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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Riddle, D. L., Keefe, F. J., Ang, D. C., Khaled, J., Dumenci, L., Jensen, M. P., Bair, M. J., Reed, S. D., & Kroenke, K. (2012) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-13-149 · Cited by 43
Dysmenorrhea and Associated Factors among Polish Women: A Cross-Sectional Study
Barcikowska, Z., Wójcik-Bilkiewicz, K., Sobierajska-Rek, A., Grzybowska, M. E., Wąż, P., & Zorena, K. (2020) · Pain Research and Management · doi:10.1155/2020/6161536 · Cited by 43
Associations among pain intensity, sensory characteristics, affective qualities, and activity limitations in patients with chronic pain: A momentary, within-person perspective
Litcher‐Kelly, L., Stone, A. A., Broderick, J. E., & Schwartz, J. E. (2004) · Journal of Pain · doi:10.1016/j.jpain.2004.07.005 · Cited by 43
Increased Pain Sensitivity Is Not Associated With Electrodiagnostic Findings in Women With Carpal Tunnel Syndrome
De-la-Llave-Rincón, A. I., Fernández‐de‐las‐Peñas, C., Laguarta-Val, S., Alonso‐Blanco, C., Martínez-Pérez, A., Arendt‐Nielsen, L., & Pareja, J. A. (2011) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e31821c29d3 · Cited by 42
“A 10-cm Numerical Pain Rating Scale (0: no pain, 10: maximum pain) was used to assess the current level of hand pain, and worst and lowest level of hand pain experienced in the preceding week.(18) Patients were asked to draw the distribution of their hand symptoms on an anatomical map.”
Method
Subgrouping for Patients With Low Back Pain: A Multidimensional Approach Incorporating Cluster Analysis and the STarT Back Screening Tool
Beneciuk, J. M., Robinson, M. E., & George, S. Z. (2014) · Journal of Pain · doi:10.1016/j.jpain.2014.10.004 · Cited by 48
Predictive Validity of the STarT Back Tool for Risk of Persistent Disabling Back Pain in a U.S. Primary Care Setting
Suri, P., Delaney, K. M., Rundell, S. D., & Cherkin, D. C. (2018) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2018.02.016 · Cited by 42
A confirmatory factor analysis of the Resilience Scale adapted to chronic pain (RS-18): new empirical evidence of the protective role of resilience on pain adjustment
Ruiz-Párraga, G. T., López-Martínez, A. E., Esteve, R., Ramírez‐Maestre, C., & Wagnild, G. M. (2014) · Quality of Life Research · doi:10.1007/s11136-014-0852-z · Cited by 41
Effects of Mantra Meditation versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults with Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (RCT)
Innes, K. E., Selfe, T. K., Kandati, S., Wen, S., & Huysmans, Z. (2018) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2018/7683897 · Cited by 46
“NRS scales have shown excellent reliability and validity for a range of populations, are easier to use, and have shown higher compliance and greater responsiveness to change with treatment than the visual analog scale (VAS), especially in older adults [44–48].”
Background
Outcomes after traffic injury: mental health comorbidity and relationship with pain interference
Pozzato, I., Craig, A. R., Gopinath, B., Kifley, A., Tran, Y., Jagnoor, J., & Cameron, I. D. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02601-4 · Cited by 48
Percutaneous Electrolysis in the Treatment of Lateral Epicondylalgia: A Single-Blind Randomized Controlled Trial
Rodríguez-Huguet, M., Góngora-Rodríguez, J., Lomas‐Vega, R., Martín‐Valero, R., Díaz‐Fernández, Á., Obrero‐Gaitán, E., Ibáñez‐Vera, A. J., & Rodríguez‐Almagro, D. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9072068 · Cited by 42
Development and Validation of Cervical Prediction Models for Patient-Reported Outcomes at 1 Year After Cervical Spine Surgery for Radiculopathy and Myelopathy
Archer, K. R., Bydon, M., Khan, I., Nian, H., Pennings, J. S., Harrell, F. E., Sivaganesan, A., Chotai, S., McGirt, M. J., Foley, K. T., et al. (2020) · Spine · doi:10.1097/brs.0000000000003610 · Cited by 48
