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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Cherrier, M. M., Amory, J. K., Ersek, M. T., Risler, L. J., & Shen, D. D. (2009) · Journal of Pain · doi:10.1016/j.jpain.2009.03.017 · Cited by 58
Association Between Directional Preference and Centralization in Patients With Low Back Pain
Werneke, M. W., Hart, D. L., Cutrone, G., Oliver, D., McGill, M. T., Weinberg, J. R., Grigsby, D., Oswald, W., & Ward, J. (2010) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2011.3415 · Cited by 59
Is chronic postsurgical pain surgery-induced? A study of persistent postoperative pain following breast reconstruction
Roth, R. S., Qi, J., Hamill, J. B., Kim, H. M., Ballard, T. N. S., Pusic, A. L., & Wilkins, E. G. (2017) · The Breast · doi:10.1016/j.breast.2017.11.001 · Cited by 59
Characteristics associated with analgesia ordering in the intensive care unit and relationships with outcome*
Freire, A. X., Afessa, B., Cawley, P. A., Phelps, S. G., & Bridges, L. (2002) · Critical Care Medicine · doi:10.1097/00003246-200211000-00011 · Cited by 59
The co-occurrence of pain and depression in adults with multiple sclerosis
Alschuler, K. N., Ehde, D. M., & Jensen, M. P. (2013) · Rehabilitation Psychology · doi:10.1037/a0032008 · Cited by 56
Clinical Investigation of Pain-related Fear and Pain Catastrophizing for Patients With Low Back Pain
George, S. Z., Calley, D. Q., Valencia, C., & Beneciuk, J. M. (2010) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e3181f21414 · Cited by 60
“To account for the pain intensity domain, patients rated their worst, best, and current pain intensity over the past 24 hours using a numerical rating scale, ranging from “0” (no pain) to “10” (worst pain imaginable).(32) These 3 pain ratings were averaged and used as the numerical rating scale pain intensity variable…”
Method
Predictor Variables for Identifying Patients with Chronic Tension-Type Headache Who are Likely to Achieve Short-Term Success with Muscle Trigger Point Therapy
Fernández‐de‐las‐Peñas, C., Cleland, J. A., Cuadrado, M. L., & Pareja, J. A. (2008) · Cephalalgia · doi:10.1111/j.1468-2982.2007.01530.x · Cited by 58
Expectation of Recovery From Low Back Pain
Kongsted, A., Vach, W., Axø, M., Bech, R., & Hestbæk, L. (2013) · Spine · doi:10.1097/brs.0000000000000059 · Cited by 58
Exploration of Somatosensory Impairments in Subjects With Mechanical Idiopathic Neck Pain: A Preliminary Study
Javanshir, K., Ortega‐Santiago, R., Bandpei, M. A. M., Miangolarra‐Page, J. C., & Fernández‐de‐las‐Peñas, C. (2010) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2010.08.022 · Cited by 58
Depressive Symptoms, Anatomical Region, and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain
George, S. Z., Coronado, R. A., Beneciuk, J. M., Valencia, C., Werneke, M. W., & Hart, D. L. (2011) · Physical Therapy · doi:10.2522/ptj.20100192 · Cited by 58
Changes in pain and pressure pain sensitivity after manual treatment of active trigger points in patients with unilateral shoulder impingement: A case series
Hidalgo-Lozano, A., Fernández‐de‐las‐Peñas, C., Díaz‐Rodríguez, L., González-Iglesias, J., Palacios‐Ceña, D., & Arroyo‐Morales, M. (2011) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2010.12.003 · Cited by 57
“Further, s (right) muscle trigger points (TrPs) according to Simons et al. changes in VAS and PPT were stratified by gender using the non-parametric U-Mann Whitney test.”
