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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Minimal Clinically Important Differences in Hand Pain Intensity (Numerical Pain Rate Scale) and Related-Function (Boston Carpal Tunnel Questionnaire) in Women With Carpal Tunnel Syndrome
López‐de‐Uralde‐Villanueva, I., Fernández‐de‐las‐Peñas, C., Cleland, J. A., Cook, C. E., De-la-Llave-Rincón, A. I., Valera‐Calero, J. A., & Plaza‐Manzano, G. (2023) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2023.07.018 · Cited by 22
Er:YAG laser vs. sharp debridement in management of chronic wounds: Effects on pain and bacterial load
Hajhosseini, B., Chiou, G. J., Dori, G., Fukaya, E., Chandra, V., Meyer, S., & Gurtner, G. C. (2019) · Wound Repair and Regeneration · doi:10.1111/wrr.12764 · Cited by 22
“However, previous research in the pain literature has found the NRS 11-point numeric scale to be sufficient as a psychometric measure of pain levels.(17) To further minimize the influence of the variability of pain scores experienced by the study population, all statistical analyses used to evaluate patients’ pain lev…”
Postoperative Pain after Treatment Using the GentleWave System: A Randomized Controlled Trial
Grigsby, D., Ordinola‐Zapata, R., McClanahan, S. B., & Fok, A. S. L. (2020) · Journal of Endodontics · doi:10.1016/j.joen.2020.04.004 · Cited by 22
“Although the visual analog scale (VAS) is one of the most widely used tools to survey the severity and relief of pain, the NRS is regarded as one of the best single-item methods available to estimate the intensity of pain (17, 18).”
Cross-Cultural Adaptation and Psychometric Properties of the Spanish Version of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders
Touche, R. L., Pardo-Montero, J., Cuenca‐Martínez, F., Visscher, C. M., Paris‐Alemany, A., & López‐de‐Uralde‐Villanueva, I. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9092831 · Cited by 22
Longitudinal study of early adaptation to the coronavirus disease pandemic among youth with chronic pain and their parents: effects of direct exposures and economic stress
Law, E. F., Zhou, C., Seung, F., Perry, F., & Palermo, T. M. (2021) · Pain · doi:10.1097/j.pain.0000000000002290 · Cited by 22
Effectiveness of a Multimodal Treatment Program for Somatoform Pain Disorder
Pieh, C., Neumeier, S., Loew, T. H., Altmeppen, J., Angerer, M., Busch, V., & Lahmann, C. (2013) · Pain Practice · doi:10.1111/papr.12144 · Cited by 21
“numeric scale, scored 0 (no pain) through 10 (worst possible pain) to rate minimum, average, and maximum pain within the past 4 weeks.(18,19) The NRS is a valid and reliable method of”
Method
Effects of Noninvasive Interactive Neurostimulation on Symptoms of Osteoarthritis of the Knee: A Randomized, Sham-Controlled Pilot Study
Selfe, T. K., Bourguignon, C. M., & Taylor, A. G. (2008) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2008.0305 · Cited by 24
Genetic Contribution of Catechol-O-Methyltransferase Polymorphism (Val158Met) in Children With Chronic Tension-Type Headache
Fernández‐de‐las‐Peñas, C., Ambite‐Quesada, S., Rivas‐Martínez, I., Ortega‐Santiago, R., De-la-Llave-Rincón, A. I., Fernández-Mayoralas, D. M., & Pareja, J. A. (2011) · Pediatric Research · doi:10.1203/pdr.0b013e318229448a · Cited by 22
The Strengthening Exercises in Shoulder Impingement trial (The SExSI-trial) investigating the effectiveness of a simple add-on shoulder strengthening exercise programme in patients with long-lasting subacromial impingement syndrome: Study protocol for a pragmatic, assessor blinded, parallel-group, randomised, controlled trial
Clausen, M. B., Bandholm, T., Rathleff, M. S., Christensen, K. B., Zebis, M. K., Graven‐Nielsen, T., Hölmich, P., & Thorborg, K. (2018) · Trials · doi:10.1186/s13063-018-2509-7 · Cited by 24
Operant Learning Versus Energy Conservation Activity Pacing Treatments in a Sample of Patients With Fibromyalgia Syndrome: A Pilot Randomized Controlled Trial
Racine, M., Jensen, M. P., Harth, M., Morley-Forster, P., & Nielson, W. R. (2018) · Journal of Pain · doi:10.1016/j.jpain.2018.09.013 · Cited by 22
Influence of Clinical, Psychological, and Psychophysical Variables on Long‐term Treatment Outcomes in Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial
Fernández‐de‐las‐Peñas, C., De-la-Llave-Rincón, A. I., Cescon, C., Barbero, M., Arias‐Buría, J. L., & Falla, D. (2019) · Pain Practice · doi:10.1111/papr.12788 · Cited by 23
“patient’s mean intensity of hand pain and the worst level of pain experienced in the preceding week.(28) Secondary outcomes included 2 subscales (functional status and severity) of the Boston Carpal Tunnel Questionnaire.”
