Showing papers in "Pain in 1983"

Ethical guidelines for investigations of experimental pain in conscious animals.

Abstract: The Committee for Research and Ethical Issues of the International Association for the Study of Pain (IASP®) is concerned with the ethical aspects of studies producing experimental pain and any suffering it may cause in animals. Such studies are essential if new and clinically relevant knowledge about the mechanisms of pain is to be acquired. Investigations in conscious animals intended to stimulate chronic pain in man are being performed. Such experiments require careful planning to avoid or at least minimize pain in the animals.

The validation of visual analogue scales as ratio scale measures for chronic and experimental pain

Abstract: Visual analogue scales (VAS) of sensory intensity and affective magnitude were validated as ratio scale measures for both chronic and experimental pain. Chronic pain patients and healthy volunteers made VAS sensory and affective responses to 6 noxious thermal stimuli (43, 45, 47, 48, 49 and 51 degrees C) applied for 5 sec to the forearm by a contact thermode. Sensory VAS and affective VAS responses to these temperatures yielded power functions with exponents 2.1 and 3.8, respectively; these functions were similar for pain patients and for volunteers. The power functions were predictive of estimated ratios of sensation or affect produced by pairs of standard temperatures (e.g. 47 and 49 degrees C), thereby providing direct evidence for ratio scaling properties of VAS. Vas sensory intensity responses to experimental pain, VAS sensory intensity responses to different levels of chronic pain, and direct temperature (experimental pain) matches to 3 levels of chronic pain were all internally consistent, thereby demonstrating the valid use of VAS for the measurement of and comparison between chronic pain and experimental heat pain.

The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment

Abstract: Cognitive and behavioral pain coping strategies were assessed by means of questionnaire in a sample of 61 chronic low back pain patients. Data analysis indicated that the questionnaire was internally reliable. While patients reported using a variety of coping strategies, certain strategies were used frequently whereas others were rarely used. Three factors: (a) Cognitive Coping and Suppression, (b) Helplessness, and (c) Diverting Attention or Praying, accounted for a large proportion of variance in questionnaire responses. These 3 factors were found to be predictive of measures of behavioral and emotional adjustment to chronic pain above and beyond what may be predicted on the basis of patient history variables (length of continuous pain, disability status, and number of pain surgeries) and the tendency of patients to somaticize. Each of the 3 coping factors was related to specific measures of adjustment to chronic pain.

Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale

Abstract: The visual analogue scale (VAS) is a simple and frequently used method for the assessment of variations in intensity of pain. In clinical practice the percentage of pain relief, assessed by VAS, is often considered as a measure of the efficacy of treatment. However, as illustrated in the present study, the validity of VAS estimates performed by patients with chronic pain may be unsatisfactory. Two types of VAS, an absolute and a comparative scale, were compared with respect to factors influencing the reliability and validity of pain estimates. As shown in this study the absolute type of VAS seems to be less sensitive to bias than the comparative one and is therefore preferable for general clinical use. Moreover, the patients appear to differ considerably in their ability to use the VAS reliably. When assessing efficacy of treatment attention should therefore be paid to several complementary indices of pain relief as well as to the individual's tendency to bias his estimates.

Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases

Abstract: This paper reports the development of a self-report instrument designed to assess pain in cancer and other diseases. It is argued that issues of reliability and validity should be considered for every pain questionnaire. Most research on measures of pain examine reliability to the relative neglect of validity concerns. The Wisconsin Brief Pain Questionnaire (BPQ) is evaluated with regard to both reliability and validity. Data from patients with cancer at 4 primary sites and from patients with rheumatoid arthritis suggest that the BPQ is sufficiently reliable and valid for research purposes. Additional methodological and theoretical issues related to validity are discussed, and the need for continuing evaluation of the BPQ and other measures of clinical pain is stressed.