MethodInfluential
Primary care randomized clinical trial: Manual therapy effectiveness in comparison with TENS in patients with neck pain
Escortell‐Mayor, E., Fuertes, R. R., Garrido-Elustondo, S., Asúnsolo, Á., Díaz-Pulido, B., Blanco‐Díaz, M., & Bejerano-Álvarez, E. (2010) · Manual Therapy · doi:10.1016/j.math.2010.07.003 · Cited by 57
Effects of an Individually Tailored Web-Based Chronic Pain Management Program on Pain Severity, Psychological Health, and Functioning
Nevedal, D. C., Wang, C., Oberleitner, L., Schwartz, S., & Williams, A. M. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2296 · Cited by 60
Prevention of Postlaparoscopic Shoulder and Upper Abdominal Pain
Tsai, H., Wang, P., Yen, M.-S., Chao, K.-C., Hsu, T., & Chen, Y. (2013) · Obstetrics and Gynecology · doi:10.1097/aog.0b013e318283fcca · Cited by 57
Short-term effects of spinal thrust joint manipulation in patients with chronic neck pain: a randomized clinical trial
Saavedra-Hernández, M., Arroyo‐Morales, M., Cantarero‐Villanueva, I., Fernández‐Lao, C., Castro‐Sánchez, A. M., Puentedura, E. J., & Fernández‐de‐las‐Peñas, C. (2012) · Clinical Rehabilitation · doi:10.1177/0269215512464501 · Cited by 57
Differences in regional homogeneity between patients with Crohn's disease with and without abdominal pain revealed by resting-state functional magnetic resonance imaging
Bao, C., Liu, P., Liu, H., Wu, L., Jin, X., Wang, S., Shi, Y., Zhang, J.-Y., Zeng, X., Ma, L., et al. (2016) · Pain · doi:10.1097/j.pain.0000000000000479 · Cited by 57
“The one-week daily pain score log that we used in the current study is considered a rather robust method for assessing the severity of chronic pain [16, 23] and has been applied in a number of studies on chronic pain including abdominal pain in CD patients [4, 39].”
Method
Kinesio taping as a treatment method in the acute phase of ACL reconstruction: A double-blind, placebo-controlled study
Balki, S., Göktaş, H. E., & Öztemür, Z. (2016) · Acta Orthopaedica et Traumatologica Turcica · doi:10.1016/j.aott.2016.03.005 · Cited by 57
Neurodynamic Techniques Versus “Sham” Therapy in the Treatment of Carpal Tunnel Syndrome: A Randomized Placebo-Controlled Trial
Wolny, T., & Linek, P. (2018) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2017.12.005 · Cited by 57
Differential Relationships Between Anxiety and Treatment-Associated Pain Reduction Among Male and Female Chronic Pain Patients
Edwards, R. R., Augustson, E. M., & Fillingim, R. B. (2003) · Clinical Journal of Pain · doi:10.1097/00002508-200307000-00003 · Cited by 55
“The reliability and validity of these ratings of pain intensity have previously been demonstrated in chronic pain populations.(43)”
Background
Fear of Pain in Patients With Advanced Cancer or in Patients With Chronic Noncancer Pain
LeMay, K., Wilson, K. G., Buenger, U., Jarvis, V., Fitzgibbon, E., Bhimji, K., & Dobkin, P. L. (2010) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e3181f3f667 · Cited by 56
“An arithmetic mean of the 4 pain scores was calculated to provide a more accurate estimate of pain severity.(32,33) A number of studies have demonstrated that the BPI(30,31) pain intensity items load onto a single factor.”
Method
Interaction between anxiety, depression, quality of life and clinical parameters in chronic tension‐type headache
Peñacoba, C., Fernández‐de‐las‐Peñas, C., González, J. L., Miangolarra‐Page, J. C., & Pareja, J. A. (2008) · European Journal of Pain · doi:10.1016/j.ejpain.2007.12.016 · Cited by 56
Disability, quality of life, personality, cognitive and psychological variables associated with fatigue in patients with multiple sclerosis
Fernández-Muñóz, J. J., Morón-Verdasco, A., Cigarán‐Méndez, M., Muñoz-Hellín, E., Pérez‐de‐Heredia‐Torres, M., & Fernández‐de‐las‐Peñas, C. (2015) · Acta Neurologica Scandinavica · doi:10.1111/ane.12370 · Cited by 56
“Pain intensity was assessed with an 11-point numerical pain rate scale (NPRS, 0: no pain; 10: worst pain), which has been found to be valid and reliable (14).”
