Musculoskeletal pain refers to discomfort or soreness affecting the muscles, bones, joints, ligaments, or tendons. It is an internal, individual experience that includes multiple aspects, such as where it hurts, how intense it feels, and what type of sensation occurs. Across the globe, this form of pain is a primary cause of disability, and measuring it in a consistent way presents major difficulties for clinicians and researchers.
To help capture these details visually, healthcare professionals and researchers frequently use body diagrams known as pain or symptom maps. On these outlines of the human body, individuals indicate where and how they feel discomfort. A scoping review—a comprehensive summary that maps out the existing evidence on a topic—was performed to examine the varieties of body diagrams used in research, the techniques people use to record their symptoms on them, the media through which they are administered, and the specific pain measurements gathered from them.
The authors examined six scientific literature databases and grey literature, which consists of research reports and materials distributed outside traditional academic publishing channels. The search covered records from the year 2000 through August 15, 2025. The study plan was registered and published in advance in the journal PLOS One (https://doi.org/10.1371/journal.pone.0319498). To be included, studies had to involve participants completing their own pain or symptom diagrams. The reviewers extracted data regarding the types of body outlines, the drawing techniques, the delivery methods, and the pain metrics gathered.
From an initial pool of 8,050 studies, 563 met the criteria for inclusion. Among these, 43 percent relied on a custom diagram developed specifically for that single study rather than a pre-existing tool.
The physical design of the diagrams shared several common elements:
- 97 percent did not include a proportional scale, meaning the outlines lacked a standardized reference bar to link the drawing to actual physical body measurements.
- 86 percent displayed a view of the entire body rather than an isolated body region.
- 65 percent were non-segmented, showing an uninterrupted body outline without dividing lines separating specific anatomical sections.
- 79 percent depicted an androgynous figure, showing no distinct male or female physical characteristics.
- 91 percent were displayed as flat, two-dimensional (2D) drawings.
The delivery format was overwhelmingly paper-based, accounting for 74 percent of the studies. When recording their pain, participants used marking in 42 percent of studies, shading across body areas in 35 percent, and checking off preset regions in 20 percent. The single pain detail evaluated most often was the physical location of the pain, which appeared in 72 percent of the studies.
There was substantial variation in the types of pain maps used, how pain was drawn, how the maps were presented, and how researchers calculated numerical values from the drawings. Discrepancies were present across body designs, anatomical divisions, patient drawing instructions, and delivery formats, showing that standardized practices are limited. Future studies need to direct work toward establishing shared standards for mapping musculoskeletal pain.