Cited by 1,247Musculoskeletal pain and rehabilitationPain Management and Opioid UsePsychometric Methodologies and Testing

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Comparative reliability and validity of chronic pain intensity measures.

Jensen, Mark P, Turner, Judith A, Romano, Joan M, Fisher, Lloyd D·1999·Pain

DOI 10.1016/s0304-3959(99)00101-3

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Abstract

Reliable and valid measures of pain are essential for conducting research on chronic pain. The purpose of this longitudinal study was to compare the reliability and validity of several measures of pain intensity. One hundred twenty-three patients with chronic pain were administered telephone interview versions of 0-10 scales of current, worst, least and average pain, immediately prior to beginning a multidisciplinary treatment program. The measures were administered again to these subjects 2 weeks (n=108), 1 month (n=106) and 2 months (n=105) after the end of treatment. The validity (defined as ability to detect changes in pain intensity over the course of treatment up to the 2-month follow-up assessment) and reliability (defined as stability over time in the 2 months after treatment) of these four measures and of composite combinations of these measures were examined. Contrary to prediction, the composite measures did not show a statistically significant superiority to the individual ratings in terms of their ability to detect change in pain intensity from pre-treatment to various points after treatment. The composite scores did, however, show greater stability than did the individual ratings after treatment. The practical conclusions of this study are; (1), individual 0-10 pain intensity ratings have sufficient psychometric strengths to be used in chronic pain research, especially research that involves group comparison designs with relatively large sample sizes, but, (2), composites of 0-10 ratings may be more useful when maximal reliability is necessary, (e.g. in studies with relatively small sample sizes, or in clinical settings where monitoring of changes in pain intensity in individuals is needed).

