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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Effect of Behavioral Activation Treatment on fibromyalgia-related pain anxiety cognition.
Lundervold, D. A., Talley, C., & Buermann, M. (2006) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100768 · Cited by 8
Reliability and Validity of Standing Back Extension Test for Detecting Motor Control Impairment in Subjects with Low Back Pain
Gondhalekar, G. A. (2016) · JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · doi:10.7860/jcdr/2016/14987.7142 · Cited by 8
Topographical Pressure Pain Sensitivity Maps of the Temporalis Muscle in People with Frequent Episodic and Chronic Tension‐Type Headache
Palacios‐Ceña, M., Castaldo, M., Wang, K., Madeleine, P., Peral, Á. L. G., Arendt‐Nielsen, L., & Fernández‐de‐las‐Peñas, C. (2017) · Pain Practice · doi:10.1111/papr.12565 · Cited by 8
“Subjects needed to report no more than 1 of the symptoms photophobia, phonophobia, or mild nausea, and no moderate or severe nausea or vomiting as requested by the ICHD-III diagnostic criteria.17 Patients were classified with FETTH when they suffered from at least 10 episodes of headache occurring on 1 to 14 days per…”
Background
A Prospective, Observational Trial Assessing the Efficacy of Abdominal Compression in Reducing Laparoscopic-Induced Shoulder Pain
Rettenmaier, M. A., Micha, J. P., Lopez, K. L., Wilcox, A. M., & Goldstein, B. H. (2017) · Surgical Innovation · doi:10.1177/1553350617718080 · Cited by 8
Oncology Section EDGE Task Force on Cancer: A Systematic Review of Clinical Measures for Pain
Harrington, S., Gilchrist, L. S., Lee, J. Y., Westlake, F., & Baker, A. (2018) · Rehabilitation Oncology · doi:10.1097/01.reo.0000000000000097 · Cited by 8
Associations of Arthritis‐Attributable Interference with Routine Life Activities: A Modifiable Source of Compromised Quality‐of‐Life
Theis, K. A., Brady, T. J., Helmick, C. G., Murphy, L. B., & Barbour, K. E. (2019) · ACR Open Rheumatology · doi:10.1002/acr2.11050 · Cited by 8
Effectiveness of a Program Combining Strengthening, Stretching, and Aerobic Training Exercises in a Standing versus a Sitting Position in Overweight Subjects with Knee Osteoarthritis: A Randomized Controlled Trial
Perez-Huerta, B. D., Díaz-Pulido, B., Pecos‐Martín, D., Beckwée, D., Lluch‐Girbés, E., Fernández-Matías, R., Rubio, M. J. B., & Gallego‐Izquierdo, T. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9124113 · Cited by 8
“Furthermore, it seems that higher exercise adherence is associated with improved physical function in overweight and obese older adults with knee OA [22].”
BackgroundResult
Oral and dental health status in patients undergoing neoadjuvant chemotherapy for locally advanced head and neck cancer
Dholam, K. P., Sharma, M. R., Gurav, S. V., Singh, G. P., & Prabhash, K. (2021) · Oral Surgery Oral Medicine Oral Pathology and Oral Radiology · doi:10.1016/j.oooo.2021.07.018 · Cited by 8
The Clinical Benefits of a Dynamic vs. Static Component as Part of a Comprehensive Warm-Up for Recreational Sports Players with Clinical Histories of Hamstring Injuries: A Randomized Clinical Trial
Gutiérrez-Coronado, J., López, L., Cardero‐Durán, M. D. L. Á., Cabello, M. A., Marhuenda, J. V. T., Hernández-Sánchez, S., Dueñas, L., Marqués‐Sulé, E., Morral, A., & Espejo-Antúnez, L. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010744 · Cited by 7
“Each subject rated the intensity of perceived pain at maximum extensibility in the AKE test on a straigh horizontal line of 100 mm length, where 0 was no pain and 100 was maximum pain [22].”
