Pain Drawings Obtained with a Tablet-Based Software App Can Improve Doctors� Understanding of Acute Pain Patients (Preprint)
Nour Shaballout, Anas Aloumar, Till-Ansgar Neubert, Martin Dusch, Florian Beissner
BACKGROUND Pain drawings are an important tool to evaluate, communicate, and objectify pain. In the past few years there has been a shift toward tablet-based acquisition of pain drawings and several studies have been conducted to test the usefulness, reliability and repeatability of electronic pain drawings . However, to our knowledge, no study has investigated the potential role of electronic pain drawings in the clinical assessment and treatment of inpatients in acute pain situations.
... E The aim of this study was to evaluate, if knowledge of the patients' electronic pain drawing has the potential to improve the doctors' understanding of their patients and to influence their clinical decision making. Furthermore, we sought to identify differences between electronic pain drawings of patients and their treating pain specialists in an acute pain situation and to find those specific characteristics derived from the pain drawings that had the largest impact on doctors' understanding. METHODS We obtained electronic pain drawings from 47 inpatients in acute pain situations before their consultation with a pain specialist on a tablet personal computer (PC) with stylus. Before looking at their patients' drawings, these specialists drew their own conception of the patients' pain after anamnesis and physical examination. Patients' drawings were then revealed to the doctors and they were asked to evaluate, how much the additional information improved their understanding of the case and how much it influenced their clinical decision on an 11-point Likert scale (0 = "not at all", 10 = "very much"). Similarities and differences of patients' and doctors' pain drawings were assessed by visual inspection and by calculating Jaccard index and intraclass correlation coefficient (ICC) of the pain area and the number of pain clusters. Exploratory analyses were conducted by means of correlation tables to identify specific factors that influenced doctors' understanding. RESULTS Patients' pain drawings significantly improved the doctors' understanding (mean score: 4.81, SD 2.60, P < .001) and to a lesser extent their clinical decision (2.68, SD 1.18, P < .001). Electronic pain drawings of patients and doctors showed fair to good similarity for pain extent (0.59 < ICC < 0.74) and poor to fair similarity for the number of pain clusters (0.40 < ICC < 0.59). Visual inspection of discrepancies revealed frequent differences in cluster size up to complete missing of clusters. Exploratory analysis showed that pain area (r = 0.454, P = .001) and widespreadness (r = 0.447, P = .002) were important factors helping doctors to understand their patients. CONCLUSIONS In a clinical setting electronic pain drawings can improve doctors' understanding of patients in acute pain situations. The ability of electronic pain drawings to visualize differences between doctors' and patients' conception of pain has the potential to improve doctor-patient communication.