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The validity and reliability of pain measures in adults with cancer
Open accessAbstract
To be most useful, clinical trials of cancer pain treatments should use pain measures that are both reliable and valid. A great variety of measures are now available that may be used to assess cancer pain. However, there are not yet any clear guidelines for selecting one or more measures over the others. The purpose of this article is to summarize the evidence concerning the validity and reliability of cancer pain measures. One hundred sixty-four articles were identified that provided psychometric data of pain measures among patients with cancer. The results indicate that commonly used single-item ratings of pain intensity are all valid and adequately reliable as measures of pain intensity, although some scales appear to be easier for patients with cancer to understand and to use than others. Multiple-item measures of pain intensity are reliable, but evidence concerning their validity is lacking. There is a paucity of research examining the psychometric properties of measures of cancer pain interference, pain relief, pain site, the temporal aspects of pain, and pain quality. This lack of evidence limits the conclusions that may be drawn concerning the reliability and validity of these other pain measures. Composite measures that combine ratings of pain intensity and pain interference into a single score appear to be both valid and reliable for describing patient populations, although their usefulness in clinical trials may be limited because they can obscure the contributions of intensity and interference to the total score. Proxy measures of cancer pain (pain ratings made by someone other than the patient) may be useful when patients are not able to provide pain ratings, but they should not be used as replacements for patient ratings when patient self-report measures are available. The discussion includes specific recommendations for selecting from among the available pain measures, as well as recommendations for future research into the assessment of cancer pain.
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“In the context of pain, the NRS has been proven to have good reliability and validity [53,54]. It is a valid measure of pain intensity (0–10) that is less influenced by present mood state [55]”
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Li, H., Shi, X., Li, J., Zhang, X., & Li, F. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-07873-6 · Cited by 8
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“The Brief Pain Inventory (BPI) is one such multiple-item measure, and is the most commonly used validated pain assessment tool in cancer research [4].”
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Wirth, J. H., Sacco, D. F., Brown, M., & Okdie, B. M. (2021) · European Journal of Social Psychology · doi:10.1002/ejsp.2738 · Cited by 7
Cynotherapy in Cancer Pain Management: A Pilot Study
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Opioïdes et douleur chronique non cancéreuse : enjeux cliniques
Houle, M., & Raymond, M.-C. (2009) · Drogues santé et société · doi:10.7202/019626ar · Cited by 6
“En général, on considère qu’une réduction de l’intensité de la douleur, de l’ordre de 28 à 30 %, représente une analgésie cliniquement significative pour le patient (Farrar et coll., 2001 ; Jensen, 2003).”
Kifle, T. (2025) · The Journal of Economic Education · doi:10.1080/00220485.2025.2468969 · Cited by 6
“Similarly, single-item measures for pain assessment (Jensen 2003), visual analogue scales (De Boer et al. 2004), stress measurement (Littman et al. 2006), happiness assessment (Abdel-Khalek 2006), and usability evaluation (Christophersen and Konradt 2011) have all demonstrated validity and…”
Acupuncture in Multiple Myeloma Peripheral Neuropathy: A Systematic Review
Lyu, C., Xiao, H., Yin, X., Li, Z., Han, C., & Xu, R. (2024) · Journal of Pain Research · doi:10.2147/jpr.s448634 · Cited by 5
“24 The NPS is a multifaceted instrument that employs a self-reported visual analogue to delineate levels of pain intensity and its corresponding attributes.”
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Rhodes, J. R., Corlett, C. E., Jensen, M. P., & Patterson, D. R. (2024) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207144.2024.2433270 · Cited by 5
“Verbal descriptors used have been indicated to represent reasonable cutoffs for mild, moderate, and severe pain ratings (Jensen, 2003; Serlin et al., 1995).”
Self-citationNociception level index variations in patients with complex regional pain syndrome: a pilot study
Santella, T. M., Richebé, P., Godin, N., & Brulotte, V. (2022) · Journal of Clinical Monitoring and Computing · doi:10.1007/s10877-022-00835-z · Cited by 5
“However, these subjective scales may be less reliable under certain circumstances, especially in the chronic pain patient population where pain modulators are frequently encountered [3].”
