vas & nprs
DESCRIPTION
evaluasi nyeri sesuai dengan skala internasionalTRANSCRIPT
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Measures of Adult PainVisual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain),McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ),Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS),and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)
GILLIAN A. HAWKER, SAMRA MIAN, TETYANA KENDZERSKA, AND MELISSA FRENCH
INTRODUCTION
Our purpose is to provide an overview of available genericand rheumatology populationspecic questionnairessuitable for evaluating pain in adult rheumatology popu-lations. The content, ease of use, and measurement prop-erties of the questionnaires are presented and comparedin order to assist both clinicians and researchers selectthe questionnaire that is most appropriate for their pur-pose. The questionnaires are presented in the followingorder: generic unidimensional pain questionnaires (VisualAnalog Scale and Numeric Rating Scale), generic multi-dimensional pain questionnaires (Short-form McGill PainQuestionnaire, Chronic Pain Grade Scale, and Short Form-36 Bodily Pain Scale), and nally an arthritis-specic painquestionnaire (Measure of Intermittent and Constant Os-teoarthritis Pain). Composite measures of arthritis symp-toms, including pain and associated disability, specicallythe Western Ontario and McMaster Universities Osteo-arthritis Index and the Arthritis Impact MeasurementScales, are described in Measures of Knee Function andMeasures of Disability, respectively.
VISUAL ANALOG SCALE (VAS) FOR PAIN
Description
Purpose. The pain VAS is a unidimensional measure ofpain intensity (1), which has been widely used in diverseadult populations, including those with rheumatic dis-eases (25).
Content. The pain VAS is a continuous scale comprisedof a horizontal (HVAS) or vertical (VVAS) line, usually 10centimeters (100 mm) in length, anchored by 2 verbaldescriptors, one for each symptom extreme (2,6). Instruc-tions, time period for reporting, and verbal descriptor an-chors have varied widely in the literature depending onintended use of the scale (7).
Number of items. The pain VAS is a single-item scale.Response options/scale. For pain intensity, the scale is
most commonly anchored by no pain (score of 0) andpain as bad as it could be or worst imaginable pain(score of 100 [100-mm scale]) (68). To avoid clustering ofscores around a preferred numeric value, numbers or ver-bal descriptors at intermediate points are not recom-mended (4,9).
Recall period for items. Varies, but most commonlyrespondents are asked to report current pain intensity orpain intensity in the last 24 hours.
Practical Application
How to obtain. The pain VAS is available in the publicdomain at no cost (7). Graphic formats for the VAS may beobtained from Scott & Huskisson (9) or online: http://www.amda.com/tools/library/whitepapers/hospiceinltc/appendix-a.pdf.
Method of administration. The pain VAS is self-completed by the respondent. The respondent is asked toplace a line perpendicular to the VAS line at the point thatrepresents their pain intensity (2,9,10).
Scoring. Using a ruler, the score is determined by mea-suring the distance (mm) on the 10-cm line between theno pain anchor and the patients mark, providing a rangeof scores from 0100 (6).
Score interpretation. A higher score indicates greaterpain intensity. Based on the distribution of pain VASscores in postsurgical patients (knee replacement, hyster-ectomy, or laparoscopic myomectomy) who describedtheir postoperative pain intensity as none, mild, moderate,or severe, the following cut points on the pain VAS havebeen recommended: no pain (04 mm), mild pain (544
Gillian A. Hawker, MD, MSc, FRCPC, Samra Mian, MSc,Tetyana Kendzerska, MD, Melissa French, MSc: Universityof Toronto, Toronto, Ontario, Canada.
Address correspondence to Gillian Hawker, MD, MSc,FRCPC, Canadian Osteoarthritis Research Program, 76Grenville Street, 8th Floor, Room 815, Womens CollegeHospital, University of Toronto, Toronto, ON, M5S 1B2.E-mail: [email protected].
Submitted for publication February 2, 2011; accepted inrevised form June 20, 2011.
Arthritis Care & ResearchVol. 63, No. S11, November 2011, pp S240S252DOI 10.1002/acr.20543 2011, American College of Rheumatology
MEASURES OF PATHOLOGY AND SYMPTOMS
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mm), moderate pain (4574 mm), and severe pain (75100 mm) (11). Normative values are not available.
Respondent burden. The VAS takes 1 minute to com-plete (3,7).
Administrative burden. The VAS is administered as apaper and pencil measure. As a result, it cannot be admin-istered verbally or by phone. No training is required otherthan the ability to use a ruler to measure distance todetermine a score (7,9). Caution is required when photo-copying the scale as this may change the length of the10-cm line (6). As slightly lower scores have been reportedon the HVAS compared to the VVAS (12), the same align-ment of scale should be used consistently within the samepatient.
Translations/adaptations. Minimal translation difcul-ties have led to an unknown number of cross-culturaladaptations.
Psychometric Information
Method of development. The pain VAS originated fromcontinuous visual analog scales developed in the eld ofpsychology to measure well-being (13,14). Woodforde andMerskey (15) rst reported use of the VAS pain scale withthe descriptor extremes no pain at all and my pain is asbad as it could possibly be in patients with a variety ofconditions. Subsequently, others reported use of the scaleto measure pain in rheumatology patients receiving phar-macologic pain therapy (2,6,9). While variable anchor paindescriptors have been used, there does not appear to beany rationale for selecting one set of descriptors over an-other.
Acceptability. The pain VAS requires little training toadminister and score and has been found to be acceptableto patients (2,10). However, older patients with cognitiveimpairment may have difculty understanding and there-fore completing the scale (6,16). Supervision during com-pletion may minimize these errors (9).
Reliability. Testretest reliability has been shown to begood, but higher among literate (r 0.94, P 0.001) thanilliterate patients (r 0.71, P 0.001) before and afterattending a rheumatology outpatient clinic (8).
Validity. In the absence of a gold standard for pain,criterion validity cannot be evaluated. For construct valid-ity, in patients with a variety of rheumatic diseases, thepain VAS has been shown to be highly correlated with a5-point verbal descriptive scale (nil, mild, moder-ate, severe, and very severe) and a numeric ratingscale (with response options from no pain to unbear-able pain), with correlations ranging from 0.710.78 and0.620.91, respectively) (3). The correlation between ver-tical and horizontal orientations of the VAS is 0.99 (12).
Ability to detect change. In patients with chronic in-ammatory or degenerative joint pain, the pain VAS hasdemonstrated sensitivity to changes in pain assessedhourly for a maximum of 4 hours and weekly for up to 4weeks following analgesic therapy (P 0.001) (10). Inpatients with rheumatoid arthritis, the minimal clinicallysignicant change has been estimated as 1.1 points on an11-point scale (or 11 points on a 100-point scale) (17). Aminimum clinically important difference of 1.37 cm has
been determined for a 10-cm pain VAS in patients withrotator cuff disease evaluated after 6 weeks of nonopera-tive treatment (18).
Critical Appraisal of Overall Value to theRheumatology Community
Strengths/caveats and cautions/clinical and researchusability. The VAS is widely used due to its simplicityand adaptability to a broad range of populations and set-tings. Its acceptability as a generic pain measure was dem-onstrated in the early 1970s. Limitations to the use of thepain VAS include the following: older patients may havedifculty completing the pain VAS due to cognitive im-pairments or motor skill issues, scoring is more compli-cated than that for the Numeric Rating Scale for pain(described below), and it cannot be administered by tele-phone, limiting its usefulness in research.
NUMERIC RATING SCALE (NRS) FOR PAIN
Description
Purpose. The NRS for pain is a unidimensional measureof pain intensity in adults (1921), including those withchronic pain due to rheumatic diseases (3,8). Althoughvarious iterations exist, the most commonly used is the11-item NRS (22), which is described here.
Content. The NRS is a segmented numeric version ofthe visual analog scale (VAS) in which a respondent se-lects a whole number (010 integers) that best reects theintensity of their pain (21). The common format is a hori-zontal bar or line (23). Similar to the pain VAS, the NRSis anchored by terms describing pain severity extremes(3,20,21).
Number of items. The pain NRS is a single 11-pointnumeric scale (3).
Response options/scale. An 11-point numeric scale(NRS 11) with 0 representing one pain extreme (e.g., nopain) and 10 representing the other pain extreme (e.g.,pain as bad as you can imagine and worst pain imag-inable) (20,21).
Recall period for items. Varies, but most commonlyrespondents are asked to report pain intensity in the last24 hours or average pain intensity (24).
Practical Application
How to obtain. Available from the web site: http://www.partnersagainstpain.com/printouts/A7012AS2.pdf.
Method of administration. The NRS can be adminis-tered verbally (therefore also by telephone) or graphicallyfor self-completion (6). The respondent is asked to indicatethe numeric value on the segmented scale that best de-scribes their pain intensity.
Scoring. The number that the respondent indicates onthe scale to rate their pain intensity is recorded. Scoresrange from 010.
Score interpretation. Higher scores indicate greaterpain intensity.
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Respondent burden. The pain NRS takes 1 minute tocomplete.
Administrative burden. The pain NRS is easy to admin-ister and score (6,25).
Translations/adaptations. Like the pain VAS, minimallanguage translation difculties support the use of the NRSacross cultures and languages (26).
Psychometric Information
Method of development. To improve discrimination fordetecting relatively small changes, an NRS comprised ofnumbers along a scale was used in a population of 100patients with a variety of rheumatic diseases (3). Varia-tions in pain descriptors used as anchors for end points onthe pain NRS have been reported in the literature (3,6,24).However, the methodology used to develop these variousanchor terms is unknown.
Acceptability. Chronic pain patients prefer the NRSover other measures of pain intensity, including the painVAS, due to comprehensibility and ease of completion(27). However, focus groups of patients with chronic backpain and symptomatic hip and knee osteoarthritis (OA)have found that the pain NRS is inadequate in capturingthe complexity and idiosyncratic nature of the pain expe-rience or improvements due to symptom uctuations(28,29).
Reliability. High testretest reliability has been ob-served in both literate and illiterate patients with rheuma-toid arthritis (r 0.96 and 0.95, respectively) before andafter medical consultation (8).
