{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:45:00Z","timestamp":1792093500071,"version":"4.4.0"},"reference-count":30,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Med Inform"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Accurate documentation of back pain is essential for effective diagnosis and treatment; however, conventional paper-based methods often lack precision and standardization, limiting their clinical utility. Digital pain drawings can improve consistency and integration; however, the literature continues to report variability in digital pain drawing methods, quantification approaches, body schemas, and implementation. Moreover, open access, anatomically labeled vector assets mapped to clinical terminology remain limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to develop an anatomically accurate, digitally segmented, open-source vector illustration of a sex-neutral human body (front and back views) for standardized back pain documentation and conduct a user-centered design validation and feasibility evaluation of its perceived usefulness, communication value, and visual acceptability.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n An interdisciplinary team used an iterative methodology informed by standard anatomical references to create the illustration, emphasizing anatomical precision, digital compatibility, and interoperability with medical coding systems. A survey-based design validation study (N=298) was conducted in the United Kingdom through the Prolific platform to evaluate perceived usefulness, confidence in identifying hypothetical pain regions (without an interactive drawing task or comparator), aesthetic appeal, and suggestions for improvement. Quantitative results were summarized descriptively with 95% CIs, and qualitative feedback guided final refinements. The finalized illustration was released under a CC BY 4.0 license.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Mean confidence ratings were 5.7 out of 7 (SD 1.2) for indicating pain regions using the illustration (95% CI 5.5-5.8) and 5.6 out of 7 (SD 1.2) for communicating pain with health care professionals (95% CI 5.5-5.8). Aesthetic ratings were more mixed (mean 4.3 out of 7, SD 1.5; 95% CI 4.1-4.5). User feedback highlighted the need for improved visual clarity, leading to adjustments in color contrast and anatomical proportions. Aesthetic concerns, including the removal of the areolae and changes to the facial features, were also addressed to enhance user comfort and neutrality.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The resulting anatomically accurate vector illustration provides a feasible, open-source foundation for digital back pain documentation tools and may support patient-clinician communication and integration with electronic health records. The design validation study supports acceptability and perceived usefulness, but it does not establish superiority over existing body maps or objective accuracy of pain localization. By releasing it under a CC BY 4.0 license, we encourage broad adoption and community-driven improvements.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/75737","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:20:11Z","timestamp":1789392011000},"page":"e75737-e75737","source":"Crossref","is-referenced-by-count":0,"title":["Open-Source Anatomical Illustration for Digital Back Pain Documentation: Development and Feasibility Evaluation"],"prefix":"10.2196","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2576-6569","authenticated-orcid":false,"given":"Yanick Xavier","family":"Lukic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0330-403X","authenticated-orcid":false,"given":"Sonja","family":"Schl\u00e4pfer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6729-1344","authenticated-orcid":false,"given":"Alessandro","family":"Holler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4158-1435","authenticated-orcid":false,"given":"Giovanni","family":"Colacicco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5259-3121","authenticated-orcid":false,"given":"Dennis","family":"Baumli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5589-3879","authenticated-orcid":false,"given":"Leana","family":"Wirth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4430-0510","authenticated-orcid":false,"given":"Steven","family":"H\u00e4sler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5446-3057","authenticated-orcid":false,"given":"Christoph J","family":"Laux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6355-9838","authenticated-orcid":false,"given":"Reto","family":"Sutter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3814-7633","authenticated-orcid":false,"given":"Georg Wilhelm","family":"Kajdi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3184-322X","authenticated-orcid":false,"given":"Benedikt","family":"Herzog","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5636-5437","authenticated-orcid":false,"given":"Sebastiano","family":"Caprara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5440-7805","authenticated-orcid":false,"given":"Claudia M","family":"Witt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4607-7620","authenticated-orcid":false,"given":"Philipp","family":"Ackermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"issue":"6","key":"R1","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1136\/annrheumdis-2013-204428","article-title":"The global burden of low back pain: estimates from the Global Burden of Disease 2010 study","volume":"73","author":"Hoy","journal-title":"Ann Rheum Dis"},{"issue":"6","key":"R2","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2020.02.175","article-title":"Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017","volume":"8","author":"Wu","journal-title":"Ann Transl Med"},{"issue":"10137","key":"R3","doi-asserted-by":"publisher","first-page":"2356","DOI":"10.1016\/S0140-6736(18)30480-X","article-title":"What low back pain is and why we need to pay attention","volume":"391","author":"Hartvigsen","journal-title":"Lancet"},{"issue":"10","key":"R4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0258329","article-title":"Pain drawing as a screening tool for anxiety, depression and reduced health-related quality of life in back pain patients: a cohort study","volume":"16","author":"We\u00dfollek","journal-title":"PLoS One"},{"issue":"9","key":"R5","doi-asserted-by":"publisher","DOI":"10.2196\/14569","article-title":"From