Sensory afferent impulses originate from dorsal root ganglia as well as from the periphery in normal and nerve injured rats

Abstract: Single units were recorded in dorsal roots or in the sciatic nerve of anaesthetised rats. It was shown by making sections, by stimulation and by collision that some ongoing nerve impulses were originating from the dorsal root ganglia and not from the central or peripheral ends of the axons. In a sample of 2731 intact or acutely sectioned myelinated sensory fibres, 4.75% +/- 3.7% contained impulses generated within the dorsal root ganglia. In 2555 axons sectioned in the periphery 2-109 days before, this percentage rose to 8.6% +/- 4.8%. There was a considerable variation between animals; 0-14% in intact and acutely sectioned nerves and 1-21% in chronically sectioned nerves. The conduction velocity of the active fibres did not differ significantly from the conduction velocity of unselected fibres. The common pattern of ongoing activity from the ganglion was irregular and with a low frequency (about 4 Hz) in contrast to the pattern of impulses originating in a neuroma which usually have a higher frequency with regular intervals. Slight mechanical pressure on the dorsal root ganglion increased the frequency of impulses. Unmyelinated fibres were also found to contain impulses originating in the dorsal root ganglion. In intact or acutely sectioned unmyelinated axons, the percentage of active fibres 4.4% +/- 3.5% was approximately the same as in myelinated fibres but there were no signs of an increase following chronic section. Fine filament dissection of dorsal roots and of peripheral nerves and collision experiments showed that impulses originating in dorsal root ganglia were propagated both orthodromically into the root and antidromically into the peripheral nerve. It was also shown that the same axon could contain two different alternating sites of origin of nerve impulses: one in the neuroma or sensory ending and one in the ganglion. These observations suggest that the dorsal root ganglion with its ongoing activity and mechanical sensitivity could be a source of pain producing impulses and could particularly contribute to pain in those conditions of peripheral nerve damage where pain persists after peripheral anaesthesia or where vertebral manipulation is painful.

Capsaicin and sensory neurones--a review.

Abstract: In the late fifties and sixties Jancso published a series of papers on ‘the peculiar pharmacological effect of capsaicin Capsaicin or 8-methyl-N-vanillyi-6-nonenamide is the irritant compound in the capsicum plant (red pepper, chilli pepper, etc.). After initial violent irritation, capsaicin application renders animals and man insensitive to further noxious chemical stimuli. This desensitization can last for weeks or months following systemic administration in rats [47]. Despite this powerful effect, at that time, no clear-cut morphological lesion could be found to accompany it. In 1977, however, Jancso’s son and colleagues reported on the effects of capsaicin administered to neonatal rats. This was followed by a life-long insensitivity to chemical irritants accompanied by destruction of the small ‘B-type’ dorsal root ganglion cells [41]. It was this discovery that began a great surge of interest in the effects of capsaicin, in laboratories all over the world, producing the considerable amount of information that we have about its actions today. Its potential as a specific toxin for peripheral C fibres has made it of particular interest to neurobiologists concerned with pain mechanisms. This review was written as a result of a meeting on capsaicin in November 1981 at the Medical Research Council in London. At this meeting, neuroscientists of different disciplines who had used capsaicin in their research or studied its mode of action came together to discuss problems. Questions that arise out of the work so far, include: (1) Is the action of capsaicin on the peripheral nerve restricted to C fibres? (2) Does capsaicin have a direct effect on central nervous tissue? (3) Is capsaicin an axonal transport blocker? (4) What is the effect of capsaicin on nerve membrane? (5) Does capsaicin treatment result in analgesia? The following review shows to what extent we can answer these and other important questions about capsaicin. It is important too, in a general sense, to decide how useful a tool capsaicin is in understanding the nervous system and how much we have learnt from it so far. The review will be restricted almost completely to the somatosensory system. The effects of capsaicin on cardiovascular, respiratory, thermoregulatory and gastroin-

The incidence of postoperative pain in children

Abstract: The incidence of pain in 170 children recovering from surgery was surveyed in two major teaching hospitals along with an analysis of analgesic medication prescribed and administered. Analgesic medication was not ordered for 16% of the patients and narcotic analgesic medication ordered was no

Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation

Abstract: The incidence and clinical picture of non-painful and painful phantom limb sensations as well as stump pain was studied in 58 patients 8 days and 6 months after limb amputation. The incidence of non-painful phantom limb, phantom pain and stump pain 8 days after surgery was 84, 72 and 57%, respectively. Six months after amputation the corresponding figures were 90, 67 and 22%, respectively. Kinaesthetic sensations (feeling of length, volume or other spatial sensation of the affected limb) were present in 85% of the patients with phantom limb both immediately after surgery and 6 months later. However, 30% noticed a clear shortening of the phantom during the follow-up period; this was usually among patients with no phantom pain. Phantom pain was significantly more frequent in patients with pain in the limb the day before amputation than in those without preoperative limb pain. Of the 67% having some phantom pain at the latest interview 50% reported that pains were decreasing. Four patients (8%), however, reported that phantom pains were worse 6 months after amputation than originally. During the follow-up period the localization of phantom pains shifted from a proximal and distal distribution to a more distal localization. While knifelike, sticking phantom pains were most common immediately after surgery, squeezing or burning types of phantom pain were usually reported later in the course. Possible mechanisms for the present findings either in periphery, spinal cord or in the brain are discussed.

