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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Mingels, S., & Granitzer, M. (2018) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2017.11.005 · Cited by 4
Spectral Clustering Reveals Different Profiles of Central Sensitization in Women with Carpal Tunnel Syndrome
Pellicer-Valero, Ó. J., Martín‐Guerrero, J. D., Fernández‐de‐las‐Peñas, C., De-la-Llave-Rincón, A. I., Rodríguez‐Jiménez, J., Navarro‐Pardo, E., & Cigarán‐Méndez, M. (2021) · Symmetry · doi:10.3390/sym13061042 · Cited by 4
“An 11-point (0: no pain, 10: maximum pain) Numerical Pain Rate Scale [16] (NPRS) was used to evaluate mean pain symptoms, as well as the worst and the lowest levels of pain symptoms experienced in the preceding week.”
Method
Effects of myofascial release applied to neck muscles and craniocervical flexor training in patients with chronic myofascial TMD: A single arm study
Calixtre, L. B., Rezende, M. A., Kamonseki, D. H., & Oliveira, A. B. (2021) · International journal of osteopathic medicine · doi:10.1016/j.ijosm.2021.05.006 · Cited by 4
Is multidisciplinary rehabilitation for low back pain effective in patients above 65 years? An observational cohort study with 12-month follow-up
PROETZEL, S., & Weigl, M. B. (2021) · European Journal of Physical and Rehabilitation Medicine · doi:10.23736/s1973-9087.21.06553-9 · Cited by 4
Effects of psychological distress on the general health to self-reported pain and function outcome relationship in knee arthroplasty: A causal mediation study
Riddle, D. L., & Jafarzadeh, S. R. (2022) · Osteoarthritis and Cartilage Open · doi:10.1016/j.ocarto.2022.100315 · Cited by 4
“The composite knee pain scale has been shown to maximize reliability over individual item pain ratings [35].”
Background
Temporal Relations Between Pain Catastrophizing and Adverse Health and Mental Health Outcomes After Whiplash Injury
Paré, C., Yamada, K., & Sullivan, M. J. L. (2023) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001168 · Cited by 4
“24 The NRS has also shown to be a more responsive measure of pain severity when compared with other similar pain severity rating scales.”
Result
VULNERABILITY FACTORS, ADJUSTMENT, AND OPIOID MISUSE IN CHRONIC NON-CANCER PAIN INDIVIDUALS.
Ramírez-Maestre, C., Barrado-Moreno, V., Esteve, R., Serrano-Ibáñez, E., de la Vega, R., Ruíz-Párraga, G., Fernández-Baena, M., Jensen, M. P., & López-Martínez, A. E. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.104606 · Cited by 3
The effect of resistance exercise on multimodal pain thresholds in local and systemic muscle sites
Lyons, K. M., Stock, M. S., Hanney, W. J., & Anderson, A. W. (2024) · Physiological Reports · doi:10.14814/phy2.16123 · Cited by 4
“(Bolton & Wilkinson, 1998; Hartrick et al., 2003; Jensen et al., 1999) Heat and PPT were performed during the baseline testing session to familiarize participants with these measures prior to the second and third session.”
Method
Tonic Cold Pain Temporal Summation and Translesional Cold Pressor Test-Induced Pronociception in Spinal Cord Injury: Association with Spontaneous and Below-Level Neuropathic Pain
Ríos‐León, M., Demertzis, E., García, R. P., & Taylor, J. (2024) · Healthcare · doi:10.3390/healthcare12222300 · Cited by 4
“Pain ratings associated with cold water were obtained during immersion at 10 s intervals and immediately thereafter using an NRS (0: no pain; 10: maximum pain) [55] to determine tonic cold pain intensity during CPT.”
Reliability and Validity of the Korean Version of the Fear of Daily Activities Questionnaire for Patients with Low Back Pain
Cha, Y.-J., & Kim, K. (2011) · The Journal of the Korea Contents Association · doi:10.5392/jkca.2011.11.5.224 · Cited by 4
“VAS 는현재 환자 자신이 허리부위에느끼는 통증 정도를 ‘0 점’(통증 없음) ∼ ‘10점’(표현할 수 없을 정도로 아픔) 의범위 안에서 1점단위로 자가-기입식으로 기록하는 검사 방법으로 일반적으로 많이 사용되고 있는 시각적 상사척도이다[12].”