Validity. For construct validity, the NRS was shown tobe highly correlated to the VAS in patients with rheumaticand other chronic pain conditions (pain 6 months): cor-relations range from 0.86 to 0.95 (3,8).
Ability to detect change. In clinical trials of pregabalinfor diabetic neuropathy, postherpetic neuralgia, chroniclow back pain, bromyalgia, and OA, analyses of the rela-tionships between changes in pain NRS scores and patientreports of overall improvement, measured using a stan-dard 7-point patient global impression of change, demon-strated a reduction of 2 points, or 30%, on the pain NRSscores to be clinically important (22). Similar results werefound in low back pain patients when changes in painNRS scores were compared to patient improvements inpain after physical therapy, using a 15-point Global Ratingof Change scale (19).
Critical Appraisal of Overall Value to theRheumatology Community
Strengths/caveats and cautions/clinical and researchusability. The pain NRS is a valid and reliable scale tomeasure pain intensity. Strengths of this measure over thepain VAS are the ability to be administered both verbally(therefore by telephone) and in writing, as well as itssimplicity of scoring. However, similar to the pain VAS,the pain NRS evaluates only 1 component of the painexperience, pain intensity, and therefore does not capturethe complexity and idiosyncratic nature of the pain expe-rience or improvements due to symptom uctuations.
MCGILL PAIN QUESTIONNAIRE (MPQ)
Description
Purpose. A multidimensional pain questionnaire de-signed to measure the sensory, affective and evaluativeaspects of pain and pain intensity in adults with chronicpain, including pain due to rheumatic diseases (30,31).
Content. The scale contains 4 subscales evaluating thesensory, affective and evaluative, and miscellaneous as-pects of pain, responses to which comprise the Pain RatingIndex, and a 5-point pain intensity scale (Present PainIntensity).
Number of items. The Pain Rating Index contains 78pain descriptor items categorized into 20 subclasses, eachcontaining 26 words that fall into 4 major subscales:sensory (subclasses 110), affective (subclasses 1115),evaluative (subclass 16), and miscellaneous (subclasses1720). There is also a 1-item pain intensity scale (30).
Response options/scale. The value (score) associatedwith each descriptor is based on its position or rank orderwithin the word set. The Present Pain Intensity scale, ameasure of the magnitude of pain experienced by an indi-vidual, is a numeric-verbal combination that indicatesoverall pain intensity (31) and includes 6 levels: none (0),mild (1), discomforting (2), distressing (3), horrible (4), andexcruciating (5) (32).
Recall period for items. Present pain (31).Examples of use. The MPQ can be used to evaluate the
efcacy and effectiveness of pain interventions and toidentify qualities of pain associated with distinct nocio-ceptive disorders and neuropathic pain disorders, includ-ing arthritis (30).
Practical Application
How to obtain. The MPQ is available at no cost fromthe developer, Ronald Melzack, PhD, Department of Psy-chology, McGill University, 1205 Dr. Peneld Avenue,Montreal, Quebec H3A 1B1, Canada, and online (http://www.qolid.org) by paying a membership fee.
Method of administration. The MPQ is interviewer-administrated using paper and pencil. The interviewermust read instructions to the respondent and dene anywords that the respondent does not understand. For eachsubclass of words, the respondent is instructed to select1 word that ts their present pain. If none of the wordsdescribe their pain, then no word is selected (30,33).
Scoring. The MPQ is scored by hand by rst countingthe number of words selected to obtain a Number of WordsChosen score (020 words). Pain Rating Index scores rangefrom 078 based on the rank values of the chosen words.The value (score) associated with each descriptor is basedon its position or rank order in the word set, such that therst word is given a value of 1, the next a value of 2 and soon. Rank values are summed within each subclass as wellas overall. Scores on the Present Pain Intensity scale rangefrom 05 (31).
Score interpretation. A higher score on the MPQ indi-cates worse pain. The Pain Rating Index is interpreted bothin terms of quantity of pain, as evidenced by the number of
S242 Hawker et al
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words used and the rank values of the words, as well as thequality of pain, as evidenced by the particular words thatare chosen. The normative mean scores across painful con-ditions ranged from 2450% of the maximum score (7).
Respondent burden. Completion of the MPQ can takeup to 20 minutes (33).
Administrative burden. No training is required to scoreand interpret the MPQ, other than the ability of the inter-viewer to dene each word (30,33). Time to score is 25minutes.
Translations/adaptations. There are a total of 44 differ-ent versions of the MPQ, representing 26 different languag-es/cultures (34). The MPQ has been translated into Eng-lish, French (35), German (3638), Norwegian (39), Danish(40), Italian (41), Japanese (42), Finnish (43), Spanish (44),Chinese (45), Dutch (46), Amharic (47), Slovak (48), Turk-ish (49), and Portuguese (5052).
Psychometric Information
Method of development. Pain descriptors were derivedfrom recording the words used by chronic pain patients todescribe their pain; these descriptors were then catego-rized into subclasses and rank ordered by intensity usinga numerical scale by groups of physicians, patients, andstudents (31,53).
Acceptability. Some respondents have difculty withthe complexity of the vocabulary used, resulting in failureto read the instructions carefully and to see essential fea-tures (54).
Reliability. In a study of general rheumatology clinicpatients, testretest reliability for the 3 MPQ pain items(nagging, aching, and stabbing) ranged from a highof 0.81 for 1-day recall to a low of 0.59 for 7-day recall (55).These ndings are consistent with those of other studiesevaluating testretest reliability in populations with a va-riety of other conditions including arthritis and other mus-culoskeletal conditions (r 0.70) (31,56,57).
Validity. Content validity. Arthritis patients, regardlessof their disease severity, used similar words to describe thesensory aspects of their pain. MPQ words have been shownto differentiate between 4 different circumstances of rheu-matoid arthritis (RA) pain (i.e., overall pain at rest, overallpain on movement, joint pain at rest, and joint pain onmovement) (58). The MPQ has the ability to detect mildpain due to the multidimensional nature of the scale andthe large number of pain descriptor options (59).
Construct validity. In RA, the number of sensory andaffective MPQ words selected has been positively corre-lated with visual analog scale (VAS) scores of severity ofpain at rest and on movement (r 0.27, P 0.01 and r 0.17, P 0.05, respectively) (58). Higher Pain Rating Indexscores are associated with negative affect (e.g., MinnesotaMultiphasic Personality Inventory, Pain CatastrophizingScale) (60). In knee pain or knee osteoarthritis patients,higher MPQ scores were associated with greater anxietyand depression (r 0.30, P 0.05 and r 0.31, P 0.05,respectively) (60), and greater symptoms and disabilityusing theWestern Ontario andMcMaster Universities painscale (r 0.340.38) (61).
Ability to detect change. In clinical trials designed toevaluate the efcacy of different pain therapies on post-operative pain after general surgical and orthopedic pro-cedures, the relative effect sizes for the MPQ-Pain RatingIndex compared with a 4-point categorical verbal ratingscale and a pain VAS were 1.08 (moderate) and 1.12(good), respectively (62).
Critical Appraisal of Overall Value to theRheumatology Community
Strengths/caveats and cautions/clinical and researchusability. The MPQ is a valid and reliable tool that eval-uates both the quality and quantity of pain through useof unique pain descriptors. This may be useful in epide-miologic studies and clinical trials of older patients withmultimorbidity, in whom pain may arise from multiplecauses. Specically, use of the MPQ may help to identifyneuropathic type pain from nocioceptive type pain. Alimitation of the MPQ is the rich vocabulary required ofrespondents for completion. Further, sex and ethnic dif-ferences may affect selection of pain descriptors. However,the interviewer can facilitate MPQ completion by provid-ing respondents with clear denitions of words duringadministration.
SHORT-FORM MCGILL PAIN QUESTIONNAIRE(SF-MPQ)
Description
Purpose. The SF-MPQ, a shorter version of the MPQ, isa multidimensional measure of perceived pain in adultswith chronic pain, including pain due to rheumatic dis-eases (30,33).
Content. The SF-MPQ is comprised of 15 words (11sensory and 4 affective) from the original MPQ (33).
Number of items. The Pain Rating Index is comprised of2 subscales: 1) sensory subscale with 11 words or itemsand 2) affective subscale with 4 words or items, which arerated on an intensity scale as 0 none, 1 mild, 2 moderate, or 3 severe. The SF-MPQ also includes 1 itemfor present pain intensity and 1 item for a 10-cm visualanalog scale (VAS) for average pain (33).
Recall period for items. Present time.Examples of use. To discriminate among different pain
syndromes (33,63,64) and evaluate the responsiveness ofdifferent symptoms to treatment (65,66).
Practical Application
How to obtain. See this section for the MPQ above.Method of administration. See this section for the MPQ
above.Scoring. For the Pain Rating Index, each selected word
is scored from 0 (none) to 3 (severe). The total Pain RatingIndex score is obtained by summing the item scores (range045). Scores on the Present Pain Intensity range from 05and on the VAS from 010.
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Score interpretation. There are no established criticalcut points. As for the MPQ, a higher score indicates worsepain.
Respondent burden. The SF-MPQ takes 25 minutesto complete (33).
Administrative burden. No training is required to scoreand interpret the SF-MPQ other than the ability of theinterviewer to dene each word (33). Time to score is1 minute.
Translations/adaptations. The SF-MPQ has been trans-lated into the following languages: English, French, Am-haric (47), Chinese (67), Czech (68), Danish (69), Farsi (70),Greek (71,72), Hebrew (73), Hindi (74), Korean (75,76),Norwegian (77), Swedish (78), Thai (79), and Turkish(49,80).
Psychometric Information
Method of development. In addition to indices of over-all pain intensity (the Present Pain Intensity [31] and VAS[81]), a selection of pain descriptors representing sensoryand affective categories were retained from the originalversion of the MPQ (31). Other than for one descriptor(splitting), those selected for inclusion in the SF-MPQwere those chosen by greater than one-third of patientswith various types of pain (31,8284).