“Validated questionnaires were used to assess disability [Neck Disability Index (NDI)](29) and neck and arm pain [Numeric Rating Scale (NRS-NP/AP)].(30) In addition, the modified Japanese Orthopaedic Association (mJOA) score(31) was collected for patients who presented with myelopathic complaints and physical exam find…”
Method
Chuna Manual Therapy vs Usual Care for Patients With Nonspecific Chronic Neck Pain
Lee, J., Cho, J., Kim, K., Lee, J., Kim, M.-R., Kim, J., Kim, M.-Y., Cho, H.-W., Lee, Y. J., Lee, S., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.13757 · Cited by 42
Patients With Chronic Tension‐Type Headache Demonstrate Increased Mechano‐Sensitivity of the Supra‐Orbital Nerve
Fernández‐de‐las‐Peñas, C., Coppieters, M. W., Cuadrado, M. L., & Pareja, J. A. (2008) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2008.00856.x · Cited by 41
Increased Spontaneous Electrical Activity at a Latent Myofascial Trigger Point After Nociceptive Stimulation of Another Latent Trigger Point
Fernández‐Carnero, J., Ge, H., Kimura, Y., Fernández‐de‐las‐Peñas, C., & Arendt‐Nielsen, L. (2010) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e3181bad736 · Cited by 41
Short-term effectiveness of spinal manipulative therapy versus functional technique in patients with chronic nonspecific low back pain: a pragmatic randomized controlled trial
Castro‐Sánchez, A. M., Lara‐Palomo, I. C., Matarán-Peñarrocha, G. A., Fernández‐de‐las‐Peñas, C., Saavedra-Hernández, M., Cleland, J., & Aguilar‐Ferrándiz, M. E. (2015) · The Spine Journal · doi:10.1016/j.spinee.2015.08.057 · Cited by 40
“Although it can be argued that we did not include a separate no-treatment control group, hence the effectiveness of these interventions cannot be ascertained, it is unlikely that patients with chronic LBP of 7 months’ Table 1 Baseline demographics for both groups* Spinal manipulation (n=31) Functional technique (n=31)…”
MethodInfluential
Factor Structure and Psychometric Properties of the Resilience Scale in a Spanish Chronic Musculoskeletal Pain Sample
Ruiz-Párraga, G. T., López-Martínez, A. E., & Gómez‐Pérez, L. (2012) · Journal of Pain · doi:10.1016/j.jpain.2012.08.005 · Cited by 40
Development of a Review-of-Systems Screening Tool for Orthopaedic Physical Therapists: Results From the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Cohort
George, S. Z., Beneciuk, J. M., Bialosky, J. E., Lentz, T. A., Zeppieri, G., Pei, Q., & Wu, S. S. (2015) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2015.5900 · Cited by 41
Development of a Clinical Prediction Rule for Identifying Women With Tension‐Type Headache Who Are Likely to Achieve Short‐Term Success With Joint Mobilization and Muscle Trigger Point Therapy
Fernández‐de‐las‐Peñas, C., Cleland, J. A., Palomeque-del-Cerro, L., Caminero, A. B., Guillem-Mesado, A., & Jiménez‐García, R. (2010) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2010.01789.x · Cited by 40
The association of headache frequency with pain interference and the burden of disease is mediated by depression and sleep quality, but not anxiety, in chronic tension type headache
Palacios-Ceña, M., Fernández-Muñoz, J. J., Castaldo, M., Wang, K.-L., Guerrero-Peral, Á., Arendt-Nielsen, L., & Fernández-de-las-Peñas, C. (2017) · The Journal of Headache and Pain · doi:10.1186/s10194-017-0730-5 · Cited by 40
“On this diary, patients registered the frequency of headaches (days per week), the headache intensity on an 11points numerical pain rate scale [21] (NPRS; 0: no pain, 10: the maximum pain), and the duration of each headache attack (hours per day).”
Background
The influence of continuous versus interval walking exercise on knee joint loading and pain in patients with knee osteoarthritis
Farrokhi, S., Jayabalan, P. S., Gustafson, J. A., Klatt, B. A., Sowa, G., & Piva, S. R. (2017) · Gait & Posture · doi:10.1016/j.gaitpost.2017.05.015 · Cited by 40
“NPRS has been shown to have concurrent and predictive validity as a measure of pain intensity [22, 23].”
