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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Background
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Pardo, G. B., Pecos‐Martín, D., Gallego‐Izquierdo, T., Salom‐Moreno, J., Fernández‐de‐las‐Peñas, C., & Ortega‐Santiago, R. (2013) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2013.05.022 · Cited by 85
Changes in readiness to self-manage pain are associated with improvement in multidisciplinary pain treatment and pain coping
Jensen, M. P., Nielson, W. R., Turner, J. A., Romano, J. M., & Hill, M. L. (2004) · Pain · doi:10.1016/j.pain.2004.06.003 · Cited by 83
“Responses to these four questions were averaged for a measure of pain severity (Jensen et al., 1999).”
Background
Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial
Fernández‐de‐las‐Peñas, C., Ortega‐Santiago, R., De-la-Llave-Rincón, A. I., Martínez-Pérez, A., Díaz, H. F.-S., Martínez-Martín, J., Pareja, J. A., & Cuadrado, M. L. (2015) · Journal of Pain · doi:10.1016/j.jpain.2015.07.012 · Cited by 83
Altered brain microstructure assessed by diffusion tensor imaging in patients with chronic pancreatitis
Frøkjær, J. B., Olesen, S. S., Gram, M., Yavarian, Y., Bouwense, S. A. W., Wilder‐Smith, O. H. G., & Drewes, A. M. (2011) · Gut · doi:10.1136/gut.2010.236620 · Cited by 83
A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding
Clark, T. J., Middleton, L., Cooper, N. A., Diwakar, L., Denny, E., Smith, P., Gennard, L., Stobert, L., Roberts, T. E., Cheed, V., et al. (2015) · Health Technology Assessment · doi:10.3310/hta19610 · Cited by 83
Can we improve cognitive–behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy.
Kerns, R. D., Burns, J. W., Shulman, M., Jensen, M. P., Nielson, W. R., Czlapinski, R. A., Dallas, M. I., Chatkoff, D. K., Sellinger, J. J., Heapy, A. A., et al. (2013) · Health Psychology · doi:10.1037/a0034406 · Cited by 81
Prevalence and psychometric screening for the detection of major depressive disorder and post-traumatic stress disorder in adults injured in a motor vehicle crash who are engaged in compensation
Guest, R., Tran, Y., Gopinath, B., Cameron, I. D., & Craig, A. R. (2018) · BMC Psychology · doi:10.1186/s40359-018-0216-5 · Cited by 81
“Research shows numerical pain rating scales have good test–retest reliability and validity [36].”
Background
Pain Catastrophizing and Beliefs Predict Changes in Pain Interference and Psychological Functioning in Persons With Spinal Cord Injury
Hanley, M. A., Raichle, K. A., Jensen, M. P., & Cardenas, D. D. (2008) · Journal of Pain · doi:10.1016/j.jpain.2008.04.008 · Cited by 81
Individuals with chronic low back pain have greater difficulty in engaging in positive lifestyle behaviours than those without back pain: An assessment of health literacy
Briggs, A. M., Jordan, J. M., O’Sullivan, P., Buchbinder, R., Burnett, A., Osborne, R. H., & Straker, L. M. (2011) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-12-161 · Cited by 81
Muscle Trigger Points, Pressure Pain Threshold, and Cervical Range of Motion in Patients With High Level of Disability Related to Acute Whiplash Injury
Fernández-Pérez, A. M., Villaverde‐Gutiérrez, C., Mora-Sánchez, A., Alonso‐Blanco, C., Sterling, M. M., & Fernández‐de‐las‐Peñas, C. (2012) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2012.4117 · Cited by 81
Pain Interference in Persons With Spinal Cord Injury: Classification of Mild, Moderate, and Severe Pain
Hanley, M. A., Gutiérrez, A. I. M., Jensen, M. P., Cardenas, D. D., & Turner, J. A. (2006) · Journal of Pain · doi:10.1016/j.jpain.2005.09.011 · Cited by 81
“In addition, hese common terms may be useful in clinical settings hen health care providers and patients discuss pain.(1)”
Background
Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial
Delgado‐de‐la‐Serna, P., Plaza‐Manzano, G., Cleland, J., Fernández‐de‐las‐Peñas, C., Martín‐Casas, P., & Díaz‐Arribas, M. J. (2019) · Pain Medicine · doi:10.1093/pm/pnz278 · Cited by 80
“Participants rated their intensity of TMD pain at rest on a numerical pain rating scale (NPRS; 0 1⁄4 no pain, 10 1⁄4 maximum pain) [20].”