Acceptability. Standardized instructions for patientcompletion have not been published. Some difcultieswith completion have been reported and attributed to un-familiar descriptors and unclear written instructions.However, experience in completing the SF-MPQ and ver-bal instructions improved completion among osteoarthri-tis (OA) patients (85).
Reliability. For internal consistency, using the SF-MPQin rheumatoid arthritis (RA) and bromyalgia patients,Cronbachs alphas were estimated at 0.730.89 (78).In the same study (78), testretest reliability ranged from0.450.73 for 1-month and 3-month intervals. Amongrheumatology patients, testretest reliability was 0.790.93 at intervals of 1 to 3 days (86). In an OA population,high intraclass correlations were demonstrated for thetotal, sensory, affective, and average pain scores (5-dayperiod): 0.96, 0.95, 0.88, and 0.89, respectively (85).
Validity. The SF-MPQ was found to have more contentvalidity among patients with bromyalgia than for thosewith RA. Percentage of use of 15 pain descriptors by 2groups was signicantly different for all words exceptthrobbing and punishing-cruel. The mean intensityscore for each word ranged from 1.69 for sickening to2.60 for tender in the bromyalgia group and 1.57 forfearful to 2.18 for aching in the RA group (78). Forconstruct validity, the SF-MPQ was found to be moder-ately correlated with both the Western and Ontario andMcMaster Universities Osteoarthritis Index and the ShortForm 36 Health Survey bodily pain scales (r 0.36 and0.36, respectively; P 0.01) in 200 patients with hip andknee OA (61).
Ability to detect change. Although designed for descrip-tive purposes, the SF-MPQ has been found to be sensitiveto the effects of pain therapies in a variety of populationsettings (8688). In patients with a range of musculoskel-
etal conditions reporting improvements in pain after reha-bilitation and surgical interventions, the Norwegian SF(NSF)-MPQ scores were found to be responsive to change(standardized response mean values 0.80): a mean im-provement in NSF-MPQ total scores 5 on the 045 scaledemonstrated a clinically important change (86). In an OApopulation, the minimum detectable change for total, sen-sory, affective, average, and current pain components havebeen estimated as 5.2, 4.5, 2.8, 1.4, and 1.4 cm, respec-tively (85).
Critical Appraisal of Overall Value to theRheumatology Community
Strengths/caveats and cautions/clinical and researchusability. The SF-MPQ is easier to use and takes lesstime to administer and complete than the longer form. Theword choices are not as complex, and the intensity rank-ing of mild, moderate, and severe is better understood bypatients (33). However, sufcient experience is requiredto adequately complete the SF-MPQ; therefore, new usersrequire supervision during completion (85). In 2009, theshort form was further revised for use in neuropathicand nonneuropathic pain conditions (SF-MPQ-2). TheSF-MPQ-2 includes 7 additional symptoms relevant toneuropathic pain, for a total of 22 items with 010 numer-ical response options (89). We await further psychometrictesting of this revised measure, which may play a usefulrole in the future with respect to identifying rheumaticdisease patients with neuropathic versus nociceptive painpatterns.
CHRONIC PAIN GRADE SCALE (CPGS)
Description
Purpose. The CPGS is a multidimensional measure thatassesses 2 dimensions of overall chronic pain severity:pain intensity and pain-related disability. It is suitable foruse in all chronic pain conditions, including chronic mus-culoskeletal (MSK) and low back pain (90).
Content. Subscale scores for pain intensity and dis-ability are combined to calculate a chronic pain gradethat enables classication of chronic pain patients into5 hierarchical categories: grades 0 (no pain) to IV (highdisability-severely limiting) (90).
Number of items. The CPGS is comprised of 7 items.Response options/scale. All items are scored on an 11-
point Likert scale, with responses ranging from 010.Recall period for items. Pain in the past 36 months.Examples of use. The CPGS has been used in epidemi-
ologic studies and clinical trials to evaluate and comparepain severity across groups and in response to treatmenteffects, and in clinical practice to improve the prognosticjudgments of physicians (9193).
Practical Application
How to obtain. Please note that the scale is availablein the original reference (90), as well as directly from theauthor.
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Method of administration. The CPGS is an interview-administered questionnaire that can also be self-completed by respondents.
Scoring. Scores are calculated for 3 subscales: the char-acteristic pain intensity score, which ranges from 0100,is calculated as the mean intensity ratings for reportedcurrent, worst, and average pain; the disability score,which ranges from 0100, is calculated as the mean ratingfor difculty performing daily, social, and work activities;and the disability points score, which ranges from 03, isderived from a combination of ranked categories of num-ber of disability days and disability score.
Score interpretation. The 3 subscale scores (character-istic pain intensity, disability score, and the disabilitypoints score) are used to classify subjects into 1 of the 5pain severity grades: grade 0 for no pain, grade I for lowdisability-low intensity, grade II for low disability-highintensity, grade III for high disability-moderately limiting,and grade IV for high disability-severely limiting.
Respondent burden. Time to complete the CPGS doesnot exceed 10 minutes.
Administrative burden. The CPGS is easy to adminis-ter. Scoring is complex.
Translations/adaptations. The CPGS has been adaptedinto UK English (94). An Italian version has been devel-oped to evaluate severity in chronic pain patients (95).
Psychometric Information
Method of development. Interviews were conductedwith primary care patients with back pain, headache,and temporomandibular disorder (96). The developmentof the graded classication drew on concepts by Turk andRudy of chronic pain severity (97,98). Two of the itemsused in the disability score were adapted from their Multi-dimensional Pain Inventory (99). The Guttman scalingmethod was used to develop the graded classication ofchronic pain (90).
Acceptability. The CPGS is easy to understand andcomplete based on a high response rate (76.3%) to a postalsurvey sent to general practice patients in the UK (94).Among MSK chronic pain patients, missing values wereonly noted in 3% of each of the questions in an Italianversion of the CPGS (100).
Reliability. For internal consistency, Cronbachs alphawas shown to be 0.74 among patients with chronicback pain (90). In an Italian version of CPGS, Cronbachsalpha ranged from 0.810.89 for subscales and globalscores in patients with chronic MSK pain (95). In UKgeneral practice patients with low back pain, testretestreliability was high after a 2-week interval (weighted 0.81 [95% condence interval 0.650.98]) (101).
Validity. For construct validity, cross-sectional and lon-gitudinal studies of general practice patients have shownthat higher scores on the CPGS, indicating greater chronicpain, are signicantly associated with higher rates of un-employment, greater pain impact scale scores, greater useof opioid analgesics and physician visits, depressed mood,and lower self-rated health status (90,94,102). Compari-sons of CPGS scores with the Short Form 36 Health Survey
(SF-36) indicate that a higher chronic pain grade using theCPGS is associated with poorer physical, psychological,social, and general health as measured by the SF-36 (P 0.001) (102) and worse scores on the SF-36 bodily painscale ( 0.545, P 0.0001) (95). Spearmans correla-tion coefcients for the CPGS scores and the various di-mensions of SF-36 were highest for the pain dimension(r 0.71 to 0.84) and lowest for the mental healthdimension (r 0.28 to 0.38) (94).
Ability to detect change. Among patients with moderateto severe chronic MSK pain, the CPGS has been shown tobe modestly responsive to changes after 12 months oftreatment with an efcacious pain intervention, with stan-dardized effect sizes for the intensity and disability sub-scales of 0.41 and 0.43, respectively. Among participantswith chronic knee or hip pain, the standardized effect sizefor the CPGS intensity was 0.32 (91).
Critical Appraisal of Overall Value to theRheumatology Community
Strengths/caveats and cautions/clinical and researchusability. The CPGS is a valid and reliable tool that isuseful for the evaluation of chronic MSK pain; it allowsfor grading of the global severity of chronic pain and there-fore analysis of the qualitative changes in chronic painover time. Further, the CPGS assesses not only aspects ofthe pain itself, but also the impact of the pain on daily,social, and work activities, which is a signicant advan-tage over many other pain questionnaires. A limitation ofthe CPGS relative to the other scales reported here is thecomplexity of scoring, which renders it less useful forassessment of pain at point of care. Additionally, furtherresearch is needed to be able to compare scoring methodsand cut points.
SHORT FORM 36 BODILY PAIN SCALE(SF-36 BPS)
Description
Purpose. The SF-36 BPS is 1 of 8 subscales of the Med-ical Outcomes Study SF-36 questionnaire (103,104), ageneric measure of health status designed for use in pop-ulation surveys (105). In 1996, version 2.0 of the SF-36(SF-36v2) was introduced to correct deciencies identiedin the original version, SF-36v1 (106). The 2-item SF-36BPS subscale assesses bodily pain as a dimension of healthstatus (104,105).
Content. The SF-36 BPS assesses bodily pain intensityand interference of pain with normal activities.
Number of items. The SF-36 BPS is a 2-item scale.Response options/scale. Intensity of bodily pain is eval-
uated using a 6-point rating scale of none to very se-vere. The extent to which pain has interfered with workis evaluated on a 5-point rating scale from not at all toextremely.
Recall period for items. The SF-36 BPS is available inboth standard (4 week) and acute (1 week) recall versions(105,106).
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Examples of use. The SF-36 and its subscales, includingthe BPS, have been used in epidemiologic studies to com-pare health status across populations and within popula-tion subgroups, such as in estimating the relative burdenof different diseases, including rheumatic diseases (107),and differentiating the health benets of different treat-ments (108).
Practical Application
How to obtain. The SF-36 and its various versions havebeen developed by the Rand Corporation and John E. Ware(SF-36 Health Survey, The Health Institute, New EnglandMedical Center Hospitals, Box 345, 750 Washington Street,Boston, MA, 02111). The Medical Outcomes Trust, HealthAssessment Lab, and Quality Metric Incorporated are co-copyright holders of all SF-36 and SF-12 surveys. AllSF-36 survey instruments, scoring manuals, and licensesfor use are available from QualityMetric at www.qualitymetric.com. Different charges are levied for academic andcommercial use.
Method of administration. The SF-36 BPS is suitablefor self-administration, computerized administration, oradministration by a trained interviewer in person or bytelephone. Telephone voice recognition interactive sys-tems and online administrations are currently beingevaluated.