Improvements in Health-Related Quality of Life and Pain: A Cohort Study in Obese Patients After Laparoscopic Sleeve Gastrectomy
Gallart‐Aragón, T., Fernández‐Lao, C., Galiano‐Castillo, N., Cantarero‐Villanueva, I., Lozano‐Lozano, M., & Arroyo‐Morales, M. (2017) · Journal of Laparoendoscopic & Advanced Surgical Techniques · doi:10.1089/lap.2017.0415 · Cited by 4
Do Patients Undergoing Physical Testing Report Pain Intensity Reliably?
White, S., McNair, P. J., Laslett, M., & Hing, W. A. (2014) · Arthritis Care & Research · doi:10.1002/acr.22530 · Cited by 4
Psychometric Evaluation and Refinement of the Pain Response Preference Questionnaire
McWilliams, L. A., Kowal, J., Sharpe, D., & Dick, B. D. (2014) · Pain Research and Management · doi:10.1155/2014/532678 · Cited by 4
“Participants rated each item using an 11-point numerical rating scale (11) ranging from 0 (no pain) to 10 (as intense as you can imagine).”
Method
Widespread Pressure Pain Hyperalgesia Is Not Associated With Morphological Changes of the Wrist Extensor Tendon in Unilateral Lateral Epicondylalgia: A Case–Control Study
Cancela‐Cilleruelo, I., Rodríguez‐Jiménez, J., Fernández‐de‐las‐Peñas, C., Cleland, J. A., & Arias‐Buría, J. L. (2024) · Physical Therapy · doi:10.1093/ptj/pzae075 · Cited by 3
Prescription opioid misuse in people with chronic noncancer pain: A multi-variable analysis of sociodemographic, clinical, and psychological factors
Ramírez‐Maestre, C., Esteve, R., Serrano‐Ibáñez, E. R., & López-Martínez, A. E. (2025) · PLoS ONE · doi:10.1371/journal.pone.0334918 · Cited by 3
“Such composite scores have been shown to be very reliable in individuals with chronic pain [52].”
Effects of TDCS and TENS on chronic low back pain: A randomized controlled clinical trial
Diniz, L. S. M., Mousinho, R. R. D. S., Cavalcante, L. L., Andrade, S. M. M. D. S., dos Santos, H. H., & de Andrade, P. R. (2025) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2025.10.044 · Cited by 3
Measurement of intragastric pressure: an objective method to ascertain whether gastric wall extension is sufficient for assessment of the non-extension sign
Imamura, K., Machii, M., Yao, K., Sou, S., Nagahama, T., Yao, T., Kanemitsu, T., Miyaoka, M., Ohtsu, K., & Ueki, T. (2021) · Endoscopy International Open · doi:10.1055/a-1352-2761 · Cited by 3
“Abdominal pain severity was graded using a numerical rating scale (NRS) from 0 to 10 (0, no pain; 10, worst imaginable pain) [10].”
Method
Modulation of Central Nociceptive Transmission by Manual Pressure Techniques in Patients with Migraine: An Observational Study
Hertogh, W. D., Amons, A. L., daele, L. V., Vanbaelen, E., & Castien, R. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11216273 · Cited by 4
Endovis Nail versus Dynamic Hip Screw for Unstable Pertrochanteric Fractures: A Feasibility Randomised Control Trial including Patients with Cognitive Impairment
Kleftouris, G., Tosounidis, T. H., Panteli, M., Gathen, M., & Giannoudis, P. V. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12134237 · Cited by 5
“Baseline characteristics included patient demographics, comorbidities, level of mobility, place of residence, pre-operative pain Numeric Rating Scale (NRS) [13], and functional and quality of life questionnaires.”
