FOUNDATION FIELDBUS (FF).

The first aim was to look at the relationship between the responses to the pain drawing and the responses to the pain question. No other study was found in the literature search that looked specifically at the pain question. There were a number of studies that looked at the pain

drawing but not directly in relation to the pain

question. Only McCaffery and Beebe (1989) and Margoles (1983) mentioned verbal description of pain location. McCaffery et al (1989) said:

"When asking a patient about the location of pain, do not rely solely on a verbal description of the location. Ask the patient to point to or trace

with two fingers the area of pain. Verbal

descriptions of pain location can be confusing and nonspecific." (p. 22)

Similarly, Margoles (1983) felt that the pain drawing provided a more accurate record of pain than the verbal or written record and said:

"the pain chart has the capability of

demonstrating areas of involvement that are not always completely disclosed or understood in the verbal recording of pain complaints." (p. 218)

The results indicated that responses to the pain drawing

and the pain question were not identical. Two aspects of

pain were measured, number of sites of pain and location of pain. To compare the responses to the pain question

and the pain drawing, the same scoring system was used

for the measures, that is, the pain site check-list was

used for the number of sites of pain and the pain location check-list was used for the location of pain

(See Appendix M and Appendix N ) .

For the number of sites of pain, scoring the pain drawing and the pain question revealed that in 18/63 or 28.6% the pain drawing scored a higher number of sites than the pain question. Regardless of whether the pain question or the pain drawing was asked at the beginning or later in the interview, the pain drawing scored a higher number of sites more often. In addition, the correlations between the different scoring systems for the number of sites of pain revealed that the weakest correlations were between the pain question with the pain-site check-list and the pain drawing with the KF, adapted Toomey and Margolis

scoring systems.

For the location of pain, the responses to the pain drawing seemed to reveal larger locations of pain such as

"upper quadrant, back and extremities" whereas the

responses to the pain question were more often coded to smaller locations such as "ventral" or "upper quadrant and extremities".

These findings suggest that the pain drawing and the pain question were measuring different aspects of pain. It was possible that the patient only mentioned their major pain with the pain question and reported other pains with the pain drawing. Perhaps when a patient was asked the pain question, they did not have the space to expand on their answer, because other questions were being fired at them and when they drew their pain they had more time to think about their pain or pains and therefore greater freedom to report more. It was possible that the author or the researcher wanted to know about the major pain when asking the pain question and subconsciously a patient would only give one site of pain and location. Or the patient felt it was important to stress only one site of pain when asked the question, because they wanted the author or researcher to know where it hurt as they were directly talking to them. With the pain drawing, the patient was not directly facing the author or researcher but looking at the paper and drawing their pain on the paper. This may have allowed the patient to draw more

sites of pain rather than just talk about the most important pain. The body outline on the paper may have given the patient a prompt to think about different areas of the body and therefore revealed more sites of pain and larger locations of pain. The pain question is an open question and did not prompt the patient to think about the whole body, but possibly made the patient concentrate on where the central or most important pain was. With this in mind, the scoring systems for the two measures were probably scoring different aspects of pain and therefore suggests why the correlations between the pain drawing with the scoring systems and the pain question with the pain site check-list were the weakest.

In addition, the pain drawing revealed more precise

locations of pain, especially regarding whether the pain was on the right or left side of the body. From the first pilot study (section 3.7.1), the author could not code

several pain questions with the Kabat-Zinn scoring

system, because it demanded details about whether the pain was on the left or right side of the body. This

detail was given in the pain drawings, but not

necessarily in the pain question. With the pain drawing the patient is forced to think about which side the pain is on, but not with the pain question.

Clinically, the pain question is possibly not adequate to assess all the number of sites of pain and the precise location of pain, even though asking "where is your pain"

is a common question asked by health professionals at the initial examination or assessment of a person's pain and may be the only such question. This study suggests that a

pain question may only report some of the patient's pain

and possibly not give a precise location. The study

supports McCaffery et al (1989) and Margoles (1983)

statements that the verbal description of pain is not adequate in disclosing all the pain sites and locations of pain. If a health professional were to only ask the pain question, other questions need to be asked about possible other sites of pain and where exactly the pain

is, right or left, in the lower or upper part of the

body, for example.

5.2.2 THE RELATIONSHIP BETWEEN THE RESPONSES TO THE PAIN