Measures for the Assessment of Pain in Adults

Abstract

An overview is provided regarding some of the most commonly used measures to assess pain in adults. These measures are appropriate for both general and rheumatologic pain populations. Most measures are easy to use in clinical settings and all are validated for use in research. A number of well-known measures such as the Visual Analog Scale, Numeric Rating Scale, McGill Pain Questionnaire, and the Short Form 36 bodily pain subscale were described in a previous issue 1. Pain is complex, and thus it is important to conduct a comprehensive assessment. Here, we discuss several other measures that are helpful for assessing the severity, location, and quality of pain as well as pain-related interference in functioning. Further, knowing whether the pain is focal (ie, isolated to one area of the body) or more widespread can indicate the degree to which the pain is centralized in nature 2-5 and thus inform the treatment approach to the care of rheumatology patients. However, the assessment of pain (location, severity, and quality) and its impact on functioning cannot possibly tell the full story. Pain is a biopsychosocial phenomenon in which thoughts, emotions, and behavior contribute significantly to pain perception and pain outcomes. Although it is beyond the scope of this review to discuss all the possible contributing and potentially ameliorating factors and their measurement, a comprehensive assessment of pain for interdisciplinary treatment could also include an assessment of underlying pain mechanisms, the perceived meaning of the pain, the level of pain acceptance, pain coping strategies, pain-related behavioral avoidance and/or fear (eg, kinesiophobia), and even resilience factors, including high levels of positive affect, strong social support, internal locus of control, and a sense of purpose in life. Questionnaires presented here include the pain severity and pain interference subscales from the Brief Pain Inventory (BPI), the Defense and Veterans Pain Rating Scale (DVPRS), the Michigan Body Map (MBM), the painDETECT questionnaire (PD-Q), the Patient-Reported Outcomes Measurement Information System Pain Interference (PROMIS-PI) scales, and ambulatory assessment of pain intensity, including the use of Ecological Momentary Assessment and daily pain diaries. The description of ambulatory assessments deviates from that of the other measures, given that this methodology diverges from the standard patient-reported outcome format. This form of pain measurement, however, is becoming the gold standard and, as such, is critical for clinicians and researchers to understand. Please see Tables 1 and 2 for an overview of psychometrics and practical applications, respectively. The importance of considering other co-occurring symptoms such as sleep, mood, and fatigue will be described briefly, although their measurement will be covered in other sections of this special edition. More comprehensive measures of functional status are also described in other sections of this issue. respectively. The BPI is used to assess pain intensity and pain interference. It was originally developed for use in cancer populations 6 but has since been validated for use in many noncancer pain populations 7, 8. There is both a long and short version of this measure, with the latter being used most often in clinical trials. The short version will be reviewed herein. The BPI assesses the presence of pain, pain intensity (worst, least, average, and current), pain location (body map), and the impact of pain interference on general activity, mood, walking ability, normal work, relationships with others, sleep, and life enjoyment. It also assists in documenting the types of pain medications being used and the amount of relief provided by those medications and other pain treatments. The BPI has a total of 15 items. The BPI uses a mixture of response sets. Item 1 asks about the presence of pain (yes/no). Item 2 is a body map and asks the respondent to shade all areas of pain and to then place an x on the area that hurts the most. Items 3 to 6 (pain intensity items: worst, least, average, and current) utilize an 11-point rating scale ranging from 0 (no pain) to 10 (pain as bad as you can imagine). Item 7 is an open-ended response field for listing pain medications. Item 8 (percentage of pain relief from medications or pain treatments) uses a 0% (no relief) to 100% (complete relief) response scale. Item 9 has seven parts representing different aspects of pain interference (general activity, mood, walking ability, normal work, relationships with others, sleep, and life enjoyment). The response set for pain interference ranges between 0 (does not interfere) and 10 (completely interferes). The time frame for the BPI is typically the past week, but some versions also use the past 24 hours. Licensing fees and $100 processing fees may be applied to use. Contact MD Anderson Cancer Center to inquire about fees for specific uses. The BPI is copyrighted and validated intellectual property. If interested, the contact information following contact information may be used: Department of System Research, Attention: Assessment Tools, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX 77030 (E-mail: [email protected]). The BPI can be administered as a paper/pencil form, a computerized form, or an interview. Some of the items represent single-item values and do not require scoring (eg, pain relief). The pain severity score is obtained by calculating the mean of the four pain severity items. The pain interference score is obtained by calculating the mean of the seven pain interference items. The BPI is easily scored by hand. The pain severity score ranges between 0 and 10, with larger values representing greater pain severity. The pain interference score similarly has a range of 0 to 10, with larger values representing greater pain interference. It takes approximately 5 minutes to complete the BPI. Administrative burden is minimal unless an interview format is used. Typically, the form is simply handed to the participant to complete. Scoring involves calculating two means and can be accomplished in under 5 minutes. The BPI has been translated into over 50 languages. A complete listing of translations is available through the MD Anderson Cancer Center website (https://www.mdand​erson.org/resea​rch/depar​tments-labs-insti​tutes/​depar​tments-divis​ions/sympt​om-resea​rch/sympt​om-asses​sment-tools/​brief-pain-inven​tory.html). 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