BackgroundInfluential
Application of the Staged Approach for Rehabilitation Classification System and Associated Improvements in Patient-Reported Outcomes Following Rehabilitation for Shoulder Pain
Podschun, L., Hill, C., Kolber, M. J., & McClure, P. W. (2024) · Physical Therapy · doi:10.1093/ptj/pzae029 · Cited by 3
Cross-Cultural Adaptation, Translation, and Validation of Pain Self-Efficacy Questionnaire in Hindi Language in Patients With Chronic Neck Pain
Geete, D. B., & Mhatre, B. (2024) · Spine · doi:10.1097/brs.0000000000005047 · Cited by 3
The relationship between changes in pain intensity and functional disability in persistent disabling low back pain during a course of cognitive functional therapy
Ussing, K., Smith, A. J., & O’Sullivan, P. (2024) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2024-0040 · Cited by 3
Chronic pain and subjective memory problems are dynamic risk factors for functional decline: An ACTIVE longitudinal study
Bell, T. R., Felix, C., Gider, N., Rebok, G. W., Crowe, M., Ball, K., Wallace, G., Black, S., Thomas, K. R., Wheeler, K. M., et al. (2025) · Experimental Gerontology · doi:10.1016/j.exger.2025.112891 · Cited by 3
“…has shown that this SF-36 pain item correlates well with comprehensive pain scales, such as the Brief Pain Inventory (BPI) and the McGill Pain Questionnaire, supporting construct validity (rs ranges from 0.76 to 0.79) (Gandek et al., 2004; Jensen et al., 1999; Ware Jr. and Sherbourne, 1992).”
Influential
Radiation therapy alone versus radiation therapy plus radiofrequency ablation/vertebral augmentation for painful spine metastasis: A phase 2 randomized controlled trial
Kotecha, R. R., Gal, O., Appel, H. R., Avendano, M. C., Pimentel, A. M., Starosciak, A. K., Rubens, M., Roy, M., Perche, D. C., Pow-Sang, C. I., et al. (2025) · Neuro-Oncology · doi:10.1093/neuonc/noaf231 · Cited by 3
Using a worst pain intensity measure in children and adolescents
Avian, A., Messerer, B., Meißner, W., Sandner‐Kiesling, A., Kammel, J., Labugger, M., Weinberg, A., & Berghold, A. (2017) · Journal of Advanced Nursing · doi:10.1111/jan.13271 · Cited by 3
Variability among methods and timing of pain assessment tools for tracking improvement of lumbar stenosis patients after surgery
Tomkins‐Lane, C., Zheng, P. Z., Sun, R., & Smuck, M. W. (2020) · The Spine Journal · doi:10.1016/j.spinee.2020.06.003 · Cited by 3
Immediate Effects of Bilateral Neuromuscular Taping on Upper Trapezius Muscle in Patients with Chronic Mechanical Neck Pain: A Randomized Clinical Trial
Sánchez-Jorge, S., Oliva‐Pascual‐Vaca, Á., Rodríguez‐López, E. S., & Valera‐Calero, J. A. (2020) · Physikalische Medizin Rehabilitationsmedizin Kurortmedizin · doi:10.1055/a-1189-3460 · Cited by 3
“Reliability and validity testing of the VAS has been well documented in previous studies [21, 22].”
Result
Cross-Cultural Adaptation and Psychometric Validation of the Turkish Version of Pain Resilience Scale
Dereli, M., Kahraman, T., & France, C. R. (2022) · Evaluation & the Health Professions · doi:10.1177/01632787221127377 · Cited by 3
Self-efficacy and commitment as psychological resources to adherence to walking despite chronic pain. A study on women with fibromyalgia
Catalá, P., Gutiérrez, L., Écija, C., & Peñacoba, C. (2021) · Ansiedad y Estrés · doi:10.5093/anyes2022a21 · Cited by 3
“All these measures were rated with an 11-point numerical rating scale (0 = “no pain” and 10 = “the worst pain you can imagine”) (Jensen et al., 1996, 1999).”
Method
Validation of the Japanese version of the 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8)
Fukumori, T., Fujishima, K., Iwasa, K., Takao, Y., Kobayashi, Y., & Nishie, H. (2023) · The Journal of Medical Investigation · doi:10.2152/jmi.70.88 · Cited by 3
Patients’ experience and utilization patterns of diclofenac gel in Germany: a real-world study with a prospective longitudinal survey and a retrospective analysis of pharmacy data
Maihöfner, C., de Haas, A., Sethi, V. S., Shanga, G. M., Wilcox, T. K., Csőke, E., & Fabrikant, K. (2023) · Current Medical Research and Opinion · doi:10.1080/03007995.2023.2243804 · Cited by 3
“The NRS ranged from 0 (no pain) to 10 (worst possible pain) 23 .”