paper to digital applications of the pain drawing: systematic review of methodological milestones","volume":"7","author":"Shaballout","journal-title":"JMIR Mhealth Uhealth"},{"issue":"10","key":"R6","doi-asserted-by":"publisher","DOI":"10.2196\/21475","article-title":"Digital pain mapping and tracking in patients with chronic pain: longitudinal study","volume":"22","author":"Galve Villa","journal-title":"J Med Internet Res"},{"issue":"2","key":"R7","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.4711","article-title":"Exploring the association between patient-drawn pain diagrams and psychological and physical health variables: a large-scale study of patients with low back pain","volume":"29","author":"Harsted","journal-title":"Eur J Pain"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1515\/sjpain-2019-0082","article-title":"Computerized quantification of pain drawings","volume":"20","author":"O\u2019Neill","journal-title":"Scand J Pain"},{"issue":"7","key":"R9","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1111\/joor.13168","article-title":"Digital pain drawings are a useful and reliable tool for assessing patients with temporomandibular disorders","volume":"48","author":"Pitance","journal-title":"J Oral Rehabil"},{"issue":"2","key":"R10","doi-asserted-by":"publisher","first-page":"e129","DOI":"10.1016\/j.jpainsymman.2023.10.019","article-title":"Reliability of the pen-on-paper pain drawing analysis using different scanning procedures","volume":"67","author":"Barbero","journal-title":"J Pain Symptom Manage"},{"issue":"5","key":"R11","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.8409","article-title":"Designing a tablet-based software app for mapping bodily symptoms: usability evaluation and reproducibility analysis","volume":"6","author":"Neubert","journal-title":"JMIR Mhealth Uhealth"},{"issue":"8","key":"R12","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1097\/00007632-200004150-00014","article-title":"Repeatability of pain drawings in a low back pain population","volume":"25","author":"Ohnmeiss","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"R13","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1097\/AJP.0000000000000230","article-title":"Digital pain drawings: assessing touch-screen technology and 3D body schemas","volume":"32","author":"Boudreau","journal-title":"Clin J Pain"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.2196\/43750","article-title":"Systematized Nomenclature of Medicine-Clinical Terminology (SNOMED CT) clinical use cases in the context of electronic health record systems: systematic literature review","volume":"11","author":"Vuokko","journal-title":"JMIR Med Inform"},{"issue":"1","key":"R15","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/j.pain.0000000000001390","article-title":"The IASP classification of chronic pain for ICD-11: chronic primary pain","volume":"160","author":"Nicholas","journal-title":"Pain"},{"issue":"1","key":"R16","doi-asserted-by":"publisher","DOI":"10.2196\/11412","article-title":"Digital pain drawings can improve doctors\u2019 understanding of acute pain patients: survey and pain drawing analysis","volume":"7","author":"Shaballout","journal-title":"JMIR Mhealth Uhealth"},{"issue":"6","key":"R17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pdig.0000274","article-title":"The role of aesthetics in intentions to use digital health interventions","volume":"2","author":"Denison-Day","journal-title":"PLOS Digit Health"},{"key":"R18","unstructured":"Decker SJ . The human in 3D: advanced morphometric analysis of high-resolution anatomically accurate computed models [PhD thesis]. University of South Florida; 2010. URL: https:\/\/digitalcommons.usf.edu\/etd\/3525\/ [Accessed 29-09-2026]"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2023.107383","article-title":"BOSS: bones, organs and skin shape model","volume":"165","author":"Shetty","journal-title":"Comput Biol Med"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.jbi.2012.09.006","article-title":"A survey of SNOMED CT implementations","volume":"46","author":"Lee","journal-title":"J Biomed Inform"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.3389\/fresc.2022.942822","article-title":"Toward a digital citizen lab for capturing data about alternative ways of self-managing chronic pain: an attitudinal user study","volume":"3","author":"Khalili-Mahani","journal-title":"Front Rehabil Sci"},{"key":"R22","unstructured":"Sch\u00fcnke M Schulte E Schumacher U . Prometheus: LernAtlas der Anatomie: Allgemeine Anatomie und Bewegungssystem [Book in German]. 2nd ed. Georg Thieme Verlag; 2007. ISBN: 9783131395221"},{"key":"R23","unstructured":"Sch\u00fcnke M Schulte E Lamperti ED Schumacher U . Thieme Atlas of Anatomy: General Anatomy and Musculoskeletal System. Thieme; 2006. ISBN: 9781588903877"},{"key":"R24","unstructured":"Sch\u00fcnke M Schulte E Schumacher U Voll M Wesker K . Prometheus LernAtlas der Anatomie \u2013 Kopf, Hals und Neuroanatomie [Book in German]. 2nd ed. Thieme; 2009. ISBN: 9783131395429"},{"key":"R25","unstructured":"Platzer W . Taschenatlas Anatomie in 3 B\u00e4nden [Book in German]. Thieme; 2005. ISBN: 9783134920093"},{"key":"R26","unstructured":"Attribution 4.0 International. Creative Commons. URL: https:\/\/creativecommons.org\/licenses\/by\/4.0\/ [Accessed 25-03-2025]"},{"key":"R27","unstructured":"DigitalHealthZurich\/open-pain-illustration. GitHub. URL: https:\/\/github.com\/DigitalHealthZurich\/open-pain-illustration [Accessed 09-04-2025]"},{"key":"R28","unstructured":"Prolific. URL: https:\/\/www.prolific.com [Accessed 09-04-2025]"},{"key":"R29","unstructured":"Office for National Statistics. URL: https:\/\/www.ons.gov.uk\/ [Accessed 09-04-2025]"},{"key":"R30","doi-asserted-by":"crossref","unstructured":"Introducing OpenAI o1\u2011preview. OpenAI. 2024. URL: https:\/\/openai.com\/index\/introducing-openai-o1-preview\/ [Accessed 09-04-2025]","DOI":"10.5040\/bci-0kgv.pt-001"}],"container-title":["JMIR Medical Informatics"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:53:17Z","timestamp":1792090397000},"score":1,"resource":{"primary":{"URL":"https:\/\/medinform.jmir.org\/2026\/1\/e75737"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":30,"URL":"https:\/\/doi.org\/10.2196\/75737","relation":{},"ISSN":["2291-9694"],"issn-type":[{"value":"2291-9694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"article-number":"v14i6e75737"}}