Headache sufferers‘drawings reflect distress, disability and illness

Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Journal of psychosomatic research (Impact Factor: 2.74). 06/2009; 66(5):465-70. DOI: 10.1016/j.jpsychores.2008.09.006
Source: PubMed


Drawings have recently been used with patients with heart problems to assess their perceptions of their illness. This study aimed to investigate whether drawings could be a useful way to assess headache patients' perceptions of their headaches and their reactions.
In a cross-sectional study, 65 university students who experienced persistent headaches were asked to draw a picture of how their headaches usually affected them. Drawings were assessed in three ways: they were categorized based on content; their size was measured; and image analysis software assessed their darkness. Associations between drawings, illness perceptions, mood, and health outcomes were assessed.
Twenty-seven people drew an external force to the head and these people had greater ratings of average pain and were more likely to attribute their headache to stress. Darker drawings were associated with greater emotional distress and lower vitality. Larger drawing size was associated with perceptions of worse consequences, worse symptoms, worse emotional representations, lower vitality, higher pain, and more days of restricted activity, lower happiness, and higher sadness.
Drawings offer an additional way to assess peoples' experience of their headaches and reflect illness perceptions and distress. People draw how they see themselves experiencing their headache and often include expressions and reactions. The inclusion of force to the head, darker drawings, and larger drawings are associated with worse perceptions of the headache and higher pain. Drawings may be a useful way for clinicians to understand patients' experience of pain.

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    • "Participants were reassured that drawing ability was not being considered. Instructions were adapted from previous research using drawings (Broadbent et al., 2009). The drawing item was followed by an open-ended question ('please add any comments if you feel it might help us to understand what your drawing means to you') to aid analysis. "
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    ABSTRACT: Introduction: This study aimed to use drawing as a means to explore the content of pain-related images in a sample of people with chronic pain. Method: Adults (n = 90) attending three United Kingdom National Health Service pain clinics were asked to bring to mind and draw an image of their pain. Drawings were analysed using critical visual analysis methodology. Results: Fifty-four participants drew a picture of their pain. Drawings were vivid, emotionally charged and included catastrophic interpretations of pain. Image content was described using three main themes: pain as an attacker, the nature of pain (pain sensations, timeline, pain location) and the impact of pain (pain as a barrier, being trapped by pain and the future with pain). Drawings reflected different perspectives taken in the image, with images of the person themselves in pain (as if seen through the eyes of an observer) evoking a sense of helplessness and isolation. Conclusion: Pain-related images can provide a valuable insight into people's pain worlds, with images reflecting pain cognitions and barriers to recovery. Clinicians may find drawing a helpful tool in the assessment and management of chronic pain, enabling a visual and shareable language for pain.
    Full-text · Article · Jul 2015
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    • "Qualitative analysis Each drawing was qualitatively assessed by identifying the prominent aspects of the drawings ( in line with previous assessments of patient drawings ( Broadbent et al . , 2009 ) ) . These initial assessments were used to develop a coding framework of the fea - tures depicted in the drawings , which was then applied independently to each drawing by two researchers ( SS and NS ) . Comparison of the coding indicated relatively few dis - crepancies . The few areas of disagreement included : definitions / descript"
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    Full-text · Article · Feb 2015 · Psychology and Health
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    • "Visual Representations of Pain Recently , researchers have begun to explore the use of visual representations as an aid to pain communication . Patients ' drawings of their headaches have been found to contain detailed information about features of the pain such as location and quality ( Broadbent , Niederhoffer , Hague , Corter , & Reynolds , 2009 ) , and clinicians are able to dif - ferentiate with some success between migraine and nonmi - graine headaches based on these images ( Stafstrom et al . , 2002 ; Wojaczynska - Stanek , Koprowski , Wróbel , & Gola , 2008 ) . "
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