Scoring. Responses for each of the 2 SF-36 BPS itemsare recoded into nal item values (109). The raw scalescore is computed as a simple algebraic sum of the recodeditem values. The raw scale score is then transformed to a0100 scale. Norm-based scores may be calculated forSF-36v2 by including population normative data in thescoring algorithms. The BPS score is only calculated ifboth items are completed.
Score interpretation. SF-36v1 BPS scores range from0100. A higher score indicates lack of bodily pain.SF-36v2 uses norm-based scoring, where 50 is the aver-age for the population. Therefore, scores above or be-low 50 can be considered above or below, respectively,the population average health status for bodily pain, andscores can be interpreted based on deviance from the mean(10 points 1 SD). Population normative data are avail-able for the US and UK.
Respondent burden. The BPS takes 2 minutes to com-plete.
Administrative burden. Training to administer, score,and interpret is minimal. Administration guidelines arespecic and clearly outlined.
Translations/adaptations. SF-36 has been translatedand adapted for use in more than 50 countries as part ofthe International Quality of Life Assessment (IQOLA) Proj-ect. Currently, published forms include the German (110),Spanish (111), Swedish (112), and Italian (113) transla-tions and English-language adaptations for use in Austra-lia/New Zealand, Canada, and the UK. Information abouttranslations is available from the IQOLA Program of theHealth Assessment Lab in Boston, Massachusetts (http://www.iqola.org).
Psychometric Information
Method of development. The Medical Outcomes Studyresearchers selected and adapted questionnaire items frominstruments in use since the 1970s and 1980s (114117) todevelop a new 149-item Functioning and Well-Being Pro-le. Items were subsequently reduced and improvementswere made in item wording, format, and scoring to pro-duce the SF-36. One item on pain intensity was retainedfrom an earlier version of the SF-20 question regardingbodily pain or discomfort. In order to improve predictionof best total scores for the Behavioural Effects of Pain Scalein the Medical Outcomes Study (114), a second item wasadded to measure the extent to which pain interferes inactivities (105).
Acceptability. Generally easy to administer and com-plete (103,118).
Reliability. For internal consistency, Cronbachs forthe SF-36 BPS administered in hip (118) and knee (119)osteoarthritis (OA) patients was 0.72 and 0.77, respec-tively; using a Chinese version of the SF-36 BPS in rheu-matoid arthritis (RA) patients, Cronbachs was 0.91(120). In adults with persistent back, hip, or knee painrecruited from primary care, Cronbachs was 0.59 (100).Among patients from 2 general practices in the UK, thetestretest reliability over a 2-week period was 0.78 (121).Over a 14-day interval, testretest reliability of a ChineseSF-36 version used in Chinese-speaking RA patients was0.82 (120).
Validity. Regarding face and content validity, itemswere derived from pre-existing questionnaires used inlarge population studies. However, both oor and ceilingeffects have been reported (118). Regarding construct va-lidity, the proportions reporting no pain on the WesternOntario and McMaster Universities Osteoarthritis Index(WOMAC) and the SF-36 BPS were 32.2% and 13.6%,respectively, and pain scores were modestly correlated(0.55) (122) among patients who had undergone jointreplacement surgery. In the same study, the WOMAC bet-ter discriminated subjects with varying severity of kneeproblems, whereas the SF-36 BPS better discriminatedsubjects with varying levels of self-reported health statusand comorbidity. In patients with hip and knee OA, cor-relations between the WOMAC pain scale and the SF-36BPS are in the range of 0.60.7 (61,121,123). In Chinese-speaking patients with RA, moderate correlations werereported between the Chinese SF-36 BPS and physicianglobal assessment of disease activity (r 0.34), physi-cians assessment of global disease activity (r 0.35),and patient pain assessment based on a pain visual analogscale (r 0.48) (120).
Ability to detect change. Although the SF-BPS is de-signed to measure the health status of populations, it hasbeen shown to be responsive to improvements in pain.Among patients undergoing knee replacement surgery,the estimated minimum clinically important difference(MCID) ranged from 16.86/100 (SD 31.83) at 6 months to6.69/100 (SD 29.20) at 2 years (119). In a similar study onhip replacement, the estimated MCID ranged from 14.67/100 (SD 26.46) to 18.34/100 (SD 27.06) at 6 months and 2years, respectively (118). The minimal detectable change
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for the SF-36 BPS ranged from 37.91/100 (knee OA) to38.09/100 (hip OA) at 6 months (118,119).
Critical Appraisal of Overall Value to theRheumatology Community
Strengths/caveats and cautions/clinical and researchusability. The SF-36 BPS is a valid and reliable genericquestionnaire designed to evaluate bodily pain as a dimen-sion of overall health status and has been widely usedinternationally and in diverse populations. Its advantagesinclude simplicity of administration and usefulness inmaking comparisons across populations for research pur-poses. At point of patient care, a disease-specic painmeasure may be more useful to discriminate levels of painseverity, and therefore response to treatment.
MEASURE OF INTERMITTENT ANDCONSTANT OSTEOARTHRITIS PAIN (ICOAP)
Description
Purpose. The ICOAP measure is a multidimensionalosteoarthritis (OA)-specic measure designed to compre-hensively evaluate the pain experience in people with hipor knee OA, including pain intensity, frequency, and im-pact on mood, sleep, and quality of life, independent ofthe effect of pain on physical function (28). It is intendedfor use alongside a measure of physical disability.
Content. The ICOAP is an 11-item scale evaluating 2pain domains: a 5-item scale evaluates constant pain anda 6-item scale evaluates intermittent pain or pain thatcomes and goes (28). Two supplementary questions canbe used to assess predictability of intermittent pain whenpresent (124). Both a hip and knee joint version of theICOAP are available (28).
Number of items: 11 items in 2 domains with 2 supple-mentary items on intermittent pain predictability.
Response options/scale. All items are constructed asrating scales with 5 levels of response. For items askingabout intensity, response options are not at all, mildly,moderately, severely, and extremely. For itemsabout frequency, response options are never, rarely,sometimes, often, and very often (28). For the sup-plementary items asking about predictability of pain, theresponse options are never, rarely, sometimes,often, and very often (124).
Recall period for items. Past week.Endorsements. Osteoarthritis Research Society Inter-
national (OARSI)/Outcome Measures in Rheumatology(OMERACT) Initiative.
Practical Application
How to obtain. The ICOAP and ICOAP Users Guidecan be obtained free of charge from the OARSI web site,www.oarsi.org.
Method of administration. The measure can be inter-viewer-administered in person or by telephone (28). Re-spondents should complete both subscales (63).
Scoring. Each ICOAP item is scored from 04. A scoreis separately produced for each subscale by summing theitems subscale scores and then normalizing each scorefrom 0 (no pain) to 100 (extreme pain). A total ICOAP scorecan be calculated by summing the 2 subscale scores, andnormalizing from 0 (no pain) to 100 (extreme pain). Ruleshave been created to deal with missing data (63). No scor-ing guidelines are available for the 2 supplementary items.
Score interpretation. Higher scores indicate a worsepain experience.
Respondent burden. The ICOAP takes 10 minutes tocomplete.
Administrative burden. Easy to administer and score.Translations/adaptations. To date, the ICOAP has been
translated into the following languages: English (NorthAmerica and UK), Czech, Dutch, French (France), Ger-man (125), Italian, Norwegian, Spanish (Castillan), Northand Central American Spanish, Swedish, Portuguese (50),Greek, Romanian, and Russian (126). Translated versionsare available at www.oarsi.org.
Psychometric Information
Method of development. Focus groups were conductedin individuals with painful hip or knee OA in 4 countries(US, UK, Canada, and Australia) to generate items pertain-ing to the OA pain experience (28,127). Content analysis ofresulting transcripts was used to identify themes, whichwere veried with participants. Subsequent psychometrictesting was conducted in subjects age 40 years with hipor knee OA drawn from rheumatologists practices, jointreplacement wait lists, and from among the members of anexisting OA cohort (28).
Acceptability. The ICOAP has been shown to be easy tounderstand and complete; subjects felt positive about theinclusion of the 2 distinct pain domains (constant painand pain that comes and goes) (126).
Reliability. Regarding content validity, Cronbachs was 0.93 (28) for 100 individuals with hip and knee OA.Testretest reliability in 76 individuals with hip and kneeOA, age 40 years, demonstrated an intraclass correlationcoefcient of 0.85 (95% condence interval 0.760.91)(122).
Validity. Content and face validity were determinedthrough focus groups used to develop the ICOAP. Forconstruct validity, descriptive analyses of items demon-strated good distribution of response options across allitems (28). Total and subscale ICOAP scores are signi-cantly correlated with scores on the Western Ontario andMcMaster Universities Osteoarthritis Index (WOMAC)pain scale, the Knee Injury and OA Outcome Score(KOOS) symptoms scale, and self-rated effect of hip/kneeproblems on quality of life, with Spearmans correlationcoefcients ranging in magnitude from 0.60 (KOOS symp-toms) to 0.81 (WOMAC pain scale) (28).
Ability to detect change. The ICOAP has been found tobe responsive to changes in OA pain in response to phar-macologic interventions (128) and joint replacement sur-gery (129). For the knee, standard response means (SRMs)ranged from 0.490.57 for the ICOAP intermittent, con-stant, and total scores comparable to that for the WOMAC
Pain Measures for Adults S247
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pain (SRM 0.54). For the hip, SRMs ranged from 0.110.19, again comparable to that for the WOMAC (SRM 0.15)(128). The ICOAP detected large improvements in painresulting from joint replacement surgery with SRMs (0.841.02 for knee replacement and 1.502.29 for hip replace-ment) (129).
Critical Appraisal of Overall Value to theRheumatology Community
Strengths/caveats and cautions/clinical and researchusability. The ICOAP is a valid and reliable measure thatis unique in that it is intended to evaluate the multi-dimensional pain experience in OA, distinct from theimpact of pain on physical functioning. Prior experiencewith the WOMAC, the most commonly used OA measure,has shown high correlations between the pain and physi-cal function subscales. As a result, evaluation of OA painusing the WOMAC is confounded by physical disability.The ICOAP is intended for use together with a measureof OA disability. Although the ICOAP has been trans-lated from English into a number of languages, only afew have been evaluated for validity, reliability, andresponsiveness.