Patterns of postoperative analgesic use with adults and children following cardiac surgery

Abstract: The postoperative prescription and administration of analgesics following cardiac surgery for 50 children were compared with those of 50 adults. Six children were the only patients in the sample who were prescribed no postoperative analgesics. Overall, children were prescribed significantly fewer potent narcotics. The administration data revealed even more pronounced group differences. During the observation period, children received 30% of all analgesic administrations while adults received 70%. Some possible reasons for these age differences in analgesic usage are presented and implications regarding the adequacy of postoperative pain control in children are discussed.

The multidimensional nature of cancer-related pain

Abstract: A critical review of the literature examining the assessment of cancer-related pain revealed a lack of systematic research. In the present study, 40 patients with cancer-related pain were compared to 37 pain-free cancer patients matched on diagnosis, stage of disease, age, sex, and inpatient vs. outpatient status. The results supported a multidimensional conceptualization of cancer-related pain consisting of sensory, affective, cognitive, and behavioral components.

Relationships between nurses' observations and patients' self-reports of pain

Abstract: Pain researchers and clinicians alike are often troubled by a lack of correspondence between non-verbal behavior and patients' self-reports of level of pain. This paper discusses some of the variables which can effect the relationship between these measures. In addition, the paper reports on the reliability of nurses' observations of pain behavior and of their inferences about the intensity of a patient's pain. In general, though these observations and inferences have adequate reliability, the correspondence between such inferences and patients' reports of pain intensity are modest, though significant. Discrepancies between observers' and patients' ratings of pain are greater in a chronic pain sample (N = 37) than in an acute pain sample (N = 34). Theoretical implications of these results are discussed.

On the evaluation of the clinical effects of acupuncture

Abstract: This paper reviews some of the recent randomised trials on acupuncture published in the literature, with particular reference to the definition of placebo (control), sham acupuncture and real acupuncture. Response rates of 30, 50 and 70% of placebo, sham and real acupuncture respectively, are suggested for the groups of patients studied. The statistical methodology necessary in the design of acupuncture trials, in order to detect differences of this order of magnitude, is discussed. If the postulated response rate had been envisaged at the onset of the trials here reviewed, then the majority of these trials have very low power at a conventional 5% level of significance. It is emphasised that one cannot necessarily conclude from trials which produce statistically non-significant results that acupuncture (when compared with placebo for example) is ineffective. The paper suggests that meaningful comparisons between alternative treatments may be made by using ‘pain free intervals’ with subsequent analysis using life table techniques. Tables are provided for determining appropriate patient numbers.

Partial antagonism of placebo analgesia by naloxone.

Abstract: Thirty subjects were given a placebo (intravenous saline), which was described as a known pain killer, once a week for 3 consecutive weeks. Experimental ischemic arm pain was produced prior to the placebo and again 1 h later. In a double blind procedure, half of the subjects received 10 mg of naloxone after placebo; the remaining subjects received naloxone vehicle. In addition to the placebo session, there were control and naloxone sessions each week to determine the normal changes in pain and the effect of naloxone on the pain, respectively, when no placebo was given. Significant placebo-induced analgesia was demonstrated, and a group of consistent placebo responders was identified. Although naloxone alone had no effect on the experimental pain, naloxone diminished the analgesic effectiveness of the placebo, suggesting that endogenous opioids are involved in producing placebo-induced analgesia.

Preoperative predictors of postoperative pain

Abstract: This study attempted to predict postoperative pain from preoperative level of anxiety and the amount of information patients possessed regarding their surgery. Pain was assessed via the McGill Pain Questionnaire (MPQ) and a measure of pain complaints--number of analgesics taken. High levels of state anxiety and a high degree of information predicted the Present Pain Intensity measured of the MPQ, but did not predict the Pain Rating Index portion of the MPQ. The number of analgesics taken was predicted from the amount of information but not the level of presurgical anxiety. Biographical variables were unrelated to postoperative pain. The results were discussed in terms of State-Trait Anxiety theory, Janis' curvilinear prediction model and a contextual perspective of information imparting.

