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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Method
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Background
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Method
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Background
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Background
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MethodInfluential
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Method
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BackgroundInfluential
Factors involved in patients’ perceptions of self-improvement after chronic pain treatment
Shaikh, M., & Hapidou, E. G. (2018) · Canadian Journal of Pain · doi:10.1080/24740527.2018.1476821 · Cited by 12
“Pain Intensity Scale The participant reports his or her “usual” and “least” subjective levels of pain experienced in the past 2 weeks.(23)”
Background
Fear-avoidance beliefs are associated with a high fat content in the erector spinae: a 1.5 tesla magnetic resonance imaging study
Wesselink, E. O., de Raaij, E. J., Pevenage, P., van der Kaay, N., & Pool, J. J. M. (2019) · Chiropractic & Manual Therapies · doi:10.1186/s12998-019-0234-2 · Cited by 13
Lateral epicondylitis: Are we missing out on radial nerve involvement? A cross-sectional study
Vasudeva, A., Parihar, R. S., Neyaz, O., Srishti, N., & Handa, G. (2021) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2021.01.014 · Cited by 12
Intensity, perception, and descriptive characteristics of chronic pain in children with cerebral palsy
Houlihan, C. M., Hanson, A., Quinlan, N. D., Puryear, C. G., & Stevenson, R. D. (2008) · Journal of Pediatric Rehabilitation Medicine · doi:10.3233/prm-2008-00026 · Cited by 12
“yond the typical course of a disease [28,42], and may be secondary to the disability itself [9,19,36].”
Healthcare Provider Advice to Engage in Walking Regimens and Adherence in Women With Fibromyalgia
Peñacoba, C., Pastor-Mira, M. D. L. Á., López-Roig, S., Sanz, Y., & Furlong, L. V. (2017) · Rehabilitation Nursing · doi:10.1097/rnj.0000000000000103 · Cited by 14
The management of chronic pain in Switzerland: A comparative survey of Swiss medical specialists treating chronic pain
Wilder‐Smith, O. H. G., Möhrle, J. J., Dolin, P., & Martin, N. C. (2001) · European Journal of Pain · doi:10.1053/eujp.2001.0248 · Cited by 12
“, 1985; Chibnall and Tait, 1994; Feine, 2000) and scales, scores or psychophysical measures (Tearnan and Dar, 1986; Brackertz et al., 1991; Defrin et al., 1999; Jensen et al., 1999).”
Background
Rehabilitative management of back pain in children: protocol for a mixed studies systematic review
Cancelliere, C., Wong, J. J., Yu, H., Mior, S. A., Brunton, G., Shearer, H. M., Rudoler, D., Hestbæk, L., Papaconstantinou, E. A., Cedraschi, C., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-038534 · Cited by 11
The assessment of paraspinal muscle epimuscular fat in participants with and without low back pain: A case-control study
Rosenstein, B., Burdick, J., Roussac, A., Rye, M., Naghdi, N., Valentin, S., Licka, T. F., Sean, M., Tétreault, P., Elliott, J., et al. (2024) · Journal of Biomechanics · doi:10.1016/j.jbiomech.2024.111928 · Cited by 11
“The scale is a self-reported rating system for pain intensity that is a reliable and valid method of detecting significant changes in perceived pain (Jensen et al., 1999; Childs, Piva, and Fritz 2005).”