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Abresch, R. T., Carter, G. T., Jensen, M. P., & Kilmer, D. D. (2002) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/104990910201900109 · Cited by 157
Pain Control by Image-Guided Radiosurgery for Solitary Spinal Metastasis
Ryu, S., Jin, R., Jin, J., Chen, Q., Rock, J. P., Anderson, J., & Movsas, B. (2008) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2007.04.020 · Cited by 153
Pain in older persons with severe dementia. Psychometric properties of the Mobilization–Observation–Behaviour–Intensity–Dementia (MOBID‐2) Pain Scale in a clinical setting
Husebo, B. S., Strand, L. I., Moe‐Nilssen, R., Husebo, S. B., & Ljunggren, A. E. (2010) · Scandinavian Journal of Caring Sciences · doi:10.1111/j.1471-6712.2009.00710.x · Cited by 162
Maneuvers to Decrease Laparoscopy-Induced Shoulder and Upper Abdominal Pain
Tsai, H. (2011) · Archives of Surgery · doi:10.1001/archsurg.2011.597 · Cited by 152
“This measurement was validated as a sensitive measure for largegroup comparisons.(24) The visual analog scale ratings were obtained at 12, 24, and 48 postoperative hours for each of the 3 types of pain: upper abdominal, shoulder, and lower abdominal.”
Method
Development and evaluation of short forms of the Pain Catastrophizing Scale and the Pain Self‐efficacy Questionnaire
McWilliams, L. A., Kowal, J., & Wilson, K. G. (2015) · European Journal of Pain · doi:10.1002/ejp.665 · Cited by 155
“This method of assessing pain severity has good psychometric properties and has been used in numerous studies (Jensen et al., 1999).”
Method
The PROMIS Physical Function Correlates With the QuickDASH in Patients With Upper Extremity Illness
Overbeek, C., Nota, S. P. F. T., Jayakumar, P., Hageman, M., & Ring, D. (2015) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-014-3840-2 · Cited by 140
“The numeric rating scale for pain is an 11-point ordinal pain intensity scale anchored at each end by opposite statements, which are ‘‘no pain’’ (0) versus ‘‘worst possible pain’’ (10) [23, 40].”
Background
The effect of vagus nerve stimulation on migraines
Hord, E. D., Evans, M. S., Mueed, S., Adamolekun, B., & Naritoku, D. K. (2003) · Journal of Pain · doi:10.1016/j.jpain.2003.08.001 · Cited by 149
Clinical Pressure Pain Threshold Testing in Neck Pain: Comparing Protocols, Responsiveness, and Association With Psychological Variables
Walton, D. M., Levesque, L. A., Payne, M., & Schick, J. (2014) · Physical Therapy · doi:10.2522/ptj.20130369 · Cited by 148
Responsiveness of visual analogue and McGill pain scale measures
Scrimshaw, S. V., & Maher, C. G. (2001) · Journal of Manipulative and Physiological Therapeutics · doi:10.1067/mmt.2001.118208 · Cited by 148
Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders
Fernández‐Carnero, J., Touche, R. L., Ortega‐Santiago, R., Galán-del-Río, F., Pesquera, J., Ge, H., & Fernández‐de‐las‐Peñas, C. (2010) · BDJ · doi:10.1038/sj.bdj.2010.1151 · Cited by 147
Measurement of pain using the visual numeric scale.
Ritter, P. L., González, V., Laurent, D. D., & Lorig, K. R. (2006) · PubMed · Cited by 147
Minimum Clinically Important Difference: Current Trends in the Orthopaedic Literature, Part II: Lower Extremity
Copay, A. G., Eyberg, B. A., Chung, A. S., Zurcher, K. S., Chutkan, N. B., & Spangehl, M. J. (2018) · JBJS Reviews · doi:10.2106/jbjs.rvw.17.00160 · Cited by 148
Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial
Bennell, K. L., Matthews, B. L., Greig, A. M., Briggs, A. M., Kelly, A. M., Sherburn, M., Larsen, J. A., & Wark, J. D. (2010) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-11-36 · Cited by 146
“Numeric rating scales have established clinimetric properties in back pain [16] and a change of at least 2 points is thought to represent a clinically meaningful improvement [17,18].”
Background
Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache
Fernández‐de‐las‐Peñas, C., Ge, H., Arendt‐Nielsen, L., Cuadrado, M. L., & Pareja, J. A. (2006) · European Journal of Pain · doi:10.1016/j.ejpain.2006.07.005 · Cited by 146
“…of both local pain, defined as pain located around the compression site, and referred pain, defined as pain located outside the local pain area evoked by TrP compression, was scored on a 10-cm horizontal visual analogue scale (Jensen et al., 1999) (VAS; range: 0 = no pain, to 10 = maximum pain).”
Fear of movement/(Re)injury in low back pain: confirmatory validation of a German version of the Tampa Scale for Kinesiophobia
Rusu, A. C., Kreddig, N., Hallner, D., Hülsebusch, J., & Hasenbring, M. I. (2014) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-15-280 · Cited by 142
“’s recommendations [28], pain intensity was assessed by a numerical rating scale (NRS) that ranged from 0 (‘no pain at all’) to 10 (‘extremely painful’).”
Method
Self-perceived burden in chronic pain: Relevance, prevalence, and predictors
Kowal, J., Wilson, K. G., McWilliams, L. A., Péloquin, K., & Duong, D. (2012) · Pain · doi:10.1016/j.pain.2012.05.009 · Cited by 145
Effects of skeletal morbidities on longitudinal patient-reported outcomes and survival in patients with metastatic prostate cancer
DePuy, V., Anstrom, K. J., Castel, L. D., Schulman, K. A., Weinfurt, K. P., & Fred Saad, C. (2007) · Supportive Care in Cancer · doi:10.1007/s00520-006-0203-x · Cited by 145
“Such composite pain ratings have greater stability than individual pain ratings and are the preferred method for scoring pain intensity [12].”
Method
Analysis of shortened versions of the Tampa scale for kinesiophobia and pain catastrophizing scale for patients after anterior cruciate ligament reconstruction
George, S. Z., Lentz, T. A., Zeppieri, G., Lee, D., & Chmielewski, T. L. (2012) · The Clinical Journal of Pain · doi:10.1097/ajp.0b013e31822363f4 · Cited by 122
“These 3 conditions were also summed and then the mean of the 3 conditions was reported as the “composite” pain intensity.(14) Knee function was assessed with the 18-item International Knee Documentation Committee (IKDC) subjective form.”
Laparoscopic Uterosacral Nerve Ablation for Alleviating Chronic Pelvic Pain A Randomized Controlled Trial
DANIELS, J. P. (2009) · JAMA · doi:10.1001/jama.2009.1268 · Cited by 142
“53) [17-64] 30.”
Postsurgical pain outcome assessment
Jensen, M. P., Chen, C., & Brugger, A. M. (2002) · Pain · doi:10.1016/s0304-3959(02)00063-5 · Cited by 140
“larger F values or lower P values as indicating greater sensitivity) as a measure of relative sensitivity is a common method for evaluating pain measures (e.g. Seymour, 1982; Littman et al., 1985; Melzack, 1987; Max et al., 1988; Jensen et al., 1999).”