A clinical comparison of two pain scales: Correlation, remembering chronic pain and a measure of compliance

Abstract: Fifteen chronic pain patients rated their pain intensity on both a visual analogue scale and a verbal scale so that comparisons between the scales could be made for each subject. Compliance to fill in the rating blanks and the remembering of pain intensity were also studied. Subjects first made a pre-baseline estimate of their pain and then they rated their pain throughout a baseline and treatment period averaging 5 weeks. Four to 9 weeks after baseline, subjects were asked to remember how much pain they had had at baseline and to confidentially provide ratings concerning their compliance. Results indicated that two-thirds of the individual subjects had significant correlations between the scales with a mean of 0.68. The one-third of the subjects who did not have significant correlations also had significantly less variability in their ratings than did subjects with significant correlations. This low level of variability may account for the lack of a significant correlation between the scales for these subjects. Discrepancies between actual baseline and remembered pain ratings were observed on both rating scales, but the visual analogue scale produced significantly greater discrepancies than the verbal scale. This was mainly because subjects tended to overestimate their baseline pain on the visual analogue scale, while discrepancies on the verbal scale were in both directions (overestimations, underestimations) when taken as a group. On the other hand, discrepancies between the pre-baseline estimate of pain and remembered ratings were smaller than the discrepancy between actual baseline ratings and remembered pain ratings suggesting that there is an important cognitive component guiding the remembered pain recordings. Finally, compliance to fill in the blanks at the scheduled time was high on both scales. Taken as a whole, the results imply that the verbal pain scale may be the scale of choice when compared to the visual analogue scale.

Regional intravenous guanethidine vs. stellate ganglion block in reflex sympathetic dystrophies: a randomized trial.

Abstract: Regional intravenous guanethidine blocks and stellate ganglion blocks have been compared in a randomized trial Nineteen patients, randomly allocated to two groups of therapy and exhibiting severe reflex sympathetic dystrophy following peripheral nerve lesions, have been treated The performance of the intravenous guanethidine block is of longer duration and superior to stellate ganglion block, as regards some early pharmacological effects (skin temperatures and amplitude of plethysmographic waves recorded before blockade and 15 min, 60 min, 24 h, 48 h after institution of the block) In fact the intravenous guanethidine group shows a persistent and significant increase of the skin temperature and of the plethysmographic traces in the blocked side 24 h and 48 h after blockade in comparison with the patients treated with stellate ganglion block Concerning the therapeutic effects (changes in pain scores and clinical signs — hyperpathia, allodynia, vasomotor disturbances, trophic changes, oedema and limited motion), recorded at the end of treatment and 1 month and 3 months follow-up, an intravenous guanethidine block carried out every 4 days up to a total of 4 blocks is comparable with a stellate ganglion block every day up to a total of 8 blocks The results of this study show that regional sympathetic block with guanethidine is a good therapeutic tool in the treatment of reflex dystrophies, especially on account of its negligible risks and contraindications

A review of follow-up studies of multidisciplinary pain units.

Abstract: Chronic pain is a major public health problem in the United States. Estimates from the National Institutes of Health put the cost of chronic pain at 40 billion dollars a year. They estimate that as many as 15 million adults suffer from low back pain with a minimum cost of 5 billion dollars in direct medical costs and 93 million work days lost every year. In an attempt to cope with this massive problem, multidisciplinary pain units have arisen which attempt to address the complex, multi-faceted aspects of a chronic pain problem. The importance of this new treatment approach is made evident by the 1981 overview of multidisciplinary pain centers published by the National Institutes of Health. In this publication, the history and success of these units since their first development by Bonica are evidenced. The purpose of the present paper is to briefly, critically summarize one small aspect of these programs, specifically follow-up analysis of the patients after discharge.

The assessment of pain by cerebral evoked potentials.