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Pain Assessment Tools in Palliative Cancer Care
Hjermstad, M. J., Haugen, D. F., Bennett, M., & Kaasa, S. (2011) · Springer eBooks · doi:10.1007/978-1-4419-1651-8_6 · Cited by 5
Madadi, Z. A. A., Azimian, J., Falahatpishe, F., & Heidari, M. A. (2017) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20170165 · Cited by 5
Psychometric Evaluation of the Pain Attitudes Questionnaire-Revised for People With Advanced Cancer
Mah, K., Tran, K., Gauthier, L. R., Rodin, G., Zimmermann, C., Warr, D. G., Librach, S. L., Moore, M. J., Shepherd, F. A., & Gagliese, L. (2017) · Journal of Pain · doi:10.1016/j.jpain.2017.02.432 · Cited by 9
Pain Management and Antiemetic Therapy in Hematologic Disorders
Peterson, S. E., Selvaggi, K. J., Scullion, B. F., & Blinderman, C. D. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-35762-3.00091-3 · Cited by 5
Sass, D., Fitzgerald, W., Wolff, B. S., Torres, I., Pagán‐Mercado, G., Armstrong, T. S., Miaskowski, C. A., Margolis, L. B., Saligan, L. N., & Kober, K. M. (2022) · Frontiers in Genetics · doi:10.3389/fgene.2022.869044 · Cited by 5
“The NRS is a valid and reliable measure to assess pain in oncology patients (Jensen, 2003).”
BackgroundBryce, T. N., Ragnarsson, K. T., Stein, A., & Biering‐Sørensen, F. (2011) · Elsevier eBooks · doi:10.1016/b978-1-4377-0884-4.10055-2 · Cited by 5
Validation of the Rotterdam Elderly Pain Observation Scale in the Hospital Setting
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“The validity of the NRS has been confirmed in studies of patients with cancer (37,38).”
BackgroundLi, K. K., Chow, E., Chiu, H. H., Bradley, N., Doyle, M., Barnes, E. A., Tsao, M. N., Sinclair, E., & Danjoux, C. E. (2008) · Journal of Cancer Pain & Symptom Palliation · doi:10.1300/j427v02n03_03 · Cited by 5
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“A study was conducted to evaluate the NPRS’s reliability and found good reliability for both worst pain (r = 0.93) and average pain (r = 0.78) [18].”
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Dissanayaka, T. D., Farrell, M. J., Zoghi, M., Egan, G. F., & Jaberzadeh, S. (2018) · Somatosensory & Motor Research · doi:10.1080/08990220.2018.1505608 · Cited by 4
Risk factors associated with pain among community adults in Northwest China
Guo, J., Fu, M., Qu, Z., Wang, X., & Zhang, X. (2019) · Journal of Pain Research · doi:10.2147/jpr.s193773 · Cited by 4
Distress Tolerance in the Comorbid Chronic Pain and Opioid Use Disorder Population
Wilson, S. C., Shaffer, J. A., & Wachholtz, A. (2022) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000001106 · Cited by 4
The prevalence of undertreatment of cancer pain in a Nigerian teaching hospital
Makama, J., Stephen, G., Joshua, I. A., & Khalid, L. (2012) · Archives of International Surgery · doi:10.4103/2278-9596.101253 · Cited by 4
Lemańska, A., Cox, A., Kirkby, N. F., Chen, T., & Faithfull, S. (2014) · International Journal of Statistics in Medical Research · doi:10.6000/1929-6029.2014.03.04.10 · Cited by 4
“This method gave a more sensitive monitoring approach in comparison to the Likert scale [37, 38].”