Background
The Optimal Screening for Prediction of Referral and Outcome (OSPRO) in patients with musculoskeletal pain conditions: a longitudinal validation cohort from the USA
George, S. Z., Beneciuk, J. M., Lentz, T. A., & Wu, S. S. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-015188 · Cited by 40
The Relationship Between Clinical and Quantitative Measures of Pain Sensitization in Knee Osteoarthritis
Moore, R. L., Clifford, A. M., Moloney, N. A., Doody, C., Smart, K. M., & O’Leary, H. (2020) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000798 · Cited by 40
Early multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle function
Hébert, J. J., Fritz, J. M., Thackeray, A., Koppenhaver, S. L., & Teyhen, D. S. (2013) · British Journal of Sports Medicine · doi:10.1136/bjsports-2013-092402 · Cited by 41
Clinical features of patients with chronic non-specific neck pain per disability level: A novel observational study
Beltrán-Alacreu, H., López‐de‐Uralde‐Villanueva, I., Calvo‐Lobo, C., Fernández‐Carnero, J., & Touche, R. L. (2018) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.64.08.700 · Cited by 39
Efficacy of Combination Therapies on Neck Pain and Muscle Tenderness in Male Patients with Upper Trapezius Active Myofascial Trigger Points
Alghadir, A. H., Iqbal, A., Anwer, S., Iqbal, Z. A., & Ahmed, H. (2020) · BioMed Research International · doi:10.1155/2020/9361405 · Cited by 42
“5 kg/cm(2) of pressure was applied at the rate of 1 kg/cm(2) by the physiotherapist while the subjects were stated to rate their pain on the VAS to evaluate local pain evoked by the application of that amount of pressure [29, 30].”
BackgroundMethod
Contribution of Chronic Fatigue to Psychosocial Status and Quality of Life in Spanish Women Diagnosed with Endometriosis
Mundo-López, A., Hernández, O. O., San-Sebastián, A. P., Galiano‐Castillo, N., Rodríguez-Pérez, O., Arroyo-Luque, M. S., Arroyo‐Morales, M., Cantarero‐Villanueva, I., Fernández‐Lao, C., & Artacho‐Cordón, F. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17113831 · Cited by 47
The Predictive Role of Executive Functions and Psychological Factors on Chronic Pain after Orthopaedic Surgery: A Longitudinal Cohort Study
Giusti, E. M., Manna, C., Varallo, G., Cattivelli, R., Manzoni, G. M., Gabrielli, S., D’Amario, F., Lacerenza, M. R., & Castelnuovo, G. (2020) · Brain Sciences · doi:10.3390/brainsci10100685 · Cited by 39
Hazards for Pain Severity and Pain Interference with Daily Living, with Exploration of Brief Pain Inventory Cutpoints, Among Women with Metastatic Breast Cancer
Castel, L. D., Abernethy, A. P., Li, Y., DePuy, V., Saville, B. R., & Hartmann, K. E. (2007) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2006.12.007 · Cited by 39
EUS–guided versus percutaneous liver biopsy: A prospective randomized clinical trial
Ali, A. H., Nallapeta, N. S., Yousaf, M. N., Petroski, G. F., Sharma, N., Rao, D. S., Yin, F., Davis, R. M., Bhat, A. P., Swi, A. I. A., et al. (2023) · Endoscopic Ultrasound · doi:10.1097/eus.0000000000000010 · Cited by 38
Pain and Post-Traumatic Stress Disorder Symptoms During Inpatient Rehabilitation Among Operation Enduring Freedom/Operation Iraqi Freedom Veterans With Spinal Cord Injury
Ullrich, P. M., Smith, B., Poggensee, L., Evans, C. T., Stroupe, K. T., Weaver, F. M., & Burns, S. P. (2012) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2012.07.018 · Cited by 39
Effect of obesity on cost per quality-adjusted life years gained following anterior cervical discectomy and fusion in elective degenerative pathology
Chotai, S., Sielatycki, J. A., Park, P., Sivaganesan, A., Kay, H. F., Stonko, D. P., Wick, J. B., McGirt, M. J., & Devin, C. J. (2016) · The Spine Journal · doi:10.1016/j.spinee.2016.06.023 · Cited by 38
The Effect of Transiliac–Transsacral Screw Fixation for Pelvic Ring Injuries on the Uninjured Sacroiliac Joint
Mardam‐Bey, S. W., Beebe, M. J., Black, J. C., Chang, E. Y., Kubiak, E. N., Bishop, J. A., McAndrew, C. M., Ricci, W. M., & Gardner, M. J. (2016) · Journal of Orthopaedic Trauma · doi:10.1097/bot.0000000000000622 · Cited by 38
Benefits of Craniosacral Therapy in Patients with Chronic Low Back Pain: A Randomized Controlled Trial
Castro‐Sánchez, A. M., Lara‐Palomo, I. C., Matarán-Peñarrocha, G. A., Saavedra-Hernández, M., Pérez‐Mármol, J. M., & Aguilar‐Ferrándiz, M. E. (2016) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2016.0068 · Cited by 38
“5 points.(27) The Tampa Scale of Kinesiophobia is a 17-item questionnaire developed to measure kinesiophobia (the fear of movement and [re]injury).”
