Authors

  1. Hesch, Jerry W.

Article Content

Background & Purpose: This paper proposes enhancement of the traditional pain drawing with transverse and sagittal plane slices to increase deep somatic representation, based on anatomical relevance. Pain drawings are a basic part of medical charts used by the medical community, including Physical Therapists (PT). The pain drawing allows the client to communicate their subjective experience of pain in a visual manner. The pain drawing is a 2-dimensional (2-D) image using a line drawing of the body in an anterior and posterior view, which by design does not allow distinction between superficial and deep pain. The author created a three dimensional (3-D) pain drawing by tracing transverse plane MRI images from THE VISIBLE HUMAN PROJECT(TM). These are linked to a typical 2-D pain drawing, which the author also enhanced with sagittal plane slices of the human body. Case Description: There are many areas of the body where both deep and superficial pain is experienced. One such example is that of traumatic injury of peripheral nerves that originate deep within the abdomen, traverse the inguinal canal, and ultimately become superficial; such as the ilioinguinal, iliohypogastric, and genital portion of the genitofemoral nerve. Each nerve having a tortuous, multi-planar, sensory pathways. Pain that is visceral, sclerotomic, or sympathetically mediated may be experienced deeply within the body. A question arises as to whether or not clients would communicate more effectively, hastening correct diagnosis if given a tool to visually express deep, 3-D pain. It is presently unknown whether or not the current use of a 2-D pain drawing encourages bias towards initially viewing pain as superficial and dermatomal. It is reasonable to assume that a 3-D pain drawing with a transverse image of the thigh, with bold demarcation in the middle, would immediately raise the index of suspicion of bone tumor, when the same pain represented on a 2-D pain drawing could appear to be a less urgent problem. Outcomes: Research shows a trend in which initial medical consultations are taking less time than is optimal when screening for serious pathology. Because medical screening is part of a PT curriculum and clinical practice, this novel tool may be worthwhile for trial use and evaluation. Research is needed to determine if the overall clinical utility of the proposed 3-D pain drawing exceeds the traditional 2-D model.