How Digital Pain Drawings Redefined Precision Pain Communication

Nearly a decade ago, before tablets were common, a small team of researchers in Aalborg, Denmark asked a remarkably simple yet pioneering question: What happens when we replace the traditional pen-and-paper pain diagram with a touchscreen and a three-dimensional (3D) body?

At the time, most clinical assessments of pain relied on two-dimensional (2D) line drawings (simplified silhouettes) on paper where patients marked with an ‘X’ or circled an area where they felt pain. These drawings were useful, but they were presented as thumbnails, were static, limited, and difficult to store or compare. As personalized and digital medicine began to emerge, the idea of using touch-screen tablets to capture precise, digital representations of pain was both radical and timely.

Spatial metrics can be drawn and captured digitally with digital pain drawings, inspired by landmark pain questionnaires, and the larger display size and shading of a 3D avatar provide guiding details.

The study, “Digital Pain Drawings: Assessing Touch-Screen Technology and 3D Body Schemas”, published in The Clinical Journal of Pain (2016) by Boudreau, Badsberg, Christensen, and Egsgaard, was among the first to test this transition scientifically. It compared three conditions:

1. Paper vs. tablet – testing whether digital input changes the recorded pain area.

2. 2D vs. 3D body schemas – testing whether the dimensionality changes communication of pain.

3. Healthy vs. chronic pain participants – testing whether drawing behavior differs depending on pain status.

Digital Pain Drawings First-of-Its-Kind Experiment

The research team didn’t just ask whether people could draw on a tablet, instead they focused on quantifying how well they could. Using pixel-based image analysis, they compared the total number of pixels (size) and consistency of pain areas drawn by healthy participants and by patients with chronic pain.

The results from Boudreau and colleagues (2015) were encouraging:

• Pain drawings collected on tablets were as reliable as those on paper.

  
  

• The differences in pain area size between platforms were statistically small (i.e. around 1% of total body area), showing that digital drawings could reproduce the same data integrity as two decades worth of traditional methods.

  
  

• When patients compared 2D versus 3D body schemas, more than a third believed that the 3D version allowed them to express their pain more accurately, while only a few preferred the simpler 2D outline.

Grouped preference and user experiences for 22 individuals with chronic pain, as assessed using a Likert scale, suggesting preference for the 3-dimensional (3D) body schema (Adopted and modified from Boudreau et al., 2015)

This made the study one of the first formal validations of touchscreen technology for clinical pain mapping, and the first ever to examine whether a 3D avatar improved the communication of pain location and extent.

Why It Mattered Then and More Today

In 2015, tablets were only beginning to appear in homes and offices, let alone hospitals. Most digital health applications were still built around questionnaires and drop-down menus rather than direct, spatial interaction. The concept of drawing pain or symptoms, with precision and anatomical context, on a portable touchscreen was both innovative and disruptive.

The study anticipated several major shifts that now define modern digital health:

• Patient-generated data as a foundation for personalized medicine.

• Interoperable digital records, replacing scattered paper charts.

• Visual analytics that allow spatial and temporal mapping of symptoms.

• And the rise of immersive interfaces (3D, VR, AR) to express subjective experience.

By exploring not only the technical equivalence between formats but also patient preference, the research highlighted something often missing from early digital health innovations: the human factor. It recognized that the interface itself, the body model, its realism, its sense of ownership can affect how people communicate pain.

Communication of Pain as a Window into the Brain

Pain drawings are more than diagnostic tools. They are, in essence, maps of human perception. Each shaded contour reflects how the nervous system interprets injury, stress, and emotion in space and time. As the authors noted, allowing patients to mark pain on a 3D body introduces new levels of precision that can later be correlated with neural, physiological, or behavioral data.

The capture and creation of body-maps showing pain, bodily symptoms and discomfort which can be readily extracted for simple and advanced data analysis, on a pixel level, to reflect underlying physiology or regions of interest, as shown for Navigate Pain, Aglance Solutions ApS.

Modern pain research increasingly relies on such high-resolution digital body maps to detect metrics capturing patterns, symmetry, spread, and intensity. With the right questions and supporting measures these metrics may reveal underlying mechanisms of chronic pain, neuropathy, or central sensitization. The groundwork for that transition was laid by studies like this one.

Looking Back to Look Forward

What began as a validation of a simple interface has since become a cornerstone of digital pain communication. Today, tablet-based and 3D body mapping systems are being integrated into more and more health studies as remote monitoring solutions and perhaps,  soon, AI-driven diagnostic tools. Yet, their credibility rests on the foundational evidence that these early experiments provided.

In retrospect, this study did more than show that tablets “work as well as paper.” It reframed pain communication as a visual, data-driven, and interactive process, paving the way for technologies that now make precision pain assessment and indeed, precision medicine possible.

As health systems worldwide continue to digitize, this pioneering work reminds us that innovation in healthcare doesn’t just mean new sensors or algorithms. Sometimes, it begins with giving patients a better way to be understood.

References

1. Boudreau, Shellie A. PhD; Badsberg, Susanne MSc; Christensen, Steffan W. MPhty; Egsgaard, Line L. PhD. Digital Pain Drawings: Assessing Touch-Screen Technology and 3D Body Schemas. The Clinical Journal of Pain 32(2):p 139-145, February 2016. | DOI: 10.1097/AJP.0000000000000230