Abstract: Cerebral evoked potentials have been recorded by various means for nearly 100 years [ 14

Pain as a symptom in depressive disorders. I. Relationship to diagnostic subgroup and depressive symptomatology

Abstract: The incidence of pain as a symptom in depressive disorders has been studied in a series of 161 depressed patients admitted to the Department of Psychiatry, Umea University. 57% of the patients reported pain as a symptom. Female patients reported pain significantly more often than male patients and the patients with pain were found to be significantly older than those without. Despite the fact that patients with neurotic reactive depressions were significantly younger than the patients in the other diagnostic subgroups, they reported pain significantly more often than patients with other depressive disorders. Patients with pain were found to have significantly more muscular tension and more autonomic disturbances while no significant differences were found in items measuring sadness or inhibition-retardation.

Acupuncture compared with placebo in post-herpetic pain

Abstract: A single blind randomised controlled study of auricular and body acupuncture compared with placebo (mock transcutaneous nerve stimulation) was performed in 62 patients with post-herpetic neuralgia. There was no difference in the amount of pain relief recorded in the two groups during or after treatment; 7 patients in the placebo group and 7 patients in the acupuncture group experienced significant improvement in their pain at the end of treatment. This suggests that acupuncture is of little value as an analgesic therapy for post-herpetic neuralgia. However the study method and the use of a mock transcutaneous nerve stimulator as a placebo may be of value when assessing the effects of acupuncture in other conditions.

A new approach to the neurolytic block of the coeliac plexus: The transaortic technique

Abstract: The present study critically examines the coeliac plexus block techniques hitherto adopted, pointing out the complications involved and stressing the seriousness of the neurological complications due to spread of the neurolytic agent to the sympathetic chain and the lumbar plexus. Contrast enhanced CT scans demonstrate the difficulties involved in confining the neurolytic agent to the anterior, peri-aortic and precrural regions. The authors report their recent experience with coeliac plexus block by means of a single transaortic needle in 28 patients. In 12 of the patients, the CT scan revealed a spread was anterior to the medial crura of the diaphragm, sometimes extending laterally towards the costovertebral gutter along the ventral surface of the diaphragm.

Naloxone fails to reverse pain thresholds elevated by acupuncture: acupuncture analgesia reconsidered.

Abstract: We were unable to demonstrate the reversal of dental acupunctural analgesia following the injection of 0.4 mg naloxone using evoked potential methodology. Since our findings differed from those of Mayer, Price and Rafii who used pain threshold methods, we attempted to replicate their study. Subjects who demonstrated acupunctural analgesia during electrical stimulation of the LI-4 point on the hands received either 1.2 mg naloxone or normal saline under double blind conditions. Pain thresholds elevated by acupuncture failed to reverse when naloxone was given. Review of experimental design issues, other related human subjects research, and animal studies on acupunctural analgesia provided little convincing evidence that endorphins play a significant role in acupunctural analgesia. Because endorphins can be released in response to a Stressor, endorphin presence sometimes correlates with acupunctural treatment in animal studies and some human studies, especially those involving pain patients. The primary analgesia elicited by acupunctural stimulation seems to involve other mechanisms.

Axoplasmic transport block reduces ectopic impulse generation in injured peripheral nerves

Abstract: Afferent fibers ending in nerve end neuromas in rats generate a substantial ectopic discharge and are sensitive to light pressure and to circulating adrenaline. Treatment of the nerve with colchicine or vinblastine at the time of the nerve section resulted in a dose-dependent reduction in the extent of this discharge. Such treatment also reduced neuroma discharge that had already gotten underway.

Non-pain and pain sensations evoked by tooth pulp stimulation.

Abstract: This study investigated the quality and magnitude of sensations evoked by electrical tooth pulp stimulation. Detection threshold (the minimum current intensity that evoked a sensation) and pain threshold were determined for tooth pulp stimuli varying in frequency from 5 to 500 Hz. The effect of frequency and intensity of tooth pulp stimulation on the magnitude of sensations was assessed using visual analog scales and verbal descriptor scales. Detection thresholds were stable over experimental sessions and independent of the frequency of the stimulating current. Pain threshold varied as a function of frequency with a minimum value at 100 Hz. Stimuli that evoked non-pain sensations at low frequencies evoked pain sensations when frequency was increased from 5 to 100 Hz. Subjects were able to scale non-pain sensations over a range of stimulus intensities and frequencies. The lowest currents evoked sensations that were nonpainful and were of constant magnitude despite changes in the frequency of stimulation. Higher stimulus currents evoked sensations that were non-painful at low stimulus frequencies and painful at high stimulus frequencies. Sensation magnitude at each stimulus intensity increased as a function of frequency. Temporal summation occurred in proportion to stimulus intensity. These findings suggest that the non-pain sensations evoked in tooth pulp are mediated by a distinct population of afferents that are not involved in the coding of pain. High frequency stimulation that increased the discharge rate of the lowest thershold pulpal afferents resulted in no summation of non-pain sensation and never produced pain. However, high frequency stimulation evocked greater magnitude sensations at higher stimulas currents, indicating that central summation mechanisms were critical for higher threshold afferents signaling more intense non-pain and pain sensations.