Method
Oxidative stress mediates associations between preoperative psychosocial phenotype and pain-related outcomes at 6 months following total knee arthroplasty: a longitudinal cohort study
Bruehl, S. P., Milne, G. L., Polkowski, G. G., Shinar, A. A., Anderson, S., Mishra, P., Larach, D. B., Martin, R., & Billings, F. T. (2023) · Pain Medicine · doi:10.1093/pm/pnad120 · Cited by 7
Exercise induced hypoalgesia during different intensities of a dynamic resistance exercise: A randomized controlled trial
Wilson, A. T., Pinette, J., Lyons, K. M., & Hanney, W. J. (2024) · PLoS ONE · doi:10.1371/journal.pone.0299481 · Cited by 7
The Contribution of Sleep Quality and Psychological Factors to the Experience of Within-Day Pain Fluctuations Among Individuals With Temporomandibular Disorders
Babiloni, A. H., Provost, C., Charlebois‐Plante, C., Koninck, B. P. D., Apinis-Deshaies, A., Beaumont, L. D., Lavigne, G. J., & Martel, M. O. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.104576 · Cited by 9
Physiotherapists’ treatment techniques in New Zealand for management of acute nonspecific low back pain and its relationships with treatment outcomes: a pilot study
Tumilty, S., Adhia, D. B., Rhodes, R., & Mani, R. (2017) · Physical Therapy Reviews · doi:10.1080/10833196.2017.1282073 · Cited by 7
Psychometric assessment of the Swedish version of the injustice experience questionnaire among patients with chronic pain
Lindqvist, E. A., Ljungvall, H., Zetterberg, L., Zetterberg, H., Bring, A., Tesséus, C. D. B., & Åsenlöf, P. (2021) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2020-0187 · Cited by 7
“conducting research on chronic pain [11], but also for tar-”
Assessing shoulder disability in orthopaedic specialist care: Introducing the Copenhagen Shoulder Abduction Rating (C-SAR)
Clausen, M. B., Witten, A., Christensen, K. B., Zebis, M. K., Foverskov, M., Cools, A. M. J., Hölmich, P., & Thorborg, K. (2022) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2022.102593 · Cited by 7
A Series of Remote Melatonin Supplement Interventions for Poor Sleep: Protocol for a Feasibility Pilot Study for a Series of Personalized (N-of-1) Trials
Butler, M. J., D’Angelo, S., Perrin, A., Rodillas, J., Miller, D., Arader, L., Chandereng, T., Cheung, Y. K., Shechter, A., & Davidson, K. W. (2023) · JMIR Research Protocols · doi:10.2196/45313 · Cited by 6
“Daily self-reported fatigue and pain ratings will be assessed via EMA using a measure adapted from the Numeric Pain Rating Scale [55].”
Effect of aquatic exercise versus standard care on paraspinal and gluteal muscles morphology in individuals with chronic low back pain: a randomized controlled trial protocol
Rosenstein, B., Montpetit, C., Vaillancourt, N., Dover, G. C., Khalini-Mahani, N., Weiss, C., Papula, L. A., Melek, A., & Fortin, M. (2023) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-023-07034-0 · Cited by 7
“The NPR has excellent reliability and validity, and can be used to identify statistical and clinically significant changes in perceived pain [61, 71].”
Background
Different measures, different outcomes? Survey into the effectiveness of chronic pain clinics in a London tertiary referral center
Shah, S., Bantel, C., Ho, A., Kuehler, B. M., Childs, S., Towlerton, G., & Goodall, I. (2015) · Journal of Pain Research · doi:10.2147/jpr.s80829 · Cited by 7
Depression According to ICD-10 Clinical Interview vs. Depression According to the Epidemiologic Studies Depression Scale to Predict Pain Therapy Outcomes
Fiegl, S., Lahmann, C., O’Rourke, T., Probst, T., & Pieh, C. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01862 · Cited by 7
“The Numeric Rating Scale is an often used self-rating instrument to measure pain intensity in chronic pain patients with a scale from 0 (no pain) to 10 (worst imaginable pain) (Joos et al., 1991; Jensen et al., 1999).”