Background
ePHoRt: Towards a Reference Architecture for Tele-Rehabilitation Systems
Pérez-Medina, J.-L., Jimenes-Vargas, K., Leconte, L., Villarreal-Narvaez, S., Rybarczyk, Y. P., & Vanderdonckt, J. M. (2019) · IEEE Access · doi:10.1109/access.2019.2927461 · Cited by 24
“to be used in the investigation of chronic pain [18].”
Background
Body Perception Disturbance and Pain Reduction in Longstanding Complex Regional Pain Syndrome Following a Multidisciplinary Rehabilitation Program
Lewis, J. S., Kellett, S., McCullough, R., Tapper, A., Tyler, C., Viner, M., & Palmer, S. (2019) · Pain Medicine · doi:10.1093/pm/pnz176 · Cited by 23
“A numerical rating scale (NRS) is a widely used, valid, and reliable scale to measure pain intensity and has been shown to have high compliance rates in chronic pain populations [30,31].”
Method
Effectiveness and Quality of Implementing a Best Practice Model of Care for Low Back Pain (BetterBack) Compared with Routine Care in Physiotherapy: A Hybrid Type 2 Trial
Schröder, K., Öberg, B. E., Enthoven, P., Hedevik, H., Fors, M., & Abbott, A. D. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10061230 · Cited by 25
“Secondary Outcome Measures Secondary outcomes were within group NRS-LBP and ODI longitudinal changes from baseline to 3, 6 and 12 months follow-up and mean differences between the control and intervention groups regarding change from baseline to 6 and 12 months follow-up.”
BackgroundMethodInfluential
Cognitive‐behavioural group treatment with hypnosis: a randomized pilot trail in fibromyalgia
Castel, A., Salvat, M., Sala, J., & Rull, M. (2009) · Contemporary Hypnosis · doi:10.1002/ch.372 · Cited by 32
Usefulness of the DN4, S-LANSS, and painDETECT screening questionnaires to detect the neuropathic pain components in people with acute whiplash-associated disorders: a cross-sectional study
Ríos‐León, M., Taylor, J., Segura‐Fragoso, A., & Barriga-Martín, A. (2023) · Pain Medicine · doi:10.1093/pm/pnad165 · Cited by 21
Pilot study of inflammatory responses following a negative imaginal focus in persons with chronic pain: Analysis by sex/gender
Darnall, B. D., Aickin, M. G., & Zwickey, H. L. (2010) · Gender Medicine · doi:10.1016/j.genm.2010.06.003 · Cited by 21
Muscle Trigger Points and Pressure Pain Sensitivity Maps of the Feet in Women with Fibromyalgia Syndrome
Tornero-Caballero, M. C., Salom‐Moreno, J., Cigarán‐Méndez, M., Morales-Cabezas, M., Madeleine, P., & Fernández‐de‐las‐Peñas, C. (2016) · Pain Medicine · doi:10.1093/pm/pnw090 · Cited by 21
Clinical Characteristics of Mixed Arteriovenous Leg Ulcers
Marin, J., & Woo, K. Y. (2017) · Journal of Wound Ostomy and Continence Nursing · doi:10.1097/won.0000000000000294 · Cited by 21
Active Trigger Points Are Associated With Anxiety and Widespread Pressure Pain Sensitivity in Women, but not Men, With Tension Type Headache
Cigarán‐Méndez, M., Jiménez‐Antona, C., Parás‐Bravo, P., Fuensalida‐Novo, S., Rodríguez‐Jiménez, J., & Fernández‐de‐las‐Peñas, C. (2019) · Pain Practice · doi:10.1111/papr.12775 · Cited by 21
Pregabalin Failed to Prevent Dry Eye Symptoms after Laser-Assisted in Situ Keratomileusis (LASIK) in a Randomized Pilot Study
Galor, A., Patel, S., Small, L. R., Rodriguez, A., Venincasa, M. J., Valido, S. E., Feuer, W. J., Levitt, R. C., Sarantopoulos, C. D., & Felix, E. R. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8091355 · Cited by 21
“Ocular pain: Three ocular pain questionnaires were administered, each targeting different aspects of pain: (a) Numerical rating scale (NRS) of ocular pain intensity (range 0–10; “no pain” to “most intense pain imaginable”) over a one week recall period (average eye pain during the past week, and worst eye pain during…”
Method
Significant others’ responses to pain in veterans with chronic pain and clinical levels of post‐traumatic stress disorder symptomatology
Alschuler, K. N., & Otis, J. D. (2012) · European Journal of Pain · doi:10.1002/j.1532-2149.2012.00180.x · Cited by 21
“NRS has been validated as a good measure of persons with chronic pain, including in comparison to other pain intensity measures (Jensen et al., 1999).”