Treatment with C1 inhibitor concentrate in abdominal pain attacks of patients with hereditary angioedema
Bork, K., Meng, G., Staubach, P., & Hardt, J. (2005) · Transfusion · doi:10.1111/j.1537-2995.2005.00602.x · Cited by 140
“We used a pain score ranging from 1 to 10 points (1 = very mild pain; 10 = extremely severe pain, unbearable pain).(31,32) Attacks were assigned into three different groups: 1 to 4 points, mild pain during attacks; 5 to 7 points, moderate pain; 8 to 10 points, severe to extremely severe pain.”
Method
A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867)
George, S. Z., Zeppieri, G., Cere, A. L., Cere, M. R., Borut, M. S., Hodges, M. J., Reed, D. M., Valencia, C., & Robinson, M. E. (2008) · Pain · doi:10.1016/j.pain.2008.07.029 · Cited by 134
Opiate self-administration as a measure of chronic nociceptive pain in arthritic rats
Colpaert, F. C., Tarayre, J. P., Aliaga, M., Slot, L. A. B., Attal, N., & Koek, W. (2001) · Pain · doi:10.1016/s0304-3959(00)00413-9 · Cited by 139
“These ̄uctuations have similarly led to analytical techniques whereby clinical data are cumulated over several days in order to enhance the reliability and validity of the measurement of pain intensity in chronic pain patients (Jensen and McFarland, 1993; Bolton, 1999; Jensen et al., 1999; Spierings et al., 2000).”
Background
Short-Term Effects of Kinesio Taping Versus Cervical Thrust Manipulation in Patients With Mechanical Neck Pain: A Randomized Clinical Trial
Saavedra-Hernández, M., Castro‐Sánchez, A. M., Arroyo‐Morales, M., Cleland, J. A., Lara‐Palomo, I. C., & Fernández‐de‐las‐Peñas, C. (2012) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2012.4086 · Cited by 139
Referred Pain from Muscle Trigger Points in the Masticatory and Neck-Shoulder Musculature in Women With Temporomandibular Disoders
Fernández‐de‐las‐Peñas, C., Galán-del-Río, F., Alonso‐Blanco, C., Jiménez‐García, R., Arendt‐Nielsen, L., & Svensson, P. J. (2010) · Journal of Pain · doi:10.1016/j.jpain.2010.03.005 · Cited by 138
Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial
Zgierska, A. E., Burzinski, C. A., Cox, J., Kloke, J. D., Stegner, A. J., Cook, D. B., Singles, J. M., Mirgain, S. A., Coe, C. L., & Bačkonja, M. (2016) · Pain Medicine · doi:10.1093/pm/pnw006 · Cited by 144
Obesity and the Impact of Chronic Pain
Marcus, D. A. (2004) · Clinical Journal of Pain · doi:10.1097/00002508-200405000-00009 · Cited by 133
“9 in clinically depressed chronic pain patients.(30) Novy et al similarly reported higher BDI levels in chronic pain patients, with a mean of 15.”
BackgroundMethodResultInfluential
Development and validation of the Pain Outcomes Questionnaire-VA
Clark, M. E., Gironda, R. J., & Young, R. W. (2003) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2003.09.0381 · Cited by 132
Selective vs argon laser trabeculoplasty: hypotensive efficacy, anterior chamber inflammation, and postoperative pain
Martínez-de-la-Casa, J. M., Garcia-Feijoo, J., Castillo, A., Matilla, M. T., Macias, J. M. P., Benitez-del-Castillo, J. M., & Garcia-Sanchez, J. (2004) · Eye · doi:10.1038/sj.eye.6700695 · Cited by 130
Fibromyalgia Survey Criteria Are Associated with Increased Postoperative Opioid Consumption in Women Undergoing Hysterectomy
Janda, A. M., As‐Sanie, S., Rajala, B., Tsodikov, A., Moser, S. E., Clauw, D. J., & Brummett, C. M. (2015) · Anesthesiology · doi:10.1097/aln.0000000000000637 · Cited by 132
Stereotactic Radiosurgery vs Conventional Radiotherapy for Localized Vertebral Metastases of the Spine
Ryu, S., Deshmukh, S., Timmerman, R. D., Movsas, B., Gerszten, P. C., Yin, F.-F., Dicker, A. P., Abraham, C. D., Zhong, J., Shiao, S. L., et al. (2023) · JAMA Oncology · doi:10.1001/jamaoncol.2023.0356 · Cited by 129
A meta-analysis of fear-avoidance and pain intensity: the paradox of chronic pain
Kroska, E. B. (2016) · Scandinavian Journal of Pain · doi:10.1016/j.sjpain.2016.06.011 · Cited by 128
The Evaluation of Change in Pain Intensity: A Comparison of the P4 and Single-Item Numeric Pain Rating Scales
Spadoni, G. F., Stratford, P. W., Solomon, P. E., & Wishart, L. R. (2004) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2004.34.4.187 · Cited by 128
Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: A randomized clinical trial
González-Iglesias, J., Fernández‐de‐las‐Peñas, C., Cleland, J. A., Alburquerque‐Sendín, F., Palomeque-del-Cerro, L., & Sánchez, R. M. (2008) · Manual Therapy · doi:10.1016/j.math.2008.04.006 · Cited by 127
Pain, Depression, and Fatigue in Community-Dwelling Adults With and Without a History of Cancer
Reyes‐Gibby, C. C., Aday, L. A., Anderson, K. O., Mendoza, T. R., & Cleeland, C. S. (2006) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2006.01.008 · Cited by 127
Cross-sectional Area of Cervical Multifidus Muscle in Females With Chronic Bilateral Neck Pain Compared to Controls
Fernández‐de‐las‐Peñas, C., Albert-Sanchís, J. C., Buil, M., Benítez-Martínez, J. C., & Alburquerque‐Sendín, F. (2008) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2008.2598 · Cited by 125
Myofascial trigger points, pain, disability, and sleep quality in individuals with mechanical neck pain.
Muñoz-Muñoz, S., Muñoz-García, M. T., Alburquerque-Sendín, F., Arroyo-Morales, M., & Fernández-de-las-Peñas, C. (2012) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2012.09.003 · Cited by 116
Reports of Chronic Pain in Childhood and Adolescence Among Patients at a Tertiary Care Pain Clinic
Hassett, A. L., Hilliard, P. E., Goesling, J., Clauw, D. J., Harte, S. E., & Brummett, C. M. (2013) · Journal of Pain · doi:10.1016/j.jpain.2013.06.010 · Cited by 123
A Framework for Assessment in Oncology Rehabilitation
Gilchrist, L. S., Galantino, M. L., Wampler, M. A., Marchese, V. G., Morris, G. S., & Ness, K. K. (2009) · Physical Therapy · doi:10.2522/ptj.20070309 · Cited by 122
Electrical stimulation of auditory and somatosensory cortices for treatment of tinnitus and pain
Ridder, D. D., Mulder, G. D., Menovsky, T., Sunaert, S. G., & Kovacs, S. (2007) · Progress in brain research · doi:10.1016/s0079-6123(07)66036-1 · Cited by 120
Gender moderates the association between depression and disability in chronic pain patients
Keogh, E., McCracken, L. M., & Eccleston, C. (2005) · European Journal of Pain · doi:10.1016/j.ejpain.2005.05.007 · Cited by 123
“The question asked patients to indicate their current pain intensity, and was derived from those found on a number of standard pain measures, which are considered valid and reliable methods of measuring pain intensity (Jensen et al., 1994, 1999).”
Method