Method
Performance of the Hepatic Encephalopathy Scoring Algorithm in a Clinical Trial of Patients With Cirrhosis and Severe Hepatic Encephalopathy
Hassanein, T., Blei, A. T., Perry, W., Hilsabeck, R. C., Stange, J., Larsen, F. S., Brown, R. S., Caldwell, S. H., McGuire, B. M., Nevens, F., et al. (2009) · The American Journal of Gastroenterology · doi:10.1038/ajg.2009.160 · Cited by 80
Evaluation and assessment of cancer pain and cancer pain treatment
Caraceni, A. T. (2001) · Acta Anaesthesiologica Scandinavica · doi:10.1034/j.1399-6576.2001.450903.x · Cited by 80
“The ability to detect changes induced by treatment is considered an important aspect of the validity of a pain measure (63).”
Background
Specific and general therapeutic mechanisms in cognitive behavioral treatment of chronic pain
Burns, J. W., Nielson, W. R., Jensen, M. P., Heapy, A., Czlapinski, R., & Kerns, R. D. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0037208 · Cited by 77
Self-citation
Optimal Screening for Prediction of Referral and Outcome (OSPRO) for Musculoskeletal Pain Conditions: Results From the Validation Cohort
George, S. Z., Beneciuk, J. M., Lentz, T. A., Wu, S. S., Dai, Y., Bialosky, J. E., & Zeppieri, G. (2018) · Journal of Orthopaedic & Sports Physical Therapy · doi:10.2519/jospt.2018.7811 · Cited by 79
Thoracolumbar Proprioception in Individuals with and without Low Back Pain: Intratester Reliability, Clinical Applicability, and Validity
Koumantakis, G. Α., Winstanley, J. B., & Oldham, J. A. (2002) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2002.32.7.327 · Cited by 79
Effects of a Physical Therapy Protocol in Patients with Chronic Migraine and Temporomandibular Disorders: A Randomized, Single-Blinded, Clinical Trial
Garrigós-Pedrón, M., Touche, R. L., Navarro-Desentre, P., Gracia-Naya, M., & Segura‐Ortí, E. (2018) · Journal of Oral & Facial Pain and Headache · doi:10.11607/ofph.1912 · Cited by 80
Referred Pain From the Trochlear Region in Tension‐Type Headache: A Myofascial Trigger Point From the Superior Oblique Muscle
Fernández‐de‐las‐Peñas, C., Cuadrado, M. L., Gerwin, R. D., & Pareja, J. A. (2005) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2005.05140.x · Cited by 78
The analgesic effect of pregabalin in patients with chronic pain is reflected by changes in pharmaco‐EEG spectral indices
Graversen, C., Olesen, S. S., Olesen, A. E., Steimle, K., Farina, D., Wilder‐Smith, O. H. G., Bouwense, S. A. W., van Goor, H., & Drewes, A. M. (2011) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.2011.04104.x · Cited by 77
Introduction to the Hepatic Encephalopathy Scoring Algorithm (HESA)
Hassanein, T., Hilsabeck, R. C., & Perry, W. (2007) · Digestive Diseases and Sciences · doi:10.1007/s10620-007-9895-0 · Cited by 77
Cervical Muscle Co-Activation in Isometric Contractions is Enhanced in Chronic Tension-Type Headache Patients
Fernández‐de‐las‐Peñas, C., Falla, D., Arendt‐Nielsen, L., & Farina, D. (2008) · Cephalalgia · doi:10.1111/j.1468-2982.2008.01584.x · Cited by 76
Multicomponent Cognitive-Behavioral Group Therapy With Hypnosis for the Treatment of Fibromyalgia: Long-Term Outcome
Castel, A., Cascón, R., Padrol, A., Sala, J., & Rull, M. (2012) · The Journal of Pain · doi:10.1016/j.jpain.2011.11.005 · Cited by 79
Multiple Active Myofascial Trigger Points Reproduce the Overall Spontaneous Pain Pattern in Women With Fibromyalgia and Are Related to Widespread Mechanical Hypersensitivity
