A Systematic Review of Pain Drawings for Perioperative Patient Management

Pain is a highly individual experience that can challenge effective patient-doctor communication. Patient drawings of pain (PDs) have been proposed as a tool to enhance communication and understanding. We aimed to evaluate the strengths and limitations of PDs for (1) screening and diagnosis of pain conditions, (2) prediction of surgical outcomes, and (3) postoperative pain monitoring in pediatric and adult surgical patients.

We conducted a systematic literature search of PubMed/MEDLINE, Embase, Web of Science, and CENTRAL up to June 1, 2023. Studies assessing PDs in surgical populations were screened, and data on study design, patient population, and outcomes were extracted.

The search identified 10,815 articles, of which 26 met the inclusion criteria, encompassing 5977 patients. Six studies (23%) assessed PDs as screening or diagnostic tools; 4 of these (67%) reported PDs to be effective in identifying neuropathic pain. Nine studies (35%) examined PDs as predictors of postoperative outcomes, particularly after nerve decompression and spine surgery. Eleven studies (42%) evaluated PDs for postoperative follow-up, demonstrating their utility in tracking pain evolution over time.

PDs represent a promising tool for preoperative screening and diagnosis of neuropathic pain, prediction of surgical response, and postoperative pain monitoring. However, heterogeneity in methodology highlights the need for standardized parameters and assessment criteria. Future prospective trials are warranted to establish consistent evaluation frameworks and to further define the clinical utility of PDs.