Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference
Open accessAbstract
BACKGROUND: Inadequate pain assessment is a barrier to appropriate pain management, but single-item "pain screening" provides limited information about chronic pain. Multidimensional pain measures such as the Brief Pain Inventory (BPI) are widely used in pain specialty and research settings, but are impractical for primary care. A brief and straightforward multidimensional pain measure could potentially improve initial assessment and follow-up of chronic pain in primary care. OBJECTIVES: To develop an ultra-brief pain measure derived from the BPI. DESIGN: Development of a shortened three-item pain measure and initial assessment of its reliability, validity, and responsiveness. PARTICIPANTS: We used data from 1) a longitudinal study of 500 primary care patients with chronic pain and 2) a cross-sectional study of 646 veterans recruited from ambulatory care. RESULTS: Selected items assess average pain intensity (P), interference with enjoyment of life (E), and interference with general activity (G). Reliability of the three-item scale (PEG) was alpha = 0.73 and 0.89 in the two study samples. Overall, construct validity of the PEG was good for various pain-specific measures (r = 0.60-0.89 in Study 1 and r = 0.77-0.95 in Study 2), and comparable to that of the BPI. The PEG was sensitive to change and differentiated between patients with and without pain improvement at 6 months. DISCUSSION: We provide strong initial evidence for reliability, construct validity, and responsiveness of the PEG among primary care and other ambulatory clinic patients. The PEG may be a practical and useful tool to improve assessment and monitoring of chronic pain in primary care.
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The PEG scale is a validated brief survey used among primary care and other ambulatory clinic patients to improve assessment and monitoring of chronic pain.
“The PEG scale is a validated brief survey which is used among primary care and other ambulatory clinic patients to improve assessment and monitoring of chronic pain. 17”
From Overview and Feasibility of a Novel Transdisciplinary Integrative Approach to High Impact Chronic Pain in Vermont (2024) · cites this paper as [17]
The Abstract Discussion and Discussion describe the PEG as a brief, initially validated scale studied among primary care and ambulatory patients. They say it may be useful for improving chronic-pain assessment and monitoring, but do not establish that its use actually improves them; the Discussion calls for further research on clinical outcomes. Page numbers are not provided in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe PEG is a validated three-item measure of pain intensity and interference with internal consistency between .73 and .89.
“The validated 3-item PEG score, is the average of pain intensity (P), interference with enjoyment in life (E), and interference with general activity (G) over the past week (Cronbach’s α = .73-.89).42–45”
Participants complete validated health survey measures at the beginning and at the end of the program.
“In this initial pilot evaluation, participants complete validated health survey measures at the beginning and at the end of the program.”
From Overview and Feasibility of a Novel Transdisciplinary Integrative Approach to High Impact Chronic Pain in Vermont (2024) · cites this paper as [17]
The PEG has shown strong reliability (α = 0.73 to α = 0.89) and construct validity.
“The PEG has shown strong reliability (α = 0.73 to α = 0.89) and construct validity.31”
From Feasibility and Acceptability of a Community-Based Modified Mindfulness-Based Stress Reduction Program for the Under- and Unemployed (2020) · cites this paper as [31]
The FSI-3 was adapted from the 3-item PEG, which is an ultra-brief version of the Brief Pain Inventory (BPI).
“The FSI-3 was adapted from the 3-item PEG which is an ultra-brief version of the Brief Pain Inventory (BPI) [55].”
From Comparative responsiveness and minimally important difference of fatigue symptom inventory (FSI) scales and the FSI-3 in trials with cancer survivors (2022) · cites this paper as [55]
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References 44 · Cited by 782
Research works printed but not linked: 2
- [5]Comprehensive Accreditation Manual for Ambulatory Care. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations, 2006. 10346340
- [6]Dahl JL, Gordon DB. Joint Commission pain standards: a progress report. APS Bulletin 2002;12.
- Authors
- Krebs, E. E., Lorenz, K. A., Bair, M. J., Damush, T. M., Wu, J., Sutherland, J. M., Asch, S. M., & Kroenke, K.
- Affiliations
- Richard L. Roudebush VA Medical Center (US)
- RAND Corporation (US)
- Regenstrief Institute (US)
- Indiana University School of Medicine (US)
- Dartmouth College (US)
- Corresponding author
- Krebs, Erin E.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2009-05-06
- Volume
- 24
- Issue
- 6
- Pages
- 733-738
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2686775
- OpenAlex
- W2163932187
- Cited by
- 782
- References
- 44
- Citations by year
- 2026: 90 · 2025: 110 · 2024: 96 · 2023: 75 · 2022: 71 · 2021: 66 · 2020: 76 · 2019: 42 · 2018: 42 · 2017: 32 · 2016: 26 · 2015: 13 · 2014: 20 · 2013: 12 · 2012: 7
- FWCI
- 4.23
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of General Internal Medicine (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- TUScholarShare (Temple University) (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs
- National Institute of Mental Health (MH 071268, R01MH071268)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- chronic pain, pain intensity, pain interference, Brief Pain Inventory, pain assessment, primary care, scale development, construct validity, responsiveness, veterans, pain screening
- MeSH terms
- Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Pain, Pain Measurement, Severity of Illness Index, Reproducibility of Results
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