Alonso‐Blanco, C., Fernández‐de‐las‐Peñas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H., & Flórez-García, M. T. (2011) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e318210110a · Cited by 76
“An 11-point numerical point rate scale (0: no pain; 10: maximum pain) was used to assess the current level of pain and the worst and the lowest level of generalized pain experienced in the preceding week.(37) Participants were asked to complete the BDI-II, a 21-item self-report questionnaire that assesses affective, c…”
Method
Malignant bone pain: Pathophysiology and treatments
Ripamonti, C. I., & Fulfaro, F. (2000) · Current Review of Pain · doi:10.1007/s11916-000-0078-3 · Cited by 76
“Recently, Jensen et al. [ 17 ] carried out a longitudinal study to statistically compare the validity and reliability of several measures of pain intensity (individual pain rating and composite pain intensity measures).”
Background
Pragmatic Implementation of a Stratified Primary Care Model for Low Back Pain Management in Outpatient Physical Therapy Settings: Two-Phase, Sequential Preliminary Study
Beneciuk, J. M., & George, S. Z. (2015) · Physical Therapy · doi:10.2522/ptj.20140418 · Cited by 77
The Pain Self‐Efficacy Questionnaire: Cross‐Cultural Adaptation into Italian and Assessment of Its Measurement Properties
Chiarotto, A., Vanti, C., Ostelo, R. W., Ferrari, S., Tedesco, G., Rocca, B., Pillastrini, P., & Monticone, M. (2015) · Pain Practice · doi:10.1111/papr.12242 · Cited by 73
Effects of pain neuroscience education and dry needling for the management of patients with chronic myofascial neck pain: a randomized clinical trial
Valiente-Castrillo, P., Martín‐Pintado‐Zugasti, A., Calvo‐Lobo, C., Beltrán-Alacreu, H., & Fernández‐Carnero, J. (2020) · Acupuncture in Medicine · doi:10.1177/0964528420920300 · Cited by 77
“The VAS has been shown to have a strong correlation with descriptive scales, as well as high sensitivity and reliability.(29) Consensus recommendations for determining clinically important changes in outcome measures for chronic pain trials suggest that a decrease of 2 points or a 30% reduction in pain intensity on th…”
Background
Fibrosis, Atrophy, and Ductal Pathology in Chronic Pancreatitis Are Associated With Pancreatic Function but Independent of Symptoms
Frøkjær, J. B., Olesen, S. S., & Drewes, A. M. (2013) · Pancreas · doi:10.1097/mpa.0b013e31829628f4 · Cited by 74
Immediate effects of a thoracic spine thrust manipulation on the autonomic nervous system: a randomized clinical trial
Sillevis, R., Cleland, J. A., Hellman, M. A., & Beekhuizen, K. (2010) · Journal of Manual & Manipulative Therapy · doi:10.1179/106698110x12804993427126 · Cited by 74
Assessing Pain Intensity in Children with Chronic Pain: Convergent and Discriminant Validity of The 0 To 10 Numerical Rating Scale in Clinical Practice
Ruskin, D. A., Lalloo, C., Amaria, K., Stinson, J., Kewley, E., Campbell, F. A., Brown, S. C., Jeavons, M., & McGrath, P. A. (2014) · Pain Research and Management · doi:10.1155/2014/856513 · Cited by 76
“Additionally, studies should evaluate whether composite measures (ie, global index of pain versus four levels of pain) may provide more sensitivity to detecting pain changes in clinical settings, as has been shown for adults (46).”