The Combined Influence of Sleep Disturbance and Depression on 12-month Outcomes After Lumbar Spine Surgery
Coronado, R. A., Pennings, J. S., Master, H., Brintz, C., Cole, K. R., Helmy, J., Oleisky, E. R., Davidson, C. A., Abtahi, A. M., Stephens, B. F., et al. (2024) · Spine · doi:10.1097/brs.0000000000005000 · Cited by 11
Evaluation of Cognitive Performance in Patients with Fibromyalgia Syndrome: A Case–Control Study
Fernández-Palacios, F. G., Pacho-Hernández, J. C., Fernández‐de‐las‐Peñas, C., Gómez‐Calero, C., & Cigarán‐Méndez, M. (2024) · Life · doi:10.3390/life14050649 · Cited by 11
“This was measured with an 11-point numerical pain rating scale (NPRS) [22] containing 4 items ranging from 0 (no pain) to 10 (the worst pain you can imagine), where the subjects were asked to indicate the least, the worst, and the average pain intensity experienced in the last week, as well as…”
Method
Generalized Mechanical Nerve Pain Hypersensitivity in Children With Episodic Tension-type Headache
Fernández-Mayoralas, D. M., Fernández‐de‐las‐Peñas, C., Ortega‐Santiago, R., Ambite‐Quesada, S., Jiménez‐García, R., & Fernández‐Jaén, A. (2010) · PEDIATRICS · doi:10.1542/peds.2010-0012 · Cited by 11
Who Benefits Most From Individualized Physiotherapy or Advice for Low Back Disorders? A Preplanned Effect Modifier Analysis of a Randomized Controlled Trial
Hahne, A. J., Ford, J. J., Richards, M. C., Surkitt, L. D., Chan, A. Y. P., Slater, S. L., & Taylor, N. F. (2017) · Spine · doi:10.1097/brs.0000000000002148 · Cited by 11
Stress in patients diagnosed with rheumatoid arthritis compared to chronic pain.
Rice, D. B., Mehta, S., Serrato, J., Pope, J. E., Harth, M., Sequeira, K., Morley-Forster, P. K., Shapiro, A. P., & Teasell, R. W. (2017) · Rehabilitation Psychology · doi:10.1037/rep0000103 · Cited by 11
Distress and Sensitization as Main Mediators of Severity in Women with Fibromyalgia: A Structural Equation Model
Liew, B. X. W., Valera‐Calero, J. A., Varol, U., Nijs, J., Arendt‐Nielsen, L., Plaza‐Manzano, G., & Fernández‐de‐las‐Peñas, C. (2022) · Biomedicines · doi:10.3390/biomedicines10051188 · Cited by 12
Effect of EDDY and manual dynamic activation techniques on postoperative pain in non-surgical retreatment: a randomized controlled trial
İnce-Yusufoğlu, S., Keskin, N. B., Uslu, G., & Helvacıoğlu-Yiğit, D. (2023) · BMC Oral Health · doi:10.1186/s12903-022-02702-4 · Cited by 11
Spanish Version of the Avoidance-Endurance Questionnaire: Factor Structure and Psychometric Properties
Ruiz-Párraga, G. T., López-Martínez, A. E., Rusu, A. C., & Hasenbring, M. I. (2015) · The Spanish Journal of Psychology · doi:10.1017/sjp.2015.89 · Cited by 11
Depicting individual responses to physical therapist led chronic pain self-management support with pain science education and exercise in primary health care: multiple case studies
Miller, J., MacDermid, J. C., Richardson, J. A., Walton, D. M., & Gross, A. (2017) · Archives of Physiotherapy · doi:10.1186/s40945-017-0032-x · Cited by 12
“(PDF 304 kb) Abbreviations BI: Bother Index; COMMENCE: Chronic Pain Self-Management Support with Pain Science Education and Exercise; DI: Dysfunction Index; IEQ: Injustice Experience Questionnaire; NFRS: Numeric Fatigue Rating Scele; NPQ: Revised Neurophysiology of Pain Questionnaire; NPRS: Numeric Pain Rating Scale;…”
MethodInfluential
Multifidus muscle size changes at different directions of head and neck movements in females with unilateral chronic non-specific neck pain and healthy subjects using ultrasonography
Amiri, S., Bandpei, M. A. M., Rezasoltani, A., Peolsson, A. L. C., & Mohammadi, M. (2017) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2017.09.011 · Cited by 11
How variability in pain and pain coping relate to pain interference during multistage ultramarathons
Alschuler, K. N., Kratz, A. L., Lipman, G. S., Krabak, B. J., Pomeranz, D., Burns, P., Bautz, J., Nordeen, C. A., Irwin, C., & Jensen, M. P. (2018) · Pain · doi:10.1097/j.pain.0000000000001397 · Cited by 13
Causal mechanisms of a healthy lifestyle intervention for patients with musculoskeletal pain who are overweight or obese
Williams, A. J., Lee, H., Kamper, S. J., O’Brien, K. M., Wiggers, J., Wolfenden, L., Yoong, S. L., Hodder, R. K., Robson, E. K., Haskins, R., et al. (2019) · Clinical Rehabilitation · doi:10.1177/0269215519831419 · Cited by 14
Evaluation of neurodynamic responses in women with frequent episodic tension type headache
Caamaño-Barrios, L. H., Galán-del-Río, F., Fernández‐de‐las‐Peñas, C., Cleland, J. A., Plaza‐Manzano, G., & Ortega‐Santiago, R. (2019) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2019.102063 · Cited by 11
Embedding pain neuroscience education in the physical therapy management of patients with chronic plantar fasciitis: a prospective case series
Mills, K. M., Preston, E., Schmitt, B. M. C., Brochu, H. K., Schafer, E. A., Robinette, P. E., Sterling, E. K., & Coronado, R. A. (2020) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2020.1821327 · Cited by 13
“sity [27], pain catastrophizing [28], and fear of movement [29].”