Background
Digital mapping of shoulder pain in patients with shoulder disorders: a reliability study
Boudreau, S. A., Jakobsen, T. L., Haraldsson, B. T., & Clausen, M. B. (2024) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2023.2300753 · Cited by 3
“As such, pain intensity is the average of the lowest, worst and average pain during the previous week and their current pain (Jensen, Turner, Romano, and Fisher, 1999).”
Prophylactic Radiotherapy Of MInimally Symptomatic Spinal Disease (PROMISSeD): study protocol for a randomized controlled trial
Rothrock, R. J., Ozair, A., Avendano, M. C., Herrera, S., Appel, H. R., Ramos, S., Starosciak, A. K., Leon-Ariza, D. S., Rubens, M., McDermott, M. W., et al. (2024) · Trials · doi:10.1186/s13063-023-07850-8 · Cited by 3
Long-term bilateral change in pain and sensitivity to high-frequency cutaneous electrical stimulation in healthy subjects depends on stimulus modality: a dermatomal examination
Escobar-Sánchez, I., Ríos‐León, M., & Taylor, J. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2023.1337711 · Cited by 3
Pain intensity and self‐perceived burden mediate the relationship between family functioning and pain catastrophizing in patients with neuropathic pain
Fang, Y., Liu, M., Wu, M., Liu, M., Niu, T., & Zhang, X. (2024) · Nursing and Health Sciences · doi:10.1111/nhs.13097 · Cited by 3
How Does Nerve Mechanical Interface Treatment Impact Pre-Surgical Carpal Tunnel Syndrome Patients? A Randomized Controlled Trial
Hernández-Secorún, M., Abenia-Benedí, H., Lucha-López, M. O., Durán‐Serrano, M., Hamam-Alcober, J. S., Krauss, J., & Hidalgo-García, C. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14080801 · Cited by 3
“They were instructed to mark the average pain intensity they experienced during the last week [18].”
Background
Protocol for a personalized (N-of-1) trial for testing the effects of a mind–body intervention on sleep duration in middle-aged women working in health care
Goodwin, A. M., Chiuzan, C. C., Friel, C. P., Miller, D., Rodillas, J., Duer-Hefele, J., Cheung, Y. K., & Davidson, K. W. (2024) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2024.101364 · Cited by 3
“…receive a health survey, which includes the PSS-10 [23], the Patient Health Questionnaire-4 (PHQ-4) [24], and additional ecological momentary assessment (EMA)-adapted questions from the Numeric Pain Rating Scale (momentary pain, fatigue, stress, mood, confidence, and concentration levels) [25,26].”
Background
Characteristics of headaches among surgeons and associated factors: A cross-sectional study
Alhusuny, A., Cook, M., Khalil, A., Thomas, L. C., & Johnston, V. (2020) · The Surgeon · doi:10.1016/j.surge.2020.07.012 · Cited by 3
Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking
Abbott, A. D., Gustafsson, K., Zhou, C., Rolfson, O., & Svensson, G. L. (2021) · Acta Orthopaedica · doi:10.1080/17453674.2021.1992932 · Cited by 3
Bayesian Linear Regressions Applied to Fibromyalgia Syndrome for Understanding the Complexity of This Disorder
Cigarán‐Méndez, M., Pellicer-Valero, Ó. J., Martín‐Guerrero, J. D., Varol, U., Fernández‐de‐las‐Peñas, C., Navarro‐Pardo, E., & Valera‐Calero, J. A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19084682 · Cited by 4
Use of fallacious arguments, Ad Hominem attacks, and biased 'expert opinions' can make CBP research 'appear flawed'.
Harrison, D. E., Harrison, D. D., Oakley, P. A., & Haas, J. W. (2006) · Europe PMC (PubMed Central) · Cited by 3
Effectiveness of Lower Trapezius Exercise in Pain and Disability among Chronic Neck Pain Subjects
Kamalakannan, M., & Anitha, A. (2015) · International Journal of Therapies and Rehabilitation Research · doi:10.5455/ijtrr.000000104 · Cited by 3

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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