Pain Expansion and Severity Reflect Central Sensitization in Primary Care Patients with Greater Trochanteric Pain Syndrome
Peña, R. F., Muñoz‐García, D., Calvo‐Lobo, C., & Fernández‐Carnero, J. (2018) · Pain Medicine · doi:10.1093/pm/pny199 · Cited by 38
Impact of Endometriosis in Women of Arab Ancestry on: Health-Related Quality of Life, Work Productivity, and Diagnostic Delay
Mousa, M., Al‐Jefout, M., AlSafar, H. S., Becker, C. M., Zondervan, K. T., & Rahmioğlu, N. (2021) · Frontiers in Global Women s Health · doi:10.3389/fgwh.2021.708410 · Cited by 38
Tumor necrosis factor-alpha is a potential diagnostic biomarker for chronic neuropathic pain after spinal cord injury
Xu, J., Xiaoqiang, E., Liu, H., Li, F., Cao, Y., Tian, J., & Yan, J. (2015) · Neuroscience Letters · doi:10.1016/j.neulet.2015.04.004 · Cited by 38
Preparing for the bundled-payment initiative: the cost and clinical outcomes of reverse shoulder arthroplasty for the surgical treatment of advanced rotator cuff deficiency at an average 4-year follow-up
Virani, N. A., Williams, C. D., Clark, R. E., Polikandriotis, J. A., Downes, K. L., & Frankle, M. A. (2013) · Journal of Shoulder and Elbow Surgery · doi:10.1016/j.jse.2013.01.003 · Cited by 37
Analysis of Pressure Pain Hypersensitivity, Ultrasound Image, and Quality of Life in Patients with Chronic Plantar Pain: A Preliminary Study
Fernández‐Lao, C., Galiano‐Castillo, N., Cantarero‐Villanueva, I., Martín‐Martín, L., Prados-Olleta, N., & Arroyo‐Morales, M. (2016) · Pain Medicine · doi:10.1093/pm/pnv022 · Cited by 37
Testing the Interpersonal Theory of Suicide in Chronic Pain
Wilson, K. G., Heenan, A., Kowal, J., Henderson, P. R., McWilliams, L. A., & Castillo, D. (2016) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000451 · Cited by 38
Are endogenous opioid mechanisms involved in the effects of aerobic exercise training on chronic low back pain? A randomized controlled trial
Bruehl, S. P., Burns, J. W., Koltyn, K. F., Gupta, R. K., Buvanendran, A., Edwards, D. A., Chont, M., Wu, Y. H., Qu’d, D., & Stone, A. L. (2020) · Pain · doi:10.1097/j.pain.0000000000001969 · Cited by 37
“average andworst pain are simple overall intensity measures that are sensitive to change with intervention.(32)”
Background
A comparison of progestogens or oral contraceptives and gonadotropin-releasing hormone agonists for the treatment of endometriosis: a systematic review
Jeng, C., Chuang, L. T., & Shen, J. (2014) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2014.888414 · Cited by 37
“Biberoglu and Behrman pain scores [15], numerical rating scores [16], and Beck Depression Inventory scores [17] all decreased from baseline values in both groups after treatment; however, in the extent of reduction in these measures between the groups were not different.”
Background
Pain Fear Avoidance and Pain Acceptance: A Cross-Sectional Study Comparing Their Influence on Adjustment to Chronic Pain Across Three Samples of Patients
Esteve, R., & Ramírez‐Maestre, C. (2013) · Annals of Behavioral Medicine · doi:10.1007/s12160-013-9499-1 · Cited by 37
“Composites of the 0–10 ratings are very reliable measures of pain intensity in chronic pain patients [50].”
Background
Attachment insecurity predicts responses to an interdisciplinary chronic pain rehabilitation program
Kowal, J., McWilliams, L. A., Péloquin, K., Wilson, K. G., Henderson, P. R., & Fergusson, D. A. (2015) · Journal of Behavioral Medicine · doi:10.1007/s10865-015-9623-8 · Cited by 36
Back to Living: Long-term Functional Status of Pediatric Patients Who Completed Intensive Interdisciplinary Pain Treatment
Randall, E. T., Smith, K. R., Conroy, C., Smith, A. M., Sethna, N., & Logan, D. E. (2018) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000616 · Cited by 37
Preoperative Predictors of Complex Regional Pain Syndrome Outcomes in the 6 Months Following Total Knee Arthroplasty
Bruehl, S. P., Billings, F. T., Anderson, S., Polkowski, G. G., Shinar, A. A., Schildcrout, J. S., Shi, Y., Milne, G. L., Dematteo, A. C., Mishra, P., et al. (2022) · Journal of Pain · doi:10.1016/j.jpain.2022.04.005 · Cited by 36
“An 11-point NRS anchored with “no pain” and “worst possible pain” was also used to rate worst knee pain in the 24 hours preceding CRPS assessment at 6-month follow-up.(47)”
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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