MethodAI-based bi-modal fusion system for automated clinical pain monitoring
Wang, H., Nienaber, S., Dinges, L., & Al-Hamadi, A. K. (2025) · Computers in Biology and Medicine · doi:10.1016/j.compbiomed.2025.111260 · Cited by 6
Álvarez-Salvago, F., Gutiérrez-García, P., Molina-García, C., Atienzar‐Aroca, S., Jiménez‐García, J. D., Aibar‐Almazán, A., Martínez‐Amat, A., & Pujol-Fuentes, C. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08830-7 · Cited by 3
“The Visual Analogue Scale (VAS), which consistently demonstrated sensitivity to changes in cancer pain associated with treatment or time [24], is a 10 cm linear scale to assess subjective pain levels, ranging from 0 (no pain) to 10 (worst imaginable pain).”
Pain in Urology: The Good, the Bad, and the Ugly
Vranken, J. H. (2013) · Springer eBooks · doi:10.1007/978-1-4614-7363-3_14 · Cited by 3
van Woerden, V., Olij, B., Fichtinger, R. S., Lodewick, T. M., Coolsen, M. M. E., den Dulk, M., Heise, D., Damink, S. W. M. O., Dejong, C. H. C., Neumann, U. P., et al. (2022) · HPB · doi:10.1016/j.hpb.2022.03.005 · Cited by 3
PRO-Trauma: Protocolo para promoção do conforto às vítimas de trauma imobilizadas
Mota, M., Cunha, M., & Santos, M. R. (2021) · Enfermagem em Foco · doi:10.21675/2357-707x.2021.v12.n2.4529 · Cited by 3
“• Tratamento de dados: - Todas as análises serão realizadas com recurso ao IBM SPSS Statistics 25; - Realizar-se-á o teste - re-teste, e validade de critério, definida como a capacidade de detetar uma diferença no desconforto cumulativo ao longo do tempo.(9-11) • Questões Éticas: - Será solicitado parecer à Comissão d…”
Measuring symptoms and toxicities: a 35-year experience
Loprinzi, C. L., Novotny, P. J., Ruddy, K. J., Jatoi, A., Le‐Rademacher, J. G., Ehlers, S. L., Cathcart-Rake, E. J., & Lee, M. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-07958-2 · Cited by 3
Klejc, K., Cruz‐Almeida, Y., & Sheffler, J. (2024) · Journal of Pain Research · doi:10.2147/jpr.s451236 · Cited by 3
“The primary outcomes assessed in this study were pain intensity , or the “magnitude of experienced pain” and pain interference , or the degree at which pain interferes with daily activities such as physical, social, and emotional activities, 31,32 and patient global impression of change in pain .”
The assessment of cancer pain: measurement strategy
Anderson, K. O. (2001) · Cambridge University Press eBooks · doi:10.1017/cbo9780511642357.006 · Cited by 3
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“[10] Researches on the techniques which are simpler, noninvasive, economically feasible, and less time‐consuming and those which require minimal armamentarium at the site of the collection and a method to make chairside diagnosis possible would inculcate the possibility of routine cytodiagnosis.[7]”
BackgroundMethodAssessment of fatigue in palliative care
Loge, J. H. (2009) · CRC Press eBooks · doi:10.1201/b13272-78 · Cited by 3
Chou, Y.-H., Liao, S.-F., Chen, D., Chen, S., & Wang, W.-T. (2025) · Discover Oncology · doi:10.1007/s12672-025-01740-y · Cited by 2
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“VAS, Numerical Rating Scale (NRS), and Verbal Rating Scale (VRS) are the most commonly used unidimensional assessment tools which are valid and adequately reliable.[27-30] There is a nonlinear relationship between cancer pain severity and functional interference,[31] with mild pain = 1–4, moderate pain = 5–6, and seve…”
BackgroundTowards a Reliable Multimodal AI Monitoring System for Pain Detection and Quantification
Wang, H., Nienaber, S., Dinges, L., Jung, M., & Al-Hamadi, A. K. (2025) · Communications in computer and information science · doi:10.1007/978-3-032-00986-9_12 · Cited by 2
Reliability of the Brief Pain Inventory (BPI) in Patients with Bone Metastases
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Palmer, P. B., Wallace, K., Clay, D., Gill, C., & Moore, K. (2015) · Rehabilitation Oncology · doi:10.1097/01893697-201533010-00006 · Cited by 2
Dental approach of orofacial pain in head and neck cancer patients
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“The use of 0 to 100 mm VAS scale was explained for patient self-assessment (12, 13).”
