Pain Sites According to Pain Drawing Versus Clinical Examination

Objectives: This study aimed to (1) compare the pain sites marked in the Pain Drawing (PD) with those reported in the clinical examination by subjects with temporomandibular disorders (TMD) and (2) verify the test-retest reliability of the PD in a TMD Brazilian sample.
Methods: Three hundred and thirty-eight subjects were evaluated according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and those presenting TMD were included in the sample (n=117; 76% women; median age 33 years, IQR: 25.5–41.5; median orofacial pain intensity 6.0, IQR: 3.5–7.5). The subjects completed the PD and were submitted to the clinical examination following the DC/TMD protocol. A subgroup of participants (n=53) was recruited for the test-retest and completed the PD a second time after an interval of six to fourteen days from the first evaluation. In order to compare the PD with the clinical examination, a grid paper was used to standardize the masseter, temporal, and temporomandibular joint (TMJ) locations with squares previously defined. For test-retest reliability, data were computed as categorical, and subjects were classified as G1 (trigeminal dermatomes), G2 (trigeminal, C2, C3, and C4 dermatomes), and G3 (other dermatomes in addition to G2’s). Kappa statistics (κ) was used for the statistical analysis, and the 95% confidence interval (CI) was also calculated.
Results: When comparing the pain sites in the PD with sites reported in the DC/TMD clinical examination, κ was fair for muscles (temporal 0.26, 95% CI 0.16 – 0.36; masseter 0.39, 95% CI 0.27 – 0.52) and slight for TMJ (0.20, 95% CI 0.07 – 0.33). The test-retest reliability of PD was substantial, with κ = 0.63 (95% CI: 0.42 – 0.84).
Conclusions: The DC/TMD Pain Drawing does not reflect the pain sites found in the clinical examination; still, it is reliable over time and can be used for pain perception assessment.