Background
A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache
Gildir, S., Tüzün, E. H., Eroğlu, G., & Eker, L. (2019) · Medicine · doi:10.1097/md.0000000000014520 · Cited by 73
“Headache intensity was evaluated using a 10-cm horizontal Visual Analog Scale (VAS; range: 0=no pain and 10= maximum pain).([16]) The HRQoL assessments of patients were performed at their first examination and at the end of the follow-up period, using the Turkish version of Short Form-36 (SF-36).”
Method
Consumers’ experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours
Briggs, A. M., Slater, H., Bunzli, S., Jordan, J. M., Davies, S., Smith, A. J., & Quintner, J. L. (2012) · BMC Health Services Research · doi:10.1186/1472-6963-12-357 · Cited by 74
“Average CLBP intensity was measured using an 11 point numeric rating scale (NRS) from 0 to 10, with the left anchor 0 = no pain and the right anchor at 10 = maximal imaginable pain [37].”
Method
Rasch analysis supports the use of the Depression, Anxiety, and Stress Scales to measure mood in groups but not in individuals with chronic low back pain
Parkitny, L., McAuley, J. H., Walton, D. M., Costa, L. O. P., Refshauge, K. M., Wand, B. M., Pietro, F. D., & Moseley, G. L. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.05.010 · Cited by 84
“’’ This instrument has been shown to adequately discriminate pain intensity in patients with chronic pain [39,40].”
Background
Major Depressive Disorder and Sleep Disturbance in Patients with Chronic Pain
Emery, P. C., Wilson, K. G., & Kowal, J. (2014) · Pain Research and Management · doi:10.1155/2014/480859 · Cited by 70
Intrathecal Hydromorphone for Chronic Nonmalignant Pain: A Retrospective Study
Anderson, V. C., Cooke, B., & Burchiel, K. J. (2001) · Pain Medicine · doi:10.1046/j.1526-4637.2001.01052.x · Cited by 72
Clinical massage and modified Proprioceptive Neuromuscular Facilitation stretching in males with latent myofascial trigger points
Trampas, A., Kitsios, A., Sykaras, E., Symeonidis, S., & Lazarou, L. (2010) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2010.02.003 · Cited by 72
Association Between Changes in Abdominal and Lumbar Multifidus Muscle Thickness and Clinical Improvement After Spinal Manipulation
Koppenhaver, S. L., Fritz, J. M., Hébert, J. J., Kawchuk, G. N., Childs, J. D., Parent, É., Gill, N. W., & Teyhen, D. S. (2011) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2011.3632 · Cited by 71
Comparison of Pain and Emotional Symptoms in Soldiers with Polytrauma: Unique Aspects of Blast Exposure
Clark, M. E., Walker, R. L., Gironda, R. J., & Scholten, J. D. (2009) · Pain Medicine · doi:10.1111/j.1526-4637.2009.00590.x · Cited by 72
Immediate effects of the strain/counterstrain technique in local pain evoked by tender points in the upper trapezius muscle
Meseguer, A. A., Fernández-de-las-Peñas, C., Navarro-Poza, J. L., Rodríguez-Blanco, C., & Gandia, J. J. B. (2006) · Clinical Chiropractic · doi:10.1016/j.clch.2006.06.003 · Cited by 72
Development and initial validation of the activity patterns scale in patients with chronic pain
Esteve, R., Ramírez-Maestre, C., Peters, M. L., Serrano-Ibáñez, E. R., Ruíz-Párraga, G. T., & López-Martínez, A. E. (2016) · The Journal of Pain · doi:10.1016/j.jpain.2015.12.009 · Cited by 71
Chronic pain after spinal cord injury: What characteristics make some pains more disturbing than others?
Felix, E. R., Cruz‐Almeida, Y., & Widerström-Noga, E. G. (2007) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2006.12.0162 · Cited by 70
“NRSs have been used widely to assess pain and have shown high reliability and validity [43].”
Physiological and Psychological Correlates of Sleep in HIV Infection
Robbins, J. L., Phillips, K. D., Dudgeon, W. D., & Hand, G. A. (2004) · Clinical Nursing Research · doi:10.1177/1054773803259655 · Cited by 70

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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