The association between pain diagram area, fear-avoidance beliefs, and pain catastrophising

Bruce F. Walker, Christine D. Losco, Anthony Armson, Amanda Meyer, Norman J. Stomski

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Background: The development of clinical practice guidelines for managing spinal pain have been informed by a biopsychosocial framework which acknowledges that pain arises from a combination of psychosocial and biomechanical factors. There is an extensive body of evidence that has associated various psychosocial factors with an increased risk of experiencing persistent pain. Clinicians require instruments that are brief, easy to administer and score, and capable of validly identifying psychosocial factors. The pain diagram is potentially such an instrument. The aim of our study was to examine the association between pain diagram area and psychosocial factors.Methods: 183 adults, aged 20-85, with spinal pain were recruited. We administered a demographic checklist; pain diagram; 11-point Numerical Rating Scale assessing pain intensity; Pain Catastrophising Scale (PCS); MOS 36 Item Short Form Health Survey (SF-36); and the Fear Avoidance Beliefs Questionnaire (FABQ). Open source software, GIMP, was used to calculate the total pixilation area on each pain diagram. Linear regression was used to examine the relationship between pain diagram area and the following variables: age; gender; pain intensity; PCS total score; FABQ-Work scale score; FABQ-Activity scale score; and SF-36 Mental Health scale score.Results: There were no significant associations between pain diagram area and any of the clinical variables.Conclusion: Our findings showed that that pain diagram area was not a valid measure to identify psychosocial factors. Several limitations constrained our results and further studies are warranted to establish if pain diagram area can be used assess psychosocial factors.

Original languageEnglish
Article number5
JournalChiropractic and Manual Therapies
Issue number1
Publication statusPublished - 20 Jan 2014
Externally publishedYes


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