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Author Spotlight: Quantifying Pain Experience – An Illustrative Approach Using the Pain Body Diagram

Author Spotlight: Quantifying Pain Experience – An Illustrative Approach Using the Pain Body Diagram

Published on: July 7, 2023

Greater Distress Is Associated With a Larger Area Marked on a Shoulder Pain Diagram

Amin Razi¹, Grant McHorse, Petar Golijanin

¹From the Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX.

The Journal of the American Academy of Orthopaedic Surgeons

|June 25, 2025

Abstract

Introduction:

In the hand and low back, the area and distribution marked on a pain diagram correlates with feelings of distress and misconceptions about sensations. Shoulder pain diagrams could help identify unhelpful thoughts and feelings that are targets for improved shoulder health. This study aimed to answer (1) What factors are associated with greater area of pain marked on a shoulder pain diagram? (2) What factors are associated with a larger proportion of total pain area in the posterior shoulder? and (3) What factors are associated with levels of upper extremity (UE)-specific capability and pain intensity?

Methods:

One hundred thirty-nine patients (51% men; 71/139) consulting a musculoskeletal specialist (58% new patients; 80/139) for shoulder pain were invited to participate. Patients marked a shoulder pain diagram and completed a survey including levels of unhelpful thinking, feelings of distress regarding symptoms, UE-specific capability (measured using the Patient-Reported Outcome Measurement Information System UE computer adaptive test; Patient-Reported Outcome Measurement Information System UE computer adaptive test), and levels of discomfort. Bivariate and multivariable analyses identified factors associated with the total area and relative location of shoulder pain (defined as the ratio of anterior marked area divided by total posterior plus anterior area) and levels of comfort and capability.

Results:

The total area marked on a pain diagram was associated with greater feelings of distress regarding symptoms. The ratio of marked posterior to total pain area was not associated with any factors in bivariate analysis. Greater levels of incapability were associated with greater feelings of distress regarding symptoms, women, older age, and less education. Greater pain intensity was associated with greater levels of distress and low income.

Conclusion:

The observation that greater distress is associated with a larger marked area on the shoulder pain diagram and higher levels of discomfort and incapability suggests that such markings could be useful to help identify modifiable mindset factors that contribute to shoulder health.

Level Of Evidence:

Level IIIb, Cross Sectional Observational Study.

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