions: effectively communicating pain experiences. Hosts Dr. Dan Bates and Justine Feitelson (Dan and Juz) emphasize the importance of patients accurately conveying their pain to healthcare providers, acknowledging the challenges this presents, especially in the context of chronic pain and sensitization.
The Importance of Pain Communication
Effective pain communication is vital for several reasons:
It helps doctors understand the patient's experience
It guides diagnosis and treatment planning
It allows patients to express the impact of pain on their lives
Patients often want to convey the severity of their pain, while doctors need specific information about location, type, and aggravating factors.
Pain Drawing: A Valuable Tool
Despite limited scientific data supporting pain drawings, they remain a crucial diagnostic tool. Dr. Bates emphasizes that he cannot effectively diagnose without visual representations of pain. Pain drawings can reveal:
Pain location and distribution
Type of pain (nociceptive, neuropathic, or nociplastic)
Potential red flags when combined with other assessments
Teaching Effective Pain Drawing
The hosts discuss techniques for both patients and clinicians:
Start with a key: Use different symbols for various pain types (e.g., achy, sharp)
Be specific about location
Confirm the drawing by having the patient point to the affected areas
Clinicians should guide patients in correcting or refining their drawings
Common Pain Patterns and Causes
The episode covers various pain patterns associated with different conditions:
Lower Back Pain
Facet joint issues
Sacroiliac (SI) joint problems
Hip-related pain
Disc pathologies
Nerve-related pain
Neck Pain
Facet joint issues
Nerve-related pain
Disc pathologies
Cervical instability
Other Pain Types
Fibromyalgia
Neuropathic pain (e.g., superficial peroneal nerve entrapment, peripheral neuropathy)
Complex Regional Pain Syndrome (CRPS)
Thoracic pain (disc, facet, costo-transverse, costo-vertebral)
Interpreting Pain Drawings
The hosts emphasize that while pain patterns can be reliable indicators of underlying issues, they often overlap, making interpretation challenging. They suggest focusing on key areas and common patterns to avoid confusion.
Connecting Pain Drawings to the Bigger Picture
Pain drawings should be considered alongside other assessments, such as:
Central Sensitization Inventory (CSI)
Depression, Anxiety, and Stress Scale (DASS-21)
This comprehensive approach helps clinicians better understand the patient's overall pain experience and guides treatment planning.
Cervical and thoracic nerve root pain distribution.
Lumbar and lower limb pain distribution.