Pain Drawings Predict Recommendations for Lumbar Spine Surgery

Introduction: As spine surgeons become increasingly overwhelmed with referrals, appropriate pre-clinic patient triaging is becoming paramount. Pain drawings are commonly used during intake in spine clinics and offer pre-clinic, patient-specific data. When stratified into organic/non-organic, have been shown to correlate with outcomes after decompressive surgery and lumbar spinal fusion. To our knowledge, no study has investigated the predictive value of pain drawings for recommendation of lumbar spine surgery. Herein, we present our investigation into this question.

Methods: After IRB approval, adult patients seen in clinic by senior author (AER) from years 2022-2024 were collected retrospectively. Inclusion criteria included minimum 1 year follow-up from initial visit and presence of pain drawing. Demographic and comorbidity data were collected, as well as the binary outcome of recommendation for lumbar surgery or not. Pain drawings were classified (AF), using the visual inspection method, as organic, possibly organic, possibly non-organic, and non-organic. Univariate and multivariate analysis with Chi-Squared and logistic regression was performed.

Results: A total of 208 included patients with drawings were included. Univariate analysis showed only pain drawing category (p=0.05) to be associated with outcome, while age, gender, bmi, smoking, cardiopulmonary comorbidities, diabetes did not (p>0.05). On multivariate analysis, only cardiac comorbidities (p=0.035) and pain drawing (p=0.025) were associated with outcome. Stratifying the pain drawings revealed organic drawings predicted recommendation for surgery (OR 2.4, p = 0.05) and non-organic drawings predicted recommendation against surgery (OR 0.5, p = 0.01). Neither possibly organic (p = 0.46) nor possibly non-organic (p = 0.49) predicted outcome.

Conclusion : Pain drawings can predict recommendation for lumbar spinal surgery and may be useful in pre-clinic patient triage. Larger sample size across multiple surgeons and institutions is required to validate these findings.