Background
Self‐Reported Issues With Driving in Patients With Chronic Pain
Fan, A., Wilson, K. G., Acharya, M., Cranney, A., Buenger, U., & Marshall, S. (2012) · PM&R · doi:10.1016/j.pmrj.2011.10.008 · Cited by 21
“● Pain intensity rated on a numerical rating scale from 0 (no pain) to 10 (as intense as you can imagine) [30].”
BackgroundMethod
Are coping and catastrophising independently related to disability and depression in patients with whiplash associated disorders?
Nieto, R., Miró, J., Huguet, A., & Saldaña, C. (2010) · Disability and Rehabilitation · doi:10.3109/09638288.2010.491576 · Cited by 23
“Numerical rating scales have shown a strong association with other measures of pain intensity and stability over time, thus demonstrating their validity and reliability as measures of pain intensity [38].”
Background
Changes in Perceived Pain Severity during Interdisciplinary Treatment for Chronic Pain
Kowal, J., Wilson, K. G., Geck, C., Henderson, P. R., & D’Eon, J. L. (2011) · Pain Research and Management · doi:10.1155/2011/817816 · Cited by 21
Pain is Associated to Clinical, Psychological, Physical, and Neurophysiological Variables in Women With Carpal Tunnel Syndrome
Fernández-Muñóz, J. J., Palacios‐Ceña, M., Cigarán‐Méndez, M., Ortega‐Santiago, R., De-la-Llave-Rincón, A. I., Salom‐Moreno, J., & Fernández‐de‐las‐Peñas, C. (2015) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000241 · Cited by 21
Resilience and Vulnerability Factors When Pain is Acute as Predictors of Disability: Findings From a Two-Year Longitudinal Study
Esteve, R., Bendayan, R., López-Martínez, A. E., & Ramírez‐Maestre, C. (2017) · Pain Medicine · doi:10.1093/pm/pnx053 · Cited by 21
Reliability and relationship of the fear-avoidance beliefs questionnaire with the shoulder pain and disability index and numeric pain rating scale in patients with shoulder pain
Riley, S. P., Tafuto, V., Cote, M. P., Brismée, J., Wright, A. A., & Cook, C. E. (2018) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2018.1453004 · Cited by 21
The “ARIANNA” Project: An Observational Study on a Model of Early Identification of Patients with Palliative Care Needs through the Integration between Primary Care and Italian Home Palliative Care Units
Scaccabarozzi, G., Amodio, E., Pellegrini, G., Limonta, F., Aprile, P. L., Lovaglio, P. G., Peruselli, C., Crippa, M., & Arianna Working Group (2018) · Journal of Palliative Medicine · doi:10.1089/jpm.2017.0404 · Cited by 21
“For pain evaluation, Numeric Pain Rating Scale 15 was used, with values of 0 (no pain) to 10 (maximum pain level).”