Hip-Joint Posture and Movement Alterations Are Associated With High Interference of Pain in the Life of Patients With Greater Trochanteric Pain Syndrome
Peña, R. F., Calvo‐Lobo, C., Touche, R. L., & Fernández‐Carnero, J. (2020) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2019.04.012 · Cited by 8
Factors Associated with Recovered Functionality After Hip Fracture in Non-Institutionalized Older Adults: A Case-Control Study Nested in a Cohort
Ramírez‐García, E., de la Torre, G. S. G., Reyes, E. J. R., Moreno-Tamayo, K. M., Espinel‐Bermúdez, M. C., & Sánchez‐García, S. (2021) · Clinical Interventions in Aging · doi:10.2147/cia.s320341 · Cited by 7
Jet-Induced Blood Release From Human Fingertips: A Single-Blind, Randomized, Crossover Trial
Xu, J., McKeage, J. W., Ruddy, B. P., Nielsen, P. M. F., & Taberner, A. J. (2021) · Journal of Diabetes Science and Technology · doi:10.1177/19322968211053895 · Cited by 7
Altered muscle strength and flexibility among a subgroup of women with chronic nonspecific low back pain: Cross-sectional case-control study
Vatandoost, S., Sheikhhoseini, R., Akhbari, B., Salavati, M., Pourahmadi, M., Farhang, M., & O’Sullivan, K. (2022) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2022.2043497 · Cited by 7
Validity and reliability of the Spanish-language version of the self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale
López‐de‐Uralde‐Villanueva, I., Gil‐Martínez, A., Candelas-Fernández, P., Ares, J. D. A., Beltrán-Alacreu, H., & Touche, R. L. (2018) · Neurología (English Edition) · doi:10.1016/j.nrleng.2016.10.003 · Cited by 7
Sensitization-associated and neuropathic-associated symptoms in patients with unilateral lateral elbow tendinopathy: an exploratory study
Cancela‐Cilleruelo, I., Rodríguez‐Jiménez, J., Fernández‐de‐las‐Peñas, C., Arendt‐Nielsen, L., & Arias‐Buría, J. L. (2023) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2023.2264384 · Cited by 7
“A 10-point Numeric Pain Rating Scale (NPRS) (0: no pain, 10: maximum pain) was used to assess the current and the worst level of elbow pain experienced in the preceding week while at rest (Jensen, Turbner, Romano, and Fisher, 1999).”
The Impact of Pain on the Quality of Life of People with Multiple Sclerosis:
Douglas, C., Wollin, J. A., & Windsor, C. A. (2009) · International Journal of MS Care · doi:10.7224/1537-2073-11.3.127 · Cited by 7
Examination and physical therapy management of a young gymnast with bilateral wrist pain: A case report
Boucher, B., & Smith-Young, B. (2017) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2017.03.002 · Cited by 7
Adding Physical Impairment to Risk Stratification Improved Outcome Prediction in Low Back Pain
Beneciuk, J. M., & George, S. Z. (2020) · Physical Therapy · doi:10.1093/ptj/pzaa179 · Cited by 7
Body Composition Asymmetries in University Ice Hockey Players and Their Implications for Lower Back Pain and Leg Injury
Resta, T., Frenette, S., Rizk, A., & Fortin, M. (2022) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000004328 · Cited by 7
Assessment of manual dysfunction in occupationally active women with carpal tunnel syndrome
Wolny, T., Linek, P., & Saulicz, E. (2019) · International Journal of Occupational Medicine and Environmental Health · doi:10.13075/ijomeh.1896.01263 · Cited by 7
Psychological and Behavioral Assessment
Seng, E. K., Kerns, R. D., & Heapy, A. A. (2013) · Elsevier eBooks · doi:10.1016/b978-0-323-08340-9.00016-5 · Cited by 7
Biopsychosocial contributors to irritability in individuals with shoulder or low back pain
Wilson, A. T., Hanney, W. J., Richardson, R. M., Klausner, S. H., & Bialosky, J. E. (2023) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2023.2294679 · Cited by 6
“Pain intensity was measured with a 101-point numerical pain rating scale (NPRS) where 0=no pain and 100=worst pain imaginable [28,29].”