Method
Response of Pain Intensity to Soft Tissue Mobilization and Neurodynamic Technique: A Series of 18 Patients With Chronic Carpal Tunnel Syndrome
De-la-Llave-Rincón, A. I., Ortega‐Santiago, R., Ambite‐Quesada, S., Crujera, A. G., Puentedura, E. J., Valenza, M. C., & Fernández‐de‐las‐Peñas, C. (2012) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2012.06.002 · Cited by 56
“The 11-point numerical pain rating scale (NPRS; 0, no pain; 10, maximum pain) was used to assess the current level of pain and the worst and the lowest level of hand pain experienced in the preceding week.(19) Pain measures were collected at baseline and 1 week after the treatment session.”
Method
Association of levels of opioid use with pain and activity interference among patients initiating chronic opioid therapy
Turner, J. A., Shortreed, S. M., Saunders, K. W., LeResche, L., & Korff, M. V. (2016) · Pain · doi:10.1097/j.pain.0000000000000452 · Cited by 56
The efficacy of external beam radiotherapy and stereotactic body radiotherapy for painful spinal metastases from renal cell carcinoma
Hunter, G. K., Balagamwala, E. H., Koyfman, S. A., Bledsoe, T. B., Sheplan, L. J., Reddy, C. A., Chao, S. T., Djemil, T., Angelov, L., & Videtic, G. M. M. (2012) · Practical Radiation Oncology · doi:10.1016/j.prro.2012.01.005 · Cited by 55
The Role of Experiential Avoidance, Resilience and Pain Acceptance in the Adjustment of Chronic Back Pain Patients Who Have Experienced a Traumatic Event: a Path Analysis
Ruiz-Párraga, G. T., & López-Martínez, A. E. (2014) · Annals of Behavioral Medicine · doi:10.1007/s12160-014-9654-3 · Cited by 60
“[44], patients were asked to rate their mildest, average and worst pain during the past 2 weeks, as well as their current pain, on a scale ranging from 0 (No pain) to 10 (Extremely painful).”
BackgroundInfluential
Impact of Biopsychosocial Factors on Chronic Pain in Persons With Myotonic and Facioscapulohumeral Muscular Dystrophy
Miró, J., Raichle, K. A., Carter, G. T., O'Brien, S. A., Abresch, R. T., McDonald, C. M., & Jensen, M. P. (2009) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909109335146 · Cited by 55
Catechol-O-Methyltransferase Val158Met Polymorphism Influences Anxiety, Depression, and Disability, but not Pressure Pain Sensitivity, in Women With Fibromyalgia Syndrome
Fernández‐de‐las‐Peñas, C., Ambite‐Quesada, S., Crujera, A. G., Cigarán‐Méndez, M., & Peñacoba, C. (2012) · Journal of Pain · doi:10.1016/j.jpain.2012.08.001 · Cited by 56
The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain
Javanshir, K., Amiri, M., Bandpei, M. A. M., Fernández‐de‐las‐Peñas, C., & Rezasoltani, A. (2015) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-150593 · Cited by 55
“Pain intensity and functional disability The mean intensity of neck pain was assessed with an 11-point numerical pain rate scale (NPRS, 0: no current pain, 10: maximum pain) [14].”
Method
Clinical Outcomes and Central Pain Mechanisms are Improved After Upper Trapezius Eccentric Training in Female Computer Users With Chronic Neck/Shoulder Pain
Heredia‐Rizo, A. M., Petersen, K. K., Madeleine, P., & Arendt‐Nielsen, L. (2018) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000656 · Cited by 55
Pain Experienced by Patients Hospitalized at the National Cancer Institute of Milan: Research Project “Towards a Pain-Free Hospital”
Ripamonti, C. I., Zecca, E., Brunelli, C., Groff, L., Boffi, R., Caraceni, A. T., Galeazzi, G., Martini, C., Panzeri, C., Saita, L., et al. (2000) · Tumori Journal · doi:10.1177/030089160008600509 · Cited by 55
Changes in masseter muscle trigger points following strain-counterstrain or neuro-muscular technique
Ibáñez-García, J., Alburquerque-Sendín, F., Rodríguez-Blanco, C., Girao, D., Atienza-Meseguer, A., Planella-Abella, S., & Fernández-de-las Peñas, C. (2009) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2008.03.001 · Cited by 78
“The reliability and validity of the VAS as a measure of pain has been established previously (Jensen et al., 1999).”