Effects of diacutaneous fibrolysis in patients with mild to moderate symptomatic carpal tunnel syndrome: a randomized controlled trial
Jiménez‐del‐Barrio, S., Estébanez-de-Miguel, E., Bueno-Gracía, E., Haddad-Garay, M., Moreno, J. M. T., & Hidalgo-García, C. (2018) · Clinical Rehabilitation · doi:10.1177/0269215518787316 · Cited by 21
Pressure pain hypersensitivity and referred pain from muscle trigger points in elite male wheelchair basketball players
Ortega‐Santiago, R., González-Aguado, Á. J., Fernández‐de‐las‐Peñas, C., Cleland, J. A., De-la-Llave-Rincón, A. I., Kobylarz, M. D., & Plaza‐Manzano, G. (2019) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2019.05.008 · Cited by 21
Post-needling soreness and trigger point dry needling for hemiplegic shoulder pain following stroke
Mendigutía-Gómez, A., Quintana-García, M. T., Martín-Sevilla, M., de Lorenzo-Barrientos, D., Rodríguez‐Jiménez, J., Fernández‐de‐las‐Peñas, C., & Arias‐Buría, J. L. (2020) · Acupuncture in Medicine · doi:10.1177/0964528419882941 · Cited by 21
The effects of McConnell patellofemoral joint and tibial internal rotation limitation taping techniques in people with Patellofemoral pain syndrome
Clifford, A. M., Dillon, S., Hartigan, K., O’Leary, H., & Constantinou, M. (2020) · Gait & Posture · doi:10.1016/j.gaitpost.2020.09.010 · Cited by 21
“The NRS has been validated for a number of chronic musculoskeletal disorders [26], and has been used among people with anterior knee pain in various research settings [24].”
Background
Impact of old age on patient-report outcomes and cost utility for anterior cervical discectomy and fusion surgery for degenerative spine disease
Chotai, S., Park, P., Sielatycki, J. A., Sivaganesan, A., Kay, H. F., Wick, J. B., McGirt, M. J., & Devin, C. J. (2016) · European Spine Journal · doi:10.1007/s00586-016-4835-3 · Cited by 21
“Validated PROs, including: neck disability index (ODI) [33], EuroQol-5D (EQ-5D) [34], short-form-12 item health survey (SF-12), physical component score (PCS) and mental component score (MCS) [35], and numeric-rating scale pain scores (NRS) for neck pain (NP) and arm pain (AP) [36] were captured.”
Preliminary study into the components of the fear-avoidance model of LBP: change after an initial chiropractic visit and influence on outcome
Field, J. R., Newell, D., & McCarthy, P. W. (2010) · Chiropractic & Manual Therapies · doi:10.1186/1746-1340-18-21 · Cited by 21
“It has been described as having a Cronbach’s a of 0.82 and intraclass correlation coefficient > 0.8 [ 56 ].”
Influential
Efficacy of laparoscopic excision of visually diagnosed peritoneal endometriosis in the treatment of chronic pelvic pain
Wykes, C. B., Clark, T. J., Chakravati, S., Mann, C. H., & Gupta, J. K. (2005) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2005.08.008 · Cited by 21
Psychologische Diagnostik
Gralow, I., Crede, S., & Schneider, E. (2011) · Springer eBooks · doi:10.1007/978-3-642-12819-6_6 · Cited by 21
Effect of adding interferential current stimulation to exercise on outcomes in primary care patients with chronic neck pain: a randomized controlled trial
Cabello, M. A., Pérez‐Mármol, J. M., Barrios-Quinta, C. J., Matarán-Peñarrocha, G. A., Castro‐Sánchez, A. M., & De-la-Cruz-Torres, B. (2019) · Clinical Rehabilitation · doi:10.1177/0269215519844554 · Cited by 20
Poststroke shoulder pain in subacute patients and its correlation with upper limb recovery after robotic or conventional treatment: A secondary analysis of a multicenter randomized controlled trial
Aprile, I. G., Germanotta, M., Cruciani, A., Pecchioli, C., Loreti, S., Papadopoulou, D., Montesano, A., Galeri, S., Diverio, M., Falsini, C., et al. (2020) · International Journal of Stroke · doi:10.1177/1747493020937192 · Cited by 20
Impact of symptom burden on work performance status in Spanish women diagnosed with endometriosis
Mundo-López, A., Hernández, O. O., Lozano‐Lozano, M., San-Sebastián, A. P., Fernández‐Lao, C., Galiano‐Castillo, N., Cantarero‐Villanueva, I., Arroyo‐Morales, M., & Artacho‐Cordón, F. (2021) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2021.04.008 · Cited by 20
Profiling and Association over Time between Disability and Pain Features in Patients with Chronic Nonspecific Neck Pain: A Longitudinal Study
Ortego, G., Lluch, E., Herrero, P., Boudreau, S. A., & Doménech‐García, V. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11051346 · Cited by 20
“The VAS is a reliable and valid tool for measuring pain [40,41].”
Method
Manipulation under Anesthesia versus Non-Surgical Treatment for Patients with Frozen Shoulder Contracture Syndrome: A Systematic Review
Salomon, M., Pastore, C., Maselli, F., Bari, M. D., Pellegrino, R., & Brindisino, F. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159715 · Cited by 20

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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