SCORING SYSTEMS

The author needed to quantify the pain drawing and the

pain question. From the literature review several

scoring systems were found to be suitable for scoring the pain drawing and the pain question. These are described below. For clarity and in order to aid the reader, each scoring system will be given a name for the remainder of this thesis.

3.6.1 SCORING SYSTEMS FOR THE PAIN DRAWING

a) Toomey, Cover and Jones (1983) described a scoring

method to measure the total number of sites of pain with

the pain drawing, as described in section 2.8.3. (see

Appendix H) . Only the anterior and posterior displays of

the body were used in this study and the additional

displays of the face, neck and the jaw were disregarded, because the present sample did not have many patients

with head or facial pain as did Toomey et al's (1983)

sample. This left in total 22 sites, (see Appendix J) The

author used a plastic template marked with the 22 sites

marked was given a score of one and each unmarked site a score of 0. The criteria to determine whether marks were present in the sites were:

1) Any area was scored 1 if any portion of it was shaded, no matter how slightly.

2) Marks were not scored which clearly serve to direct the scorer’s attention to the intensity of pain in an area rather than its distribution.

3) Areas which were circled were to be treated as if the entire circled area had been shaded.

4) Marks outside the drawing were to be disregarded.

For location of pain the area was given a specific number. The numbered areas which had been shaded were

recorded on the coding sheet. (see appendix K) . This

scoring system will be known as the adapted Toomey scoring system.

b) Another scoring system was devised by Margolis, Tait and Krause (1986) to measure the number of sites of pain

and the percentage of body surface in pain. It was

described in section 2.8.4 (see appendix I). The author used a plastic template with the 45 sites marked to cover

the patients’ drawings. As in the adapted Toomey scoring

system the same criteria were used to quantify the number of pain sites. In addition, weights were assigned to sites equal to the percentage of body surface they covered. To score the drawings, the number of sites in

pain and the weighted equivalent were calculated. The weighted score reflected the total percentage of body surface that the patient shaded as painful. Also the specific numbered areas in pain were recorded as the location of pain. This scoring system will be known as the Margolis scoring system.

c) A further scoring system for the pain drawing was described by Gray, Rothwell and Wastell (1986) and by Wastell and Gray (1987). (see section 2.8.5) A similar method was used to score the pain drawing. The author used a grid which was ruled in a 1.0 cm squares and the front of the body was indexed from A-1 horizontally and 1-19 vertically and the back of the body again A-I horizontally and 1-19 vertically. A plastic template with the grid and the body outline on it was superimposed onto the drawing and a score of one given to every square marked or enclosed in a circle of pain. This scoring

system will be known as the Gray scoring system.

3.6.2 SCORING SYSTEMS FOR BOTH THE PAIN DRAWING AND THE PAIN QUESTION

a) Kabat-Zinn (1983) devised the Body Part Problem

Assessment (BPPA) which consists of a list of 53 body regions. This list was used as a check-list to tick any body region which had been marked on the pain drawing or recorded in the pain question. The total number of sites of pain were counted and the location of pain recorded.

This scoring system will be known as the K a bat-Zinn c h e c k - l i s t .

b) Toomey, Gover and Jones (1984) grouped their patients

into 4 groups: head and/or neck; low back; both

(head/neck and low back) and neither (head/neck nor low

back but extremities, trunk or upper back). This was used

by the author to classify the pain locations from the responses of the pain question and the pain drawing. This scoring system will be known as Gover check-list.

c) Savedra, Tesler, Holzemer, Wilkie and Ward (1989)

arrived at a list of 10 areas of pain by calculating the frequencies of pain sites marked by the children and adolescents in their study. This list of areas of pain was used as a check-list to code the number of sites and location of pain from the responses of the pain question and the pain drawing. This scoring system will be known as the Savedra check-list.

d) Another list of frequencies of pain areas was

described by Tait, Chibnall and Margolis (1990).

Describing their data they found that the pain

distributions were quite varied for their sample. They categorised these areas of pain into 8 groups. These groups or list of pain areas were used by the author to count the number of sites recorded and the locations were ticked if they were present in the response to the pain question and the pain drawing. This scoring system will

be known as the Tait check-list.