MethodLee, Y., Chien, C., Lin, P., Lin, M., Wang, C., Lu, H., Chen, Y., & Hung, C. (2017) · doi:10.6696/ijhns.2017.0103.06 · Cited by 2
2013 Jin Shin Jyutsu® Patient Response
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Interpreting patient-reported outcomes in rheumatology
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What reliability can and cannot tell us about pain report and pain neuroimaging
Letzen, J. E., Boissoneault, J., Sevel, L. S., & Robinson, M. E. (2016) · Pain · doi:10.1097/j.pain.0000000000000546 · Cited by 2
“of pain that go well beyond simple measures of pain intensity.(2,4,5,7,8,13,15,17) It should be noted that the impetus for neuroimaging-based biomarker studies generated from the notion”
BackgroundTan, C. J., Timon, C. A., Stassen, L. F. A., Clark, R. A., Meldrum, D., Baily-Scanlan, M., & Broderick, J. M. (2020) · Rehabilitation Oncology · doi:10.1097/01.reo.0000000000000240 · Cited by 1
Rogers, A. H., Gallagher, M. W., & Zvolensky, M. J. (2023) · Psychology Health & Medicine · doi:10.1080/13548506.2023.2188229 · Cited by 2
“are widely used and accepted in clinical and research settings as having strong psychometric properties (Butt et al., 2008; Jensen, 2003; Mannion et al., 2014; Stinson et al., 2006).”
MethodFat grafting in breast surgery: a retrospective single-breast centre 6-year experience
Papadopoulos, S., Vidovic, G., Tio, J., Moysiadis, T., Lioupis, M., Athanasiadis, A. P., & Abdallah, A. (2024) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-024-07708-7 · Cited by 1
“…intense pain using a numeric rating scale (NRS) ranging from 0 (no pain) to 10 (worst possible pain), which is known for its high level of reliability and significant sensitivity to changes in pain intensity [7], with a raw score pain reduction that is comparable to percentage pain reduction [8].”
Howren, M. B., & Pagedar, N. A. (2024) · Otolaryngology · doi:10.1002/ohn.1066 · Cited by 1
The Pain System Is Not a Bodily Disturbance Detector
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“Under these conditions, we would detect a significant ability of immersive VR to affect the recall of painful stimuli experienced during their immersion.”
Factors affecting the influenza vaccination of high risk adults in Hawai'i.
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Medication Safety in Rehabilitation Medicine
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“The participants were asked to point their average level of pain within the past week, using an 11-point scale, ranging from 0 (no pain) to 10 (maximum pain) [16].”
MethodThe Overview of Pain in Cancer Patients
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The Supportive Care sCore (SCC): trigger alert validation study in solid tumours
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BackgroundResponse to letter by Mercadante
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BackgroundMethodOncogériatrie: évaluation et prise en charge de la douleur
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The development and evaluation of a palliative care admission assessment tool
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Cancer du sein : Approche traditionnelle de traitement en physiothérapie,
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Metadata
- Authors
- Jensen, M. P.
- Affiliations
- University of Washington (US)
- Corresponding author
- Jensen, Mark P.
- ORCID
- Jensen, Mark P.
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2003-02
- Volume
- 4
- Issue
- 1
- Pages
- 2-21
- ISSN
- 1526-5900 (ISSN-L)
- OpenAlex
- W1969092046
- Cited by
- 427
- References
- 28
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 18 · 2023: 10 · 2022: 13 · 2021: 26 · 2020: 18 · 2019: 12 · 2018: 24 · 2017: 20 · 2016: 18 · 2015: 22 · 2014: 25 · 2013: 30 · 2012: 31
- FWCI
- 10.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- cancer pain, pain assessment, psychometric properties, validity, reliability statistics, pain intensity, pain interference, analgesia, patient self-report, clinical trial outcome measures
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Female, Humans, Male, Middle Aged, Neoplasms, Pain, Pain Measurement, Reproducibility of Results
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