DISCUSSION
There are multiple measures available to assess pain inadult rheumatology populations. Each measure has itsown strengths and weaknesses. Both the Visual AnalogScale for Pain and the Numeric Rating Scale (NRS) for Painare unidimensional single-item scales that provide an es-timate of patients pain intensity. They are easy to admin-ister, complete, and score. Of the 2, the pain NRS may bepreferred at point of patient care due to simpler scoring. Inresearch, the pain NRS may similarly be preferred due toits ability to be administered both verbally and in writing.However, neither measure provides a comprehensive eval-uation of pain in patients with rheumatic disease. To eval-uate the multiple dimensions of acute and chronic pain, anumber of valid and reliable questionnaires are available.The McGill Pain Questionnaire (MPQ) is a generic painmeasure useful largely for research purposes to describenot only the quantity (intensity), but also the quality of thepatients pain. The Chronic Pain Grade Scale (CPGS) issimilarly a generic pain measure useful for research pur-poses to describe, evaluate and compare chronic pain se-verity (its intensity and impact) across groups and in re-sponse to treatment effects. The third genericmultidimensional pain measure, the Short Form-36 BodilyPain Scale (SF-36 BPS), is useful in evaluating pain in thecontext of overall health status, and therefore most suit-able for use in making comparisons across populationsand between subgroups within populations. Unlike theMPQ and CPGS, the SF-36 BPS is simple enough for use atpoint of care. Finally, the Measure of Intermittent andConstant Osteoarthritis Pain is an osteoarthritis-specicpain measure that is recommended for descriptive andevaluative purposes in both clinical practice and researchto provide a comprehensive evaluation of the pain expe-rience in osteoarthritis, including the impact of pain on
mood, sleep and quality of life, separate and distinct fromthe impact of pain on functioning. Due to the variability inpurpose, content, method of administration, respondentand administrative burden, and evidence to support thepsychometric properties of each measure, no one painmeasure can be recommended for use in all situations. Weencourage clinicians and researchers to use this informa-tion presented in this chapter to help guide the selection ofthe questionnaire that is most appropriate for their specicpurpose.
AUTHOR CONTRIBUTIONS
All authors were involved in drafting the article or revising itcritically for important intellectual content, and all authors ap-proved the nal version to be published.
REFERENCES
1. McCormack HM, Horne DJ, Sheather S. Clinical applications of visualanalogue scales: a critical review. Psychol Med 1988;18:100719.
2. Huskisson EC. Measurement of pain. Lancet 1974;2:112731.3. Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson
JA. Studies with pain rating scales. Ann Rheum Dis 1978;37:37881.4. Huskisson EC, Wojtulewski JA, Berry H, Scott J, Hart FD, Balme HW.
Treatment of rheumatoid arthritis with fenoprofen: comparison withaspirin. Br Med J 1974;1:17680.
5. Berry H, Huskisson EC. Treatment of rheumatoid arthritis. Clin TrialsJ 1972;4:135.
6. Jensen MP, Karoly P, Braver S. The measurement of clinical painintensity: a comparison of six methods. Pain 1986;27:11726.
7. Burckhardt CS, Jones KD. Adult measures of pain: The McGill PainQuestionnaire (MPQ), Rheumatoid Arthritis Pain Scale (RAPS), Short-Form McGill Pain Questionnaire (SF-MPQ), Verbal Descriptive Scale(VDS), Visual Analog Scale (VAS), and West Haven-Yale Multidisci-plinary Pain Inventory (WHYMPI). Arthritis Rheum 2003;49:S96104.
8. Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, GoldsmithCH. Reliability of pain scales in the assessment of literate and illiteratepatients with rheumatoid arthritis. J Rheumatol 1990;17:10224.
9. Scott J, Huskisson EC. Graphic representation of pain. Pain 1976;2:17584.
10. Joyce CR, Zutshi DW, Hrubes VF, Mason RM. Comparison of xedinterval and visual analogue scales for rating chronic pain. Eur J ClinPharmacol 1975;8:41520.
11. Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scaleratings and change scores: a reanalysis of two clinical trials of post-operative pain. J Pain 2003;4:40714.
12. Scott J, Huskisson EC. Vertical or horizontal visual analogue scales.Ann Rheum Dis 1979;38:560.
13. Aitken RC. Measurement of feelings using visual analogue scales. ProcR Soc Med 1969;62:98993.
14. Clarke PR, Spear FG. Reliability and sensitivity in the self-assessmentof well-being. [abstract]. Bull Br Psychol Soc 1964;17:18A.
15. Woodforde JM, Merskey H. Some relationships between subjectivemeasures of pain. J Psychosom Res 1972;16:1738.
16. Kremer E, Atkinson JH, Ignelzi RJ. Measurement of pain: patientpreference does not confound pain measurement. Pain 1981;10:2418.
17. Wolfe F, Michaud K. Assessment of pain in rheumatoid arthritis:minimal clinically signicant difference, predictors, and the effect ofanti-tumor necrosis factor therapy. J Rheumatol 2007;34:167483.
18. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinicallyimportant differences (MCID) and patient acceptable symptomaticstate (PASS) for visual analog scales (VAS) measuring pain in patientstreated for rotator cuff disease. J Shoulder Elbow Surg 2009;18:92732.
19. Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric painrating scale in patients with low back pain. Spine 2005;30:13314.
20. Jensen MP, McFarland CA. Increasing the reliability and validity ofpain intensity measurement in chronic pain patients. Pain 1993;55:195203.
21. Rodriguez CS. Pain measurement in the elderly: a review. Pain ManagNurs 2001;2:3846.
22. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinicalimportance of changes in chronic pain intensity measured on an11-point numerical pain rating scale. Pain 2001;94:14958.
S248 Hawker et al
-
23. Johnson C. Measuring pain. Visual analog scale versus numeric painscale: what is the difference? J Chiropr Med 2005;4:434.
24. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP,Katz NP, et al. Core outcome measures for chronic pain clinical trials:IMMPACT recommendations. Pain 2005;113:919.
25. Jensen MP, Karoly P, ORiordan EF, Bland F Jr, Burns RS. The sub-jective experience of acute pain. Clin J Pain 1989;5:1539.
26. Langley GB, Sheppeard H. The visual analogue scale: its use in painmeasurement. Rheumatol Int 1985;5:1458.
27. De C Williams AC, Davies HT, Chadury Y. Simple pain rating scaleshide complex idiosyncratic meanings. Pain 2000;85:45763.
28. Hawker GA, Davis AM, French MR, Cibere J, Jordan JM, March L, et al.Development and preliminary psychometric testing of a new OA painmeasure: an OARSI/OMERACT initiative. Osteoarthritis Cartilage2008;16:40914.
29. Hush JM, Refshauge KM, Sullivan G, De Souza L, McAuley JH. Donumerical rating scales and the Roland-Morris Disability Question-naire capture changes that are meaningful to patients with persistentback pain? Clin Rehabil 2010;24:64857.
30. Burckhardt CS. The use of the McGill Pain Questionnaire in assessingarthritis pain. Pain 1984;19:30514.
31. Melzack R. The McGill Pain Questionnaire: major properties andscoring methods. Pain 1975;1:27799.
32. Escalante A, Lichtenstein MJ, White K, Rios N, Hazuda HP. A methodfor scoring the pain map of the McGill pain questionnaire for use inepidemiologic studies. Aging Clin Exp Res 1995;7:35866.
33. Melzack R. The short-form McGill Pain Questionnaire. Pain 1987;30:1917.
34. Menezes CL, Maher CG, McAuley JH, Costa LO. Systematic review ofcross-cultural adaptations of McGill Pain Questionnaire reveals a pau-city of clinimetric testing. J Clin Epidemiol 2009;62:93443.
35. Boureau F, Luu M, Doubrere JF, Gay C. Construction of a question-naire for the self-evaluation of pain using a list of qualiers. Therapie1984;39:11929.
36. Geissner E. Measuring pain via questionnaires: several results con-cerning the validity of a modied German version of the McGill PainQuestionnaire. Z Klin Psychol 1988;17:33440.
37. Kiss I, Muller H, Abel M. The McGill Pain Questionnaire: Germanversion. Pain 1987;29:195207.
38. Stein C, Mendl G. The German counterpart to McGill Pain Question-naire. Pain 1988;32:2515.
39. Kim HS, Schwartz-Barcott D, Holter IM, Lorensen M. Developing atranslation of the McGill pain questionnaire for cross-culturalcomparison: an example from Norway. J Adv Nurs 1995;21:4216.
40. Van Lankveld WF, van Pad Bosch PF, van de Putte LF, van der StaakCF, Naring G. Pain in rheumatoid arthritis measured with the visualanalogue scale and the Dutch version of the McGill Pain Question-naire. Ned Tijdschr Geneeskd 1992;136:116670.
41. Maiani G, Sanavio E. Semantics of pain in Italy: the Italian version ofthe McGill Pain Questionnaire. Pain 1985;22:399405.
42. Hasegawa M, Hattori S, Mishima M, Matsumoto IF, Kimura T, Baba Y,et al. The McGill Pain Questionnaire, Japanese version, reconsidered:conrming the theoretical structure. Pain Res Manag 2001;6:17380.
43. Ketovuori H, Pontinen PJ. A pain vocabulary in Finnish: the Finnishpain questionnaire. Pain 1981;11:24753.
44. Lazaro C, Bosch F, Torrubia R, Banos JE. The development of aSpanish questionnaire for assessing pain: preliminary data concerningreliability and validity. Euro J Psychol Assess 1994;10:14551.
45. Hui YL, Chen AC. Analysis of headache in a Chinese patient popula-tion. Ma Zui Xue Za Zhi 1989;27:138.
46. Van der Kloot WA, Oostendorp RA, van der Meij J, van den HJ. TheDutch version of the McGill pain questionnaire: a reliable pain ques-tionnaire. Ned Tijdschr Geneeskd 1995;139:66973. In Dutch.