Background
Two-Week Cervical Vagus Nerve Stimulation in Chronic Pancreatitis Patients Induces Functional Connectivity Changes of Limbic Structures
Muthulingam, J. A., Hansen, T. M., Olesen, S. S., Drewes, A. M., & Frøkjær, J. B. (2021) · Neuromodulation Technology at the Neural Interface · doi:10.1111/ner.13482 · Cited by 11
A New Version of the Impairment and Functioning Inventory for Patients With Chronic Pain (IFI‐R)
Ramírez‐Maestre, C., & Esteve, R. (2014) · PM&R · doi:10.1016/j.pmrj.2014.11.013 · Cited by 11
“Composites of the 0-10 ratings are very reliable measures of pain intensity in patients with chronic pain [38].”
Background
Case report: Physiotherapy strategies for a woman with symphysis pubis diastasis occurring during labour
Shim, J.-H., & Oh, D. (2011) · Physiotherapy · doi:10.1016/j.physio.2011.01.005 · Cited by 11
“[6] Jensen MP, Turner JA, Romano JM, Fisher LD.”
BackgroundMethod
Differential Diagnosis and Physical Therapy Management of a Patient With Radial Wrist Pain of 6 Months' Duration: A Case Report
González-Iglesias, J., Huijbregts, P. A., Fernández‐de‐las‐Peñas, C., & Cleland, J. A. (2010) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2010.3210 · Cited by 11
Promoting unsupervised walking in women with fibromyalgia: a randomized controlled trial
Pastor-Mira, M. D. L. Á., López-Roig, S., Martínez‐Zaragoza, F., Boyer, A. L., Furlong, L. V., Zarceño, E. L., Écija, C., & Peñacoba, C. (2020) · Psychology Health & Medicine · doi:10.1080/13548506.2020.1774068 · Cited by 11
“– Pain intensity perception: Measured by the mean score of the maximum, minimum, and usual pain intensity during the last week and pain intensity at time of the assessment (Jensen et al., 1999), where 0 = ‘no pain at all’ and 10 = ‘the worst pain you can imagine’ (α = .”
Background
Medial branch radiofrequency ablation outcomes in patients with centralized pain
Morffi, D., Larach, D. B., Moser, S. E., Goesling, J., Hassett, A. L., & Brummett, C. M. (2019) · Regional Anesthesia & Pain Medicine · doi:10.1136/rapm-2018-100275 · Cited by 10
Differences in Resilience Mechanisms and Physical Activity among Women Experiencing Chronic Pain with Higher or Lower Resilience
Brittain, D. R., Gyurcsik, N. C., Cary, M. A., Moser, E., & Davis, L. (2021) · Women s Health Issues · doi:10.1016/j.whi.2021.11.004 · Cited by 12
Trajectories of Physical Function and Disability Over 12 Months in Older Adults With Chronic Low Back Pain
Coyle, P. C., Pohlig, R. T., Knox, P. J., Pugliese, J. M., Sions, J. M., & Hicks, G. E. (2022) · Journal of Geriatric Physical Therapy · doi:10.1519/jpt.0000000000000365 · Cited by 10
“15,29,30 The Fear-Avoidance Beliefs Physical Activity Questionnaire (FABQ-PA) was used to measure pain-related fear of movement, where a higher score indicates more fear.”
