DEVELOPMENT OF A NOVEL SOFTWARE FOR PAIN DRAWING ANALYSIS

A. Kanellopoulos¹, E. Kanellopoulos², Z. Dimitriadis¹, N. Strimpakos¹, A. Koufogianni¹, I. Poulis¹

Background: Chronic pain is a common problem, quite often complex and persistent, with a significant impact on individuals, economy, and society. Frequently, the pain is expressed in an expanded area, sometimes far away from the expected location (if there is any), which is a well-recognized nowadays sign of central sensitization (CS). Quantification of pain is an overly complex and demanding task due to the nature of this symptom. Although Analog Pain Drawings (APD) -like pen-on-paper drawings- have been extensively used in the clinical assessment and in clinical research in an attempt to quantify the pain extent and to describe pain location, there is a lack of a Digital Pain Drawing (DPD) Software, that would be able to quantify and analyze the digital pain distribution obtained by the patients.

Purpose: The authors designed and developed a freely available software to analyze data from digital pain drawings.

Methods: The application was developed in four stages. All stages were conducted by the researchers.
Stage 1:  The literature was reviewed for the current state of DPD analysis methods and software available. The application analysis conducted was based on the information gathered from the literature, and software specifications were defined.
Stage 2: A professional illustrator created a new HD digital body map image (Reference Image -RI) and the programmers created the preliminary screen layouts, which were assessed by the whole team. Based on the results, the final layout of the screens and the final RI were developed.
Stage 3: The programmers finalized a custom-built software (pain_distribution.exe, available for download at https://www.hprl.physio.uth.gr/pain-distribution) developed in VC++ and designed to use exclusively our reference image in order to automate its calculations.
Stage 4: The application was tested thoroughly for validity and reliability errors (bugs) until its performance became absolute.

Results: We developed a custom-built software named “Pain Distribution”. The main functions of the application are: Pain extent: The Pain Distribution application automatically calculates the number of the pixels the patient has chosen; Smart Selected Area Calculations Tool: filling possible uncolored gaps inside the drawings of the patients; Probe Tool: provides the Frequency Distribution from a group of images; Central Sensitization Threshold: Prior to any calculation, the user has the option to select the threshold over which the patient is considered with Central Sensitization; Results: Results and statistics are presented in the Graphical User Interface (GUI) for both every image and the frequency distribution, providing mean values, standard deviations, and CS indicators. Exporting: Results can be exported in *.txt file format for further analysis.

Conclusion(s): A novel Pain Distribution application was developed, freely available for use in any setting, clinical, research or academic.

Implications: Pain Distribution is a novel application, which analyses the area of pain drawn digitally by the patients. Further development of the application is possible in case of demands from the pain scientific community.  

Funding, acknowledgements: The project was not supported by any funding.

Keywords: pain assessment, pain drawing analysis, pain distribution software

Topic: Pain & pain management

Did this work require ethics approval? No

Institution: University of Thessaly, Greece

Committee: Department of Physical Therapy Ethical Committee

Reason: Software development. No experiment with human or any other being took place.