Background
Gender Differences in Pain Severity, Disability, Depression, and Widespread Pressure Pain Sensitivity in Patients with Fibromyalgia Syndrome Without Comorbid Conditions
Castro-Sánchez, A. M., Matarán-Peñarrocha, G. A., López-Rodríguez, M. M., Lara-Palomo, I. C., Arendt-Nielsen, L., & Fernández-de-las-Peñas, C. (2012) · Pain Medicine · doi:10.1111/j.1526-4637.2012.01523.x · Cited by 69
Clinical Trial Methodology of Pain Treatment Studies
Gilron, I., & Jensen, M. P. (2011) · Regional Anesthesia & Pain Medicine · doi:10.1097/aap.0b013e318217a635 · Cited by 54
“One study that did this compared the reliability (defined as stability over a 2-month epoch) and validity (defined as the ability to detect change in pain with treatment) of individual pain intensity ratings versus composite scores made up of averages of these pain ratings.(79) Psychometric theory would suggest that i…”
Background
The evaluation of lumbar multifidus muscle function via palpation: reliability and validity of a new clinical test
Hébert, J. J., Koppenhaver, S. L., Teyhen, D. S., Walker, B. F., & Fritz, J. M. (2013) · The Spine Journal · doi:10.1016/j.spinee.2013.08.056 · Cited by 54
The contribution of posttraumatic stress symptoms to chronic pain adjustment.
Ruiz-Párraga, G. T., & López-Martínez, A. E. (2013) · Health Psychology · doi:10.1037/hea0000040 · Cited by 59
Insight into Urogynecologic Features of Women with Interstitial Cystitis/Painful Bladder Syndrome
Gardella, B., Porru, D., Ferdeghini, F., Gabellotti, E. M., Nappi, R. E., Rovereto, B., & Spinillo, A. (2008) · European Urology · doi:10.1016/j.eururo.2008.01.079 · Cited by 54
“The prevalence of vulvodynia in the whole population is between 2% and 10%, whereas pelvic pain accounts for almost 15% of referrals to gynecologists [10,17].”
New Empirical Evidence of the Validity of the Chronic Pain Acceptance Questionnaire: The Differential Influence of Activity Engagement and Pain Willingness on Adjustment to Chronic Pain
Bendayan, R., Esteve, R., & Blanca, M. J. (2012) · British Journal of Health Psychology · doi:10.1111/j.2044-8287.2011.02039.x · Cited by 54
Bilateral Pressure Pain Sensitivity Mapping of the Temporalis Muscle in Chronic Tension‐Type Headache
Fernández‐de‐las‐Peñas, C., Ge, H., Cuadrado, M. L., Madeleine, P., Pareja, J. A., & Arendt‐Nielsen, L. (2008) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2007.01005.x · Cited by 53
Investigation of Central Pain Processing in Shoulder Pain: Converging Results From 2 Musculoskeletal Pain Models
Valencia, C., Kindler, L. L., Fillingim, R. B., & George, S. Z. (2011) · Journal of Pain · doi:10.1016/j.jpain.2011.10.006 · Cited by 53
“Other studies have also shown that this aggregate measure has sufficient psychometric strengths.(12,13)”
Result
Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial
O’Keeffe, M., Purtill, H., Kennedy, N., O’Sullivan, P., Dankaerts, W., Tighe, A., Allworthy, L., Dolan, L., Bargary, N., & O’Sullivan, K. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-007156 · Cited by 55

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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