Method
Short-Term Effects of Dry Needling with a Standard Exercise Program on Pain and Quality of Life in Patients with Chronic Mechanical Neck Pain
Almushahhim, M., Nuhmani, S., Joseph, R., Muslem, W. H. A., & Abualait, T. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11206167 · Cited by 10
“The NPRS ranges from 0 to 10 (0: minimum pain; 10: maximum pain) and is an effective tool for determining a patient’s pain intensity level [33].”
Method
Ultrasound‐guided percutaneous electrical nerve stimulation versus surgery for women with unilateral carpal tunnel syndrome: A randomized parallel‐group trial
Fernández‐de‐las‐Peñas, C., Ortega‐Santiago, R., De-la-Llave-Rincón, A. I., Cleland, J. A., Pareja, J. A., Díaz, H. F.-S., & Arias‐Buría, J. L. (2023) · European Journal of Pain · doi:10.1002/ejp.2117 · Cited by 10
“…experienced the preceding F I G U R E 2 Application of ultrasound- guided percutaneous electrical stimulation on the patient on the arm (a, b) and forearm (c, d) points. week were evaluated with an 11- point Numerical Pain Rating Scale (NPRS, 0: no pain; 10: maximum pain) (Jensen et al., 1999).”
Association between musculoskeletal pain and exposures to awkward postures during work: a compositional analysis approach
Lohne, F. K., Xu, K., Fimland, M. S., Palarea‐Albaladejo, J., & Redzovic, S. E. (2024) · Annals of Work Exposures and Health · doi:10.1093/annweh/wxae027 · Cited by 10
The Physical and Psychological Experience of Rowing the North Atlantic Solo and Unassisted
Alschuler, K. N., Whibley, D., Alberts, N. M., Kaylor, M. L., & Kratz, A. L. (2020) · Wilderness and Environmental Medicine · doi:10.1016/j.wem.2019.12.008 · Cited by 10
The Role of Fear-Avoidance Beliefs on Low Back Pain-Related Disability in a Developing Socioeconomic and Conservative Culture: A Cross-Sectional Study of a Pakistani Population
Khan, M. N. U., Morrison, N. M. V., & Marshall, P. W. (2020) · Journal of Pain Research · doi:10.2147/jpr.s258314 · Cited by 15
Refractory Chronic Pain and Obesity: Promising Implications for Multidisciplinary Pain Rehabilitation
Pudalov, L. R., Krause, S. J., Heinberg, L. J., & Hogue, O. (2021) · Pain Medicine · doi:10.1093/pm/pnab055 · Cited by 10
Perioperative oxidative stress predicts subsequent pain-related outcomes in the 6 months after total knee arthroplasty
Bruehl, S. P., Milne, G. L., Schildcrout, J. S., Shi, Y., Anderson, S., Shinar, A. A., Polkowski, G. G., Mishra, P., & Billings, F. T. (2022) · Pain · doi:10.1097/j.pain.0000000000002670 · Cited by 10
The Development and Validation of the Client Expectations of Massage Scale
Boulanger, K. T., Campo, S., Glanville, J. L., Lowe, J. B., & Yang, J. (2012) · International Journal of Therapeutic Massage & Bodywork Research Education & Practice · doi:10.3822/ijtmb.v5i3.176 · Cited by 10
“The validity and reliability of this type of rating scale has been supported(22).”
Background
A Randomized Controlled Trial of Patient-Controlled Valve Catheter and Indwelling Foley Catheter for Short-term Bladder Drainage
Kandadai, P., Dueñas-García, O. F., Pilzeck, A. L., Saini, J., Flynn, M. K., Leung, K., & Patterson, D. (2016) · Urogynecology · doi:10.1097/spv.0000000000000249 · Cited by 10
“We used the VAS score for pain to represent our primary outcome because VAS scores have also been shown to be reliable and valid in terms of evaluating both acute and chronic pain.(10,11) Although we were not powered to detect differences in the individual and composite QOL outcomes, we were able to appreciate that VC…”
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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