The Effect of Physical Therapy on Somatosensory Tinnitus
Yu, H., Gong, J., Hong, G.-W., Zhou, R., Fu, X.-P., Fan, T., Zheng, Y., Peng, Y., Li, J., & Wang, Y. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13123496 · Cited by 6
“The numerical pain rating scale (NPRS: 0 = no pain, 10 = maximum pain) was used to assess the intensity of somatic spasm pain [41].”
Method
Effectiveness of a novel multicomponent treatment in women with fibromyalgia: A randomized clinical trial
Araya‐Quintanilla, F., Álvarez‐Bueno, C., Cavero‐Redondo, I., Ramírez‐Vélez, R., Sepúlveda‐Loyola, W., & Gutiérrez‐Espinoza, H. (2024) · British Journal of Pain · doi:10.1177/20494637241293760 · Cited by 7
“20,21 A previous study showed that a decrease of 2.0 points in the NPRS could be considered a minimal clinically important difference.”
Influential
History of chronic pain and opioid use is associated with cognitive decline and mild cognitive impairment
Bell, T. R., Elman, J. A., Gustavson, D. E., Lyons, M. J., Fennema‐Notestine, C., Williams, M. E., Panizzon, M. S., Pearce, R. C., Reynolds, C. A., Sanderson‐Cimino, M. E., et al. (2025) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617725101057 · Cited by 6
“…high internal consistency ( α range: .88 – .91) and strong correlations with comprehensive pain scales like the Brief Pain Inventory and McGill Pain Questionnaire ( r range: .76 – .79), supporting their construct validity (Gandek et al., 2004; Jensen et al., 1999; Ware & Sherbourne, 1992).”
Exploring the Underlying Mechanisms of Action of Dry Needling
Meulemeester, K. D., Calders, P., & Cagnie, B. (2021) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000001732 · Cited by 6
“Subjects had to score their neck pain at that moment on an 11-point NRS ranging from 0 (no pain) to 10 (worst pain).(28) Pain scores were also asked by text messages 1, 2, and 7 days after treatment.”
Method
A Series of Personalized Virtual Light Therapy Interventions for Fatigue: Feasibility Randomized Crossover Trial for N-of-1 Treatment
Butler, M. J., D’Angelo, S., Ahn, H., Chandereng, T., Miller, D., Perrin, A., Romain, A.-M. N., Scatoni, A., Friel, C. P., Cheung, Y. K., et al. (2023) · JMIR Formative Research · doi:10.2196/45510 · Cited by 6
“Symptoms of fatigue were also assessed via EMA using a measure adapted from the Numeric Pain Rating Scale [44].”
Method
Effects of Adding Four Sessions of Ultrasound-Guided Percutaneous Electrical Nerve Stimulation to an Exercise Program in Patients with Shoulder Pain: A Randomized Controlled Trial
Valenzuela-Rios, C., Arias‐Buría, J. L., Rodríguez‐Jiménez, J., Palacios‐Ceña, M., & Fernández‐de‐las‐Peñas, C. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13113171 · Cited by 6
“In this case, between-group mean change scores, but not their 95% confidence intervals, slightly surpassed the MCID of 1.1 points for shoulder pain [26], supporting that the clinical relevance of PENS is small with the current dosage.”
BackgroundMethodInfluential
Understanding the Associations between Executive Function and Psychological Variables in Fibromyalgia Syndrome: A Network Analysis Approach
Pacho-Hernández, J. C., Fernández-Palacios, F. G., Tejera-Alonso, Á., Fernández‐de‐las‐Peñas, C., Varol, U., Valera‐Calero, J. A., Fernández-Méndez, L. M., & Cigarán‐Méndez, M. (2024) · Healthcare · doi:10.3390/healthcare12161678 · Cited by 6
“A 10-point (0: no pain, 10: maximum pain) Numerical Pain Rate Scale (NPRS) was used to evaluate the mean pain intensity [29].”
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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