A validation of the pain interference index in adults with long-standing pain
Open accessAbstract
BACKGROUND: Chronic pain is a major health problem and more knowledge is needed regarding the interference of pain on behaviors in different life domains. Clinically useful and statistically sound pain interference measures are highly important. Studies on youths have shown that the Pain Interference Index (PII) is a reliable and valid instrument that is sensitive to change following behavioral treatment. This measure may also have utility for adults, but no study has so far evaluated the statistical properties of the PII for long-standing pain in adults. METHODS: Data were collected from 239 consecutive adults with non-specific chronic pain referred to a tertiary pain clinic. We investigated the factor structure of items using a principal component analysis. Cronbach's alpha was calculated to assess internal consistency. The questionnaire's ability to predict levels of, e.g., disability was analyzed by means of regression analyses. RESULTS: Analyses illustrated the adequacy of a one-factor solution with six items. Cronbach's alpha (0.85) suggested a satisfactory internal consistency among items. The PII explained significant amounts of variance in pain disability, physical, and mental health-related quality of life and depression, suggesting concurrent criteria validity. CONCLUSION: The PII is a brief questionnaire with reliable and valid statistical properties to assess pain interference in adults. Other studies support the reliability and validity of PII for use with youths, and now the PII can be used to analyze the influence of pain on behaviors across age groups. Potentially, the PII can also be used as an outcome measure in clinical trials.
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The Pain Interference Index has been developed in Swedish for chronic pain populations and has shown good internal consistency and concurrent validity.
“PII has been developed in Swedish for chronic pain populations, has shown good internal consistency and concurrent validity (Kemani et al., 2016).”
From Internet-delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1-year follow-up (2021) · cites this paper as Kemani et al., 2016
The Discussion (page unavailable) reports satisfactory internal consistency and adequate concurrent criterion validity in adults with long-standing pain. The Participants section says questionnaires were administered in Swedish, and the paper describes an English version validated separately, but our copy does not establish that the PII was originally developed in Swedish. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe negative influence of pain on behaviours affecting everyday life is usually conceptualized as pain interference.
“The negative influence of pain on behaviours affecting everyday life is usually conceptualized as pain interference (Kemani et al., 2016).”
From Internet-delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1-year follow-up (2021) · cites this paper as Kemani et al., 2016
The psychometric evaluation of the PII supported a single factor structure and showed satisfactory internal consistency (Cronbach's alpha = 0.85).
“The psychometric evaluation of the instrument [18] supported a single factor structure and showed satisfactory internal consistency, indicated by a Cronbach’s alpha of 0.85.”
From Baseline Pro-Inflammatory Cytokine Levels Moderate Psychological Inflexibility in Behavioral Treatment for Chronic Pain (2022) · cites this paper as [18]
ACT does not primarily target pain intensity or related symptoms, but rather the influence of pain on a person's daily life.
“ACT does not primarily target pain intensity or related symptoms, but rather the influence of pain on a person’s daily life [11], as assessed by, e.g., The Pain Interference Index (PII) [18].”
From Baseline Pro-Inflammatory Cytokine Levels Moderate Psychological Inflexibility in Behavioral Treatment for Chronic Pain (2022) · cites this paper as [18]
The PII explained a significant amount of variance in pain disability, health-related quality of life and depressive symptoms, indicating adequate concurrent criterion validity.
“Furthermore, results from this study also showed that PII explained a significant amount of variance in pain disability, health-related quality of life and depressive symptoms, indicating adequate concurrent criterion validity.”
From Baseline Pro-Inflammatory Cytokine Levels Moderate Psychological Inflexibility in Behavioral Treatment for Chronic Pain (2022) · cites this paper as [18]
Chronic pain often impacts mood, sleep, physical activities, social relations, and work.
“Chronic pain often impacts mood, sleep, physical activities, social relations and work (Breivik et al., 2006;Dworkin et al., 2005;Kemani et al., 2016;Miller & Cano, 2009).”
From Internet-delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1-year follow-up (2021) · cites this paper as Kemani et al., 2016
Baseline characteristics such as pain intensity and pain duration correspond with those of previous research using participants recruited from pain clinics.
“However, baseline characteristics in the present study such as pain intensity and pain duration correspond with those of previous research using participants recruited from pain clinics [38, 45, 48].”
From ACTsmart: Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain—A Pilot Trial. (2021) · cites this paper as [45]
The Pain Interference Index (PII) is a six-item questionnaire measuring pain interference in adults over the last 2 weeks, with a one-factor structure and satisfactory internal consistency (Cronbach's α = 0.85) in the original validation study.
“The PII is a six-item questionnaire measuring pain interference in adults in the last 2 weeks. The 6-point Likert scale ranges from “not at all” to “very much,” with lower scores indicating lower interference. In the original validation study [45], the instrument showed a one-factor structure and satisfactory internal consistency (Cronbach’s α = 0.85).”
From ACTsmart: Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain—A Pilot Trial. (2021) · cites this paper as [45]
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Self-citation
- Authors
- Kemani, M. K., Zetterqvist, V., Kanstrup, M., Holmström, L., & Wicksell, R. K.
- Affiliations
- Karolinska University Hospital (SE)
- Linköping University (SE)
- Corresponding author
- Kemani, M. K.
- Venue
- Acta Anaesthesiologica Scandinavica
- Publisher
- Wiley
- Published
- 2015-08-27
- Volume
- 60
- Issue
- 2
- Pages
- 250-258
- ISSN
- 0001-5172 (ISSN-L)
- 1399-6576
- OpenAlex
- W1888129392
- Cited by
- 23
- References
- 22
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 4 · 2019: 3 · 2016: 1 · 2015: 1
- FWCI
- 0.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Anaesthesiologica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kommunfullmäktige, Stockholms Stad
- Karolinska Institutet
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- chronic pain, pain interference, adults, psychometric validation, factor structure, internal consistency, pain-related disability, health-related quality of life, depression
- MeSH