47. Aboud FE, Hiwot MG, Arega A, Molla M, Samson SN, SeyoumN, et al.The McGill Pain Questionnaire in Amharic: Zwai Health Center pa-tients reports on the experience of pain. Ethiop Med J 2003;41:4561.
48. Bartko D, Kondas M, Janco S. Quantication of pain in neurology.Cesk Neurol Neurochir 1984;47:11321.
49. Kuguoglu S, Aslan FE, Olgun N. Turkish version of the McGill Mel-zack Pain Questionnaire Form (MPQF). Agri-Istanbul 2003;15:4751.
50. Goncalves RS, Cabri J, Pinheiro JP, Ferreira PL, Gil J. Cross-culturaladaptation and validation of the Portuguese version of the intermittentand constant osteoarthritis pain (ICOAP) measure for the knee. Osteo-arthritis Cartilage 2010;18:105861.
51. Pimenta CA, Teixeiro MJ. Proposal to adapt the McGill Pain Ques-tionnaire into Portuguese. Rev Esc Enferm USP 1996;30:47383. InPortuguese.
52. Varoli FK, Pedrazzi V. Adapted version of the McGill Pain Question-naire to Brazilian Portuguese. Braz Dent J 2006;17:32835.
53. Torgerson WS. Theory and methods of scaling. New York: Wiley andSon; 1958.
54. Chapman CR, Casey KL, Dubner R, Foley KM, Gracely RH, ReadingAE. Pain measurement: an overview. Pain 1985;22:131.
55. Broderick JE, Schwartz JE, Vikingstad G, Pribbernow M, Grossman S,Stone AA. The accuracy of pain and fatigue items across differentreporting periods. Pain 2008;139:14657.
56. Love A, Leboeuf C, Crisp TC. Chiropractic chronic low back painsufferers and self-report assessment methods. Part I. A reliabilitystudy of the Visual Analogue Scale, the Pain Drawing and the McGillPain Questionnaire. J Manipulative Physiol Ther 1989;12:215.
57. Roche PA, Klestov AC, Heim HM. Description of stable pain in rheu-matoid arthritis: a 6 year study. J Rheumatol 2003;30:17338.
58. Papageorgiou AC, Badley EM. The quality of pain in arthritis: thewords patients use to describe overall pain and pain in individualjoints at rest and on movement. J Rheumatol 1989;16:10612.
59. Katz J, Clairoux M, Kavanagh BP, Roger S, Nierenberg H, Redahan C,et al. Pre-emptive lumbar epidural anesthesia reduces postoperativepain and patient-controlled morphine consumption after lower ab-dominal surgery. Pain 1994;59:395403.
60. Creamer P, Lethbridge-Cejku M, Hochberg MC. Determinants of painseverity in knee osteoarthritis: effect of demographic and psychosocialvariables using 3 pain measures. J Rheumatol 1999;26:178592.
61. Gandhi R, Tsvetkov D, Dhottar H, Davey JR, Mahomed NN. Quantify-ing the pain experience in hip and knee osteoarthritis. Pain Res Manag2010;15:2248.
62. Jenkinson C, Carroll D, Egerton M, Frankland T, McQuay H, Nagle C.Comparison of the sensitivity to change of long and short form painmeasures. Qual Life Res 1995;4:3537.
63. ICOAP Users Guide. Osteoarthritis Research Society International.2011. URL: http://www.oarsi.org/pdfs/pain_indexes/ICOAP_USERS_GUIDE_07072010.pdf.
64. Rasmussen PV, Sindrup SH, Jensen TS, Bach FW. Symptoms andsigns in patients with suspected neuropathic pain. Pain 2004;110:4619.
65. Dworkin RH, Corbin AE, Young JP Jr, Sharma U, LaMoreaux L, Bock-brader H, et al. Pregabalin for the treatment of postherpetic neuralgia:a randomized, placebo-controlled trial. Neurology 2003;60:127483.
66. Gilron I, Bailey JM, Tu D, Holden RR, Weaver DF, Houlden RL.Morphine, gabapentin, or their combination for neuropathic pain.N Engl J Med 2005;352:132434.
67. Hsieh LL, Kuo CH, Yen MF, Chen TH. A randomized controlledclinical trial for low back pain treated by acupressure and physicaltherapy. Prev Med 2004;39:16876.
68. Knotek P, Solcova I, Zalsky M. Czech version of the short form McGillPain Questionnaire: restandardization. Bolest 2002;5:16972.
69. Perkins FM, Werner MU, Persson F, Holte K, Jensen TS, Kehlet H.Development and validation of a brief, descriptive Danish pain ques-tionnaire (BDDPQ). Acta Anaesthesiol Scand 2004;48:48690.
70. Naja-Ghezeljeh T, Ekman I, Nikravesh MY, Emami A. Adaptationand validation of the Iranian version of Angina Pectoris characteristicsquestionnaire. Int J Nurs Pract 2008;14:4706.
71. Georgoudis G, Watson PJ, Oldham JA. The development and valida-tion of a Greek version of the short-form McGill Pain Questionnaire.Eur J Pain 2000;4:27581.
72. Georgoudis G, Oldham JA, Watson PJ. Reliability and sensitivity mea-sures of the Greek version of the short form of the McGill PainQuestionnaire. Eur J Pain 2001;5:10918.
73. Sloman R, Rosen G, Rom M, Shir Y. Nurses assessment of pain insurgical patients. J Adv Nurs 2005;52:12532.
74. Ahuja S, Saluja V, Bhattacharya A. AModied Short formMcGill PainQuestionnaire for evaluation of post-operative pain and behaviouralresponse to pain relief. J Anaesthesiol Clin Pharmacol 1999;15:14953.
75. Lee HF, Nicholson LL, Adams RD, Maher CG, Halaki M, Bae SS.Development and psychometric testing of Korean language versionsof 4 neck pain and disability questionnaires. Spine (Phila Pa 1976)1976;31:18415.
76. Lee MC, Essoka G. Patients perception of pain: comparison betweenKorean-American and Euro-American obstetric patients. J Cult Divers1998;5:2937.
77. Ljunggren AE, Strand LI, Johnsen TB. Development of the Norwegianshort-form McGill Pain Questionnaire (NSF-MPQ). Adv Physiother2007;9:16980.
78. Burckhardt CS, Bjelle A. A Swedish version of the short-form McGillPain Questionnaire. Scand J Rheumatol 1994;23:7781.
79. Kitisomprayoonkul W, Klaphajone J, Kovindha A. Thai Short-formMcGill Pain Questionnaire. J Med Assoc Thai 2006;89:84653.
80. Yakut Y, Yakut E, Bayar K, Uygur F. Reliability and validity of theTurkish version short-form McGill pain questionnaire in patients withrheumatoid arthritis. Clin Rheumatol 2007;26:10837.
81. Huskisson EC. Current practice in rheumatology. Practitioner 1983;227:1087.
82. Grushka M, Sessle BJ. Applicability of the McGill Pain Questionnaireto the differentiation of toothache pain. Pain 1984;19:4957.
83. Hunter M. The Headache Scale: a new approach to the assessment ofheadache pain based on pain descriptions. Pain 1983;16:36173.
Pain Measures for Adults S249
-
84. Leavitt JW. Science enters the birthing room: obstetrics in Americasince the eighteenth century. J Am Hist 1983;70:281304.
85. Grafton KV, Foster NE, Wright CC. Test-retest reliability of the Short-Form McGill Pain Questionnaire: assessment of intraclass correlationcoefcients and limits of agreement in patients with osteoarthritis.Clin J Pain 2005;21:7382.
86. Strand LI, Ljunggren AE, Bogen B, Ask T, Johnsen TB. The Short-FormMcGill Pain Questionnaire as an outcome measure: test-retest reliabil-ity and responsiveness to change. Eur J Pain 2008;12:91725.
87. Birch S, Jamison RN. Controlled trial of Japanese acupuncture forchronic myofascial neck pain: assessment of specic and nonspeciceffects of treatment. Clin J Pain 1998;14:24855.
88. Ruoff GE, Rosenthal N, Jordan D, Karim R, Kamin M. Tramadol/acetaminophen combination tablets for the treatment of chroniclower back pain: a multicenter, randomized, double-blind, placebo-controlled outpatient study. Clin Ther 2003;25:112341.
89. Dworkin RH, Turk DC, Revicki DA, Coyne KS, Peirce-Sandner S,Burke LB, et al. Development and initial validation of an expandedand revised version of the Short-form McGill Pain Questionnaire(SF-MPQ-2). Pain 2009;144:3542.
90. Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity ofchronic pain. Pain 1992;50:13349.
91. Elliott AM, Smith BH, Smith WC, Chambers WA. Changes in chronicpain severity over time: the Chronic Pain Grade as a valid measure.Pain 2000;88:3038.
92. Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA. Theepidemiology of chronic pain in the community. Lancet 1999;354:124852.
93. Von Korff M, Stewart WF, Lipton RB. Assessing headache severity.Neurology 1994;44:S406.
94. Smith BH, Penny KI, Purves AM, Munro C, Wilson B, Grimshaw J,et al. The Chronic Pain Grade questionnaire: validation and reliabilityin postal research. Pain 1997;71:1417.
95. Salaf FF, Stancati AF, Grassi W. Reliability and validity of the Italianversion of the Chronic Pain Grade questionnaire in patients withmusculoskeletal disorders. Clin Rheumatol 2006;25:61931.
96. Von Korff M, Dworkin SF, Le RL. Graded chronic pain status: anepidemiologic evaluation. Pain 1990;40:27991.
97. Turk DC, Rudy TE. Towards a comprehensive assessment of chronicpain patients. Behav Res Ther 1987;25:23749.
98. Turk DC, Rudy TE. Toward an empirically derived taxonomy ofchronic pain patients: integration of psychological assessment data.J Consult Clin Psychol 1988;56:2338.
99. Kerns RD, Turk DC, Rudy TE. TheWest Haven-Yale MultidimensionalPain Inventory (WHYMPI). Pain 1985;23:34556.
100. Krebs EE, Bair MJ, Damush TM, Tu W, Wu J, Kroenke K. Comparativeresponsiveness of pain outcome measures among primary care pa-tients with musculoskeletal pain. Med Care 2010;48:100714.