Authors: Jensen, M. P., Turner, J. A., Romano, J. M., & Fisher, L. D.
Affiliations: University of Washington (US)
Corresponding author: Jensen, Mark P
ORCID: Jensen, Mark P
Turner, Judith A
Romano, Joan M
Venue: Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1999-11
Volume: 83
Issue: 2
Pages: 157-162
ISSN: 0304-3959 (ISSN-L)
DOI: 10.1016/s0304-3959(99)00101-3
OpenAlex: W2009568727
Cited by: 1,247
References: 14
Citations by year: 2026: 38 · 2025: 39 · 2024: 52 · 2023: 49 · 2022: 55 · 2021: 75 · 2020: 92 · 2019: 77 · 2018: 64 · 2017: 64 · 2016: 68 · 2015: 60 · 2014: 66 · 2013: 52 · 2012: 52
FWCI: 6.73
Type: journal article
Language: en
Open access: closed
Locations: Pain (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health
U.S. Public Health Service (R01 31683)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Keywords: chronic pain, pain intensity assessment, reliability statistics, validity, multidisciplinary pain management, longitudinal change detection
MeSH terms: Adult, Aged, Analgesics, Analysis of Variance, Chronic Disease, Counseling, Female, Follow-Up Studies, Humans, Interviews as Topic, Longitudinal Studies, Male, Middle Aged, Occupational Therapy, Pain, Pain Measurement, Patient Care Team, Psychotherapy, Socioeconomic Factors, Time Factors, Reproducibility of Results, Physical Therapy Modalities, Pain Management

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Comparative reliability and validity of chronic pain intensity measures.

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