PRISM (Pictorial Representation of Illness and Self Measure): A Novel Visual Instrument to Assess Pain and Suffering in Orofacial Pain Patients

Aims: To use PRISM (Pictorial Representation of Illness and Self Measure), a visual instrument that has recently been developed and validated to assess suffering in patients with chronic physical illness, in orofacial pain patients and test for associations of PRISM with established assessment tools for pain, affective symptoms, and sleep. Of particular interest was the utility of PRISM as a screening tool for severely suffering patients. Methods: One hundred and two orofacial pain patients recruited from a specialized outpatient service completed a questionnaire-based survey, including established assessment tools: the Visual Analog Scale (VAS), Graded Chronic Pain Scale (GCPS), the Hospital Anxiety and Depression Scale (HADS), and the Insomnia Severity Index (ISI), as well as a paper and pencil version of PRISM. Results: Of the 102 patients who submitted the clinical questionnaire, 74 performed the PRISM-test (response rate: 72%). PRISM scores correlated strongly with all subscores of pain (measured by GCPS) and sleep (measured by ISI). Further, a trend was observed in the correlation with affective symptoms measured by the HADS. PRISM could readily detect patients with high, pain-related suffering. Conclusion: These data add support to the hypothesis that the PRISM task in its paper and pencil version is measuring the burden of suffering. The clinical utility of this simple graphic tool therefore lies in its potential to alert clinicians to a high burden of suffering and thus it may help to identify orofacial pain patients who may benefit from more comprehensive assessment and treatment. Prospective studies are needed to clarify this claim. Keywords: anxiety, depression, orofacial pain, PRISM, sleep, suffering