Efficacy of EMG biofeedback, pseudotherapy, and conventional medical treatment for chronic rheumatic back pain.

Abstract: Twenty-four patients suffering from chronic rheumatic back pain were treated with EMG biofeedback, a credible pseudotherapy, or conventional medical treatment alone during a 4 week inpatient stay at a Rheumatology Clinic. At the end of the treatment phase and at the 4 month followup the patients in the biofeedback group showed significant improvements in the duration, intensity and quality of their back pain as well as their EMG levels, negative self-statements and utilization of the health care system. In contrast, the pseudotherapy group showed minimal, but non-significant improvements and the medically treated group remained unchanged.

The validity of experimental pain measures

Abstract: Forty subjects served in a study investigating the characteristics of experimental pain measures. Subjects indicated when their pain threshold and tolerance levels had been reached with each of three Stressors: cold, pressure, and electrical shock. Using the multitrait-multimethod matrix procedure, the measures of threshold and tolerance were found to show both generality and discriminant validity across Stressors. Threshold judgements, which emphasize discrimination of nociceptive quality, and tolerance decisions, which indicate an unwillingness to receive more intense stimuli, are not equivalent measures of responsiveness. Both should be obtained in studies involving experimental pain. Stressors, while related, are also not equivalent. Minimum method variance was associated with the discomfort produced by electrical pulse trains.

Transcutaneous electrical nerve stimulation (TENS) as compared to placebo TENS for the relief of acute oro-facial pain

Abstract: The present paper describes the effect of high frequency, low frequency and placebo TENS on acute oro-facial pain in 62 patients, attending to an emergency clinic for dental surgery; they had all suffered pain for 1-4 days. The patients were randomly assigned to one of three groups receiving either high frequency (100 Hz), low frequency (2 Hz) or placebo TENS. In the two groups receiving TENS (42 patients) 16 patients reported a reduction in pain intensity exceeding 50%; out of these 16 patients, 4 patients reported complete relief of pain. In the placebo group (20 patients) 2 patients reported a pain reduction of more than 50%; out of these 2 patients, none reported a complete pain relief. Mechanical vibratory stimulation augmented the pain reduction obtained by TENS in 5 out of 10 patients.

Periaqueductal grey stimulation: an association between selective inhibition of dorsal horn neurones and changes in peripheral circulation

Abstract: In barbiturate-anaesthetized and paralysed cats, dorsal horn neurones were studied during electrical stimulation of the periaqueductal grey matter (PAG) and the midbrain ventral tegmentum (VT). Responses to impulses in unmyelinated primary afferents were selectively inhibited by stimulation in the PAG, whereas stimulation in the VT non-selectively reduced both these responses and those to innocuous cutaneous stimuli. Stimulation in the PAG but not the VT produced changes in peripheral circulation. This was observed as a rise in the levels of carbon dioxide in expired air, a rise in muscle temperature in the hind limb and a fall in skin temperature of the pinna or glabrous skin. The combination of suppression of spinal transmission of impulses related to pain and an increase in perfusion of muscles may be a mechanism appropriate to coping with a potentially injurious environment.

Children's drawings of their pain.

Abstract: Children and adolescents with recurrent migraine headaches or musculo-skeletal pain were asked to draw a picture of their pain and another picture of themselves in pain. The drawings were categorized according to content and color. No differences in content or dominant color of drawings was found for sex and there were no changes with age (5–18 years). Children with recurrent migraine more often drew themselves doing something to relieve their pain, than did children with musculoskeletal pain. Implications for the use of pain drawings in the treatment of chronic and recurrent pain are discussed.