101. Dunn KM, Jordan K, Croft PR. Does questionnaire structure inuenceresponse in postal surveys? J Clin Epidemiol 2003;56:106.
102. Penny KI, Purves AM, Smith BH, Chambers WA, Smith WC. Relation-ship between the chronic pain grade and measures of physical, socialand psychological well-being. Pain 1999;79:2759.
103. Ware JE, Kosinski M, Keller SK. SF-36 physical and mental healthsummary scales: a users manual. Boston: The Health Institute; 1994.
104. McHorney CA, Ware JE, Raczek AE. The MOS 36-Item Short-FormHealth Survey (SF-36) II: psychometric and clinical tests of validity inmeasuring physical and mental health constructs. Med Care 1993;31:24763.
105. Ware JE Jr, Sherbourne CD. The MOS 36-item Short-Form healthsurvey (SF-36). I. Conceptual framework and item selection. Med Care1992;30:47383.
106. Ware JE, Kosinski M, Dewey JE. How to score version two of the SF-36Health Survey. Lincoln (RI): QualityMetric; 2000.
107. Ware JE, Gandek B. Overview of the SF-36 Health Survey and theInternational Quality of Life Assessment (IQOLA) project. J Clin Epi-demiol 1998;51:90312.
108. Shiely JC, Bayliss MS, Keller SD, Tsai C, Ware JE. SF-36 Health Surveyannotated bibliography: the rst edition (1988-1995). Boston: TheHealth Institute, New England Medical Center; 1996.
109. Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey:
manual and interpretation guide. Boston: The Health Institute, NewEngland Medical Center; 1993.
110. Bullinger M. German translation and psychometric testing of theSF-36 Health Survey: preliminary results from the IQOLA Project. SocSci Med 1995;41:135966.
111. Alonso J, Prieto L, Anto JM. The Spanish version of the SF-36 HealthSurvey (the SF-36 health questionnaire): an instrument for measuringclinical results. Med Clin (Barc) 1995;104:7716. In Spanish.
112. Sullivan M, Karlsson J, Ware JE Jr. SF-36 Halsoenkat: Svensk manualoch tolkningsguide (Swedish manual and interpretation guide).Gothenburg: Sahlgrenska University Hospital; 1994.
113. Apolone G, Cifani S, Liberati MC, Mosconi P. Questionario sullo statodi salute SF-36. Traduzione e validazione della versione italiana:risultati del progetto IQOLA. Metodologia e Didattica Clinica 1997;5:8694.
114. Stewart AL, Ware JE. Measuring functioning and well-being: the Med-ical Outcomes Study approach. Durham (NC): Duke University Press;1992.
115. Dupuy HJ. The Psychological General Well-Being (PGWB) Index. In:Wenger NK, Mattson ME, Furberg JF, Elinson JA, editors. Assessmentof quality of life in clinical trials of cardiovascular therapies. NewYork: Le Jacq; 1984. p. 17083.
116. Hulka BS, Cassel JC. The AAFP-UNC study of the organization, utili-zation, and assessment of primary medical care. Am J Public Health1973;63:494501.
117. Patrick DL, Bush JW, Chen MM. Methods for measuring levels ofwell-being for a health status index. Health Serv Res 1973;8:22845.
118. Quintana JM, Escobar A, Bilbao A, Arostegui I, Lafuente I, Vidaur-reta I. Responsiveness and clinically important differences for theWOMAC and SF-36 after hip joint replacement. Osteoarthritis Carti-lage 2005;13:107683.
119. Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidaur-reta I. Responsiveness and clinically important differences for theWOMAC and SF-36 after total knee replacement. Osteoarthritis Car-tilage 2007;15:27380.
120. Koh ET, Leong KP, Tsou IY, Lim VH, Pong LY, Chong SY, et al. Thereliability, validity and sensitivity to change of the Chinese version ofSF-36 in oriental patients with rheumatoid arthritis. Rheumatology(Oxford) 2006;45:10238.
121. Brazier JE, Harper R, Jones NM, OCathain A, Thomas KJ, UsherwoodT, et al. Validating the SF-36 Health Survey questionnaire: new out-come measure for primary care. BMJ 1992;305:1604.
122. Bombardier C, Mel C, Paul J, Green R, Hawker GA, Wright J, et al.Comparison of a generic and a disease-specic measure of pain andphysical function after knee replacement surgery. Med Care 1995;33:AS13144.
123. Salaf F, Leardini G, Canesi B, Mannoni A, Fioravanti A, Caporali R,et al. Reliability and validity of the Western Ontario and McMasterUniversities (WOMAC) Osteoarthritis Index in Italian patients withosteoarthritis of the knee. Osteoarthritis Cartilage 2003;11:55160.
124. Hawker GA, French MR, Elkayam JG, Davis AM. Unpredictabilityof intermittent knee OA pain: impact on pain, function, and mood[abstract]. Arthritis Rheum 2010;62 Suppl 10:S2845.
125. Kessler S, Grammozis A, Gunther KP, Kirschner S. The Intermittentand Constant Pain Score (ICOAP): a questionnaire to assess pain inpatients with gonarthritis. Z Orthop Unfall 2010;149:226. In Ger-man.
126. Maillefert JF, Kloppenburg M, Fernandes L, Punzi L, Gunther KP,Martin Mola E, et al. Multi-language translation and cross-culturaladaptation of the OARSI/OMERACT measure of intermittent and con-stant osteoarthritis pain (ICOAP). Osteoarthritis Cartilage 2009;17:12936.
127. Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, et al.Understanding the pain experience in hip and knee osteoarthritis: anOARSI/OMERACT initiative. Osteoarthritis Cartilage 2008;16:41522.
128. Hawker GA, Davis A, Lohmander S. Responsiveness of the newOARSI-OMERACT OA pain and function measures [abstract]. AnnRheum Dis 2009;68 Suppl 3:350.
129. Davis AM, Lohmander LS, Wong R, Venkataramanan V, Hawker GA.Evaluating the responsiveness of the ICOAP following hip or kneereplacement. Osteoarthritis Cartilage 2010;18:10435.
S250 Hawker et al
-
Summar
yTab
leforAdult
Pain
Mea
sure
s*
Scale
Purp
ose/co
nten
tMetho
dof
administration
Respo
nden
tbu
rden
Adm
inistrative
burd
enSc
ore
interp
retation
Reliability
eviden
ceValidity
eviden
ceAbility
tode
tect
chan
geStreng
ths
Cau
tion
s
VAS
Unidim
ension
almea
sure
ofpainintensity
Onehorizon
talor
vertical
linewith
varyingtimepoints
anddescriptor
anch
ors
Self-ad
ministered
Pen
cil/pap
er1minute
Notrainingrequ
ired
Ability
touse
aru
lerto
mea
sure
distance
toscore
VASrequ
ired
Higher
scores
indicate
grea
terpainintensity
Goo
d;T
estretest
reliab
ilityhigher
amon
gliterate
than
illiterate
rheu
matolog
you
tpatients
(r
0.94
and
r
0.71
,respec
tive
ly)
Goo
d;V
ASscores
show
nto
behighly
correlated
withother
pain
mea
sure
scores
Ran
ger
0.62
0.91
Exc
ellent;Sen
sitive
tomea
suringch
ange
sin
painasso
ciated
withtrea
tmen
tor
time.
(MCID
of1.37
cmon
10-cm
pain
VAS;c
han
geof
1.1
points
on11
-point
scale)
Acc
eptable/va
lid/
reliab
lemea
sure
ofpainintensity
May
not
beap
propriate
foruse
inolder
and/
orilliterate
pop
ulation
NRS
Unidim
ension
almea
sure
ofpainintensity
Asingle11
-pointscale
that
consistsof
anumeric
segm
ented
horizon
talba
ror
line
Self-ad
ministered
orinterviewer-
administered
(bytelephon
e)
1minute
Notrainingrequ
ired
toad
minister
andscore
Higher
scores
indicate
grea
terpainintensity
Noestablished
cut
points
Exc
ellent;Testretest
reliab
ilityhighforbo
thliterate
andilliterate
rheu
matolog
you
tpatients
(r
0.96
and
r
0.95
resp
ective
ly)
Exc
ellent;Con
stru
ctva
lidity:
NRShighly
correlated
toVASin
patients
with
rheu
matic
andother
chronic
pain
conditions.
(r0.86
)
Exc
ellent;A
reduction
of2points,o
r30
%,
onNRSscores
isclinically
important
Acc
eptable/va
lid/
reliab
lemea
sure
ofpainintensity
Can
bead
ministered
bytelephon
e
Doe
snot
capture
the
complexan
didiosy
ncratic
nature
ofpainex
perience
orim
prove
men
tsdueto
symptom
uctuations
MPQ
Amultidim
ension
almea
sure
ofsenso
ry,
affectivean
dev
aluativeaspec
tsof
painan
dpain
intensity
Com
prisedof
78pain
descriptoritem
san
don
e-item
pain
intensity
scale
Interviewer-
administered
Pen
cil/pap
er
20
minutesNotrainingrequ
ired
toscore(25
minutesto
score)
Interviewer
must
hav
eab
ilityto
describeea
chpaindescriptor
Higher
scores
onM
PQ
indicateworse
pain
Noestablished
cut
points
Goo
d;T
estretest
reliab
ilityin
rheu
matolog
ypop
ulation
sis
adeq
uate(r0.70
)
Goo
d;C
onstru
ctva
lidity:
MPQ
wordspos
itively
correlated
withpain
VASscores
atrest
and
onthemov
emen
tin
rheu
matoidarthritis
patients
(ran
ge0.17
0.27
).In
knee
OA
patients,
higher
MPQ
scores
asso
ciated
withgrea
ter
anxiety,
dep
ression,
symptoms,
and
disab
ilityusingthe
WOM
AC
(r0.30
)
Goo
d;E
SforM
PQ-
PainRatingIndex
compared
with4-
pointca
tego
rica
lve
rbal
rating
scalean
dapain
VASwere1.08
(mod
erate)
to1.12
(goo
d)
Acc
eptable/va
lid/
reliab
lemea
sure
ofqu
alityan
dqu
antity
ofpain
usinguniquepain
descriptors
Richvo
cabu
lary
ofresp
onden
tsrequ
ired
forco
mpletion
Ethnic
andsex
difference
smay
affect
selectionof
paindescriptors
SF-M
PQ
Amultidim
ension
almea
sure
ofperce
ived
painintensity
Com
prisedof
15pain
descriptoritem
s
Interviewer-
administered
Pen
cil/pap
er
25minutes
Notrainingrequ
ired
toscore(1
minute
toscore)
Interviewer
must
hav
eab
ilityto
describeea
chpaindescriptor
Higher
scores
onSF-M
PQ
indicate
worse
pain
Noestablished
cut
points
Goo
d;Intern
alco
nsisten
cy:
Cronba
chs
alphain
rheu
matolog
ypop
ulation
range
dfrom
0.73
to0.89
.Testretest
reliab
ility
range
dfrom
0.45
to0.73
at1-
and3-mon
thintervals.
For
13day
intervals,
testretestwas
high(ran
ge:0
.79
0.93
).IC
Cwas
highforea
chSF-
MPQ
subs
cale,V
AS
averag
epainan
dtotal
scores
(ICC0.89
)
Goo
d;C
ontentva
lidity:
Themea
nintensity
scores
forea
chSF-
MPQ
wordsrange
dfrom
1.57
to2.60
inrh
eumatolog
ypatients.
InOA
patients,S
F-
MPQ
ismod
erately
correlated
withbo
thW
OM
AC
andSF-26
bodilypainscales
(r
0.36
andr
0.36
,respec
tive
ly)
Goo
d;InM
SK
patients,
SRM
values
for
Norweg
ianSF-M
PQ
were0.80
.Clinically
important
chan
ge:m
ean
improve
men
tin
total
scores5on
the0
45NSF-M
PQ
scale
Minim
um
detec
table
chan
gefortotal,
senso
ry,a
ffec
tive
,av
erag
ean
dcu
rren
tpainare5.2,
4.5,
2.8,
1.4,
1.4cm
Acc
eptable/va
lid/
reliab
lesh
ort-form
versionof
the
MPQ
Easierto
use,m
ore
understan
dab
le,
andtake
sless
timeto
administer
andco
mplete
than
thelonge
rform
Supervision
during
completion
requ
ired
fornew
users
CPGS
Amultidim
ension
alpainmea
sure
that
assesses
2dim
ension
sof
overallch
ronic
painseve
rity:p
ain
intensity
andpain-
relateddisab
ility
Subs
cale
scores
for
painintensity
and
disab
ilityare
combined
toca
lculate
ach
ronic
paingrad
ean
dclassify
chronic
painpatients
into
5hierarchical
catego
ries:g
rades
0(nopain)to
IV(high
disab
ility-seve
rely
limiting)
Self-ad
ministered
orinterviewer-
administered
10
minutesNotrainingrequ
ired
Easyto
administer
butscoringis
complex
3su
bsca
lescores
are
usedto
classify
subjec
tsinto
1of
5painseve
rity
catego
ries
Goo
d;Intern
alco
nsisten
cy:
Cronba
chs
0.74
inlow
back
painpatients.
Inch
ronic
MSK
pain
patients,C
ronba
chs
range
dfrom
0.81
0.89
foran
ItalianCPGS
Testretest
reliab
ilitywas
highafter2-wee
kinterval
inUK
general
practicepatients
(weigh
ted
0.81
95%
CI0.65
0.98)
Goo
d;C
onstru
ctva
lidity:
Spea
rman
sco
rrelation
coefcien
tsforCPGS
andSF-36werehigh
forthepaindim
ension
(r0.71
to0.84
)an
dlow
forthemen
tal
hea
lthdim
ension
(r
0.28
to0.38
)
Goo
d;E
ffec
tsize
sfor
CPGSintensity
and
disab
ilitysu
bsca
les
inch
ronic
MSK
patients
were
0.41
and0.43
,resp
ective
ly.In
chronic
knee
orhip
pain,e
ffec
tsize
was
0.32
Acc
eptable,
valid
andreliab
lemea
sure
ofch
ronic
MSK
pain.C
PGSallows
forthegrad
ingof
glob
alseve
rity
ofch
ronic
pain
andqu
alitative
chan
gesin
chronic
painov
ertime
Com
plexity
ofscoring
limitsitsuse
for
assessmen
tof
painat
pointof
care (con
tinued
)
Pain Measures for Adults S251
-
Summar
yTab
le(C
ontd)
Scale
Purp
ose/co
nten
tMetho
dof
administration
Respo
nden
tbu
rden
Adm
inistrative
burd
enSc
ore
interp
retation
Reliability
eviden
ceValidity
eviden
ceAbility
tode
tect
chan
geStreng
ths
Cau
tion
s
SF-36BPS
A2-item
bodilypain
scalethat
mea
sures
painintensity
and
paininterferen
cewith
normal
activities.
TheSF-36BPis
1of
the8SF-36su
bsca
les
Self-ad
ministered,
computer-
administered,
orinterviewer-
administered
(in-perso
nor
bytelephon
e)
2minutes
Minim
altraining
requ
ired
toad
minister,
and
score.
(Users
Guideav
ailable)
Higher
scores
indicate
lack
ofbo
dilypain
Exc
ellent;Intern
alco
nsisten
cy:C
ronba
chs
in
hip
andkn
eeOA
patients
was
0.72
and
0.77
,respec
tive
ly.U
sing
aChineseve
rsion,
Cronba
chsin
RA
patients
was
0.91
.Testretest
reliab
ility
was
0.78
inge
neral
practicepatients
and
0.82
inChinese-
spea
kingRA
patients
over
a2-wee
kperiod
Goo
d;C
onstru
ctva
lidity:
proportion
ofpatients
reportingnopainon
WOM
AC
andBPS
were32
.2%
and
13.6%
.Correlation
sbe
twee
nW
OM
AC
pain
scalean
dSF-36BPS
range
dfrom
0.6
0.7
Acc
eptable;
MCID
inpatients
undergo
ing
knee
replace
men
tsu
rgeryrange
dfrom
16.86/10
0(SD
31.83)
at6mon
thsto
6.69
/10
0(SD
29.20)
at2ye
ars.
For
hip
replace
men
t,M
CID
range
dfrom
14.67/
100(SD
26.46)
to18
.34/10
0(SD
27.06)
at6mon
thsan
d2
yearsresp
ective
ly.
MDC
range
dfrom
37.91/10
0to
38.09/
100at
6mon
thsfor
hip
andkn
ee,
resp
ective
ly
Acc
eptable,
valid
andreliab
lege
neric
mea
sure
ofbo
dilypain
that
issimple
toad
ministeran
duse
indiverse
pop
ulation
s
May
not
beauseful
mea
sure
todiscrim
inateleve
lsof
painseve
rity
and
thusresp
onse
totrea
tmen
t
ICOAP
Multidim
ension
alscale
that
comprehen
sive
lyev
aluates
thepain
experience
inpeo
ple
withhip
orkn
eeOA,
indep
enden
tof
the
effect
ofpainon
phys
ical
function
An11
-item
scale
evaluating2pain
dom
ains:
constan
tpainan
dinterm
ittent
pain(painthat
comes
andgo
es)
Twosu
pplemen
tary
question
sca
nbe
used
toassess
the
predictability
ofinterm
ittentpain,
when
present
Interviewer-
administered
(inperso
nor
bytelephon
e)Respon
den
tssh
ould
complete
both
subs
cales
10
minutesNotrainingrequ
ired
toad
ministeran
dscore.
(Users
Guideav
ailable)
Higher
scores
indicate
worse
pain
experience
Exc
ellent;Intern
alco
nsisten
cy:C
ronba
chs
was
0.93
inhip
and
knee
OA
subjec
ts.T
est
retest
reliab
ilitywas
highin
hip
andkn
eeOA
subjec
ts(ICC
0.85
)
Goo
d;C
onstru
ctva
lidity:
Spea
rman
sco
rrelation
coefcien
tsforIC
OAP
scores
range
dfrom
0.60
to0.81
for
WOM
AC
andKOOS,
resp
ective
ly
Goo
d;F
orkn
eeOA,
SRM
srange
dfrom
0.49
0.57forIC
OAP
subs
cales.
For
hip
OA,S
RM
srange
dfrom
0.11
0.19
.SRM
srange
dfrom
0.84
1.02forkn
eereplace
men
tan
d1.50
2.29forhip
replace
men
t
Acc
eptable/va
lid/
reliab
lemea
sure
ofthemulti-
dim
ension
alpain
experience
inOA,
distinct
from
the
impac
tof
pain
onphys
ical
functioning
Only
afew
tran
slated
versionsof
the
ICOAPhav
ebe
enassessed
forva
lidity,
reliab
ility,
and
resp
onsive
ness
*VAS
visu
alan
alog
scale;
MCID
min
imum
clin
ically
impor
tantd
ifference
;NRS
numeric
ratingsc
ale;
MPQ
McG
illP
ainQues
tion
naire;O
A
osteoa
rthritis;
WOM
AC
Wes
tern
Ontarioan
dM
cMas
terUniversities
Osteo
arth
ritis
Index
;ES
effect
size
;SF-M
PQ
Shor
tFor
mM
PQ;ICC
intrac
lass
correlationco
efcien
t;M
SK
musc
ulosk
eletal;S
RM
stan
dardized
resp
onse
mea
n;N
SF
Nor
weg
ianShor
tFor
m;C
PGS
Chro
nic
PainGradeSca
le;9
5%CI
95%
conden
cein
terv
al;SF-36BPS
Shor
tFor
m36
Bod
ilyPain
Sca
le;RA
rheu
matoid
arth
ritis;
MDC
min
imal
detec
tablech
ange
;IC
OAP
Mea
sure
ofIn
term
ittentan
dCon
stan
tOsteo
arth
ritisPain;KOOS
Knee
Injury
and
Osteo
arth
ritisOutcom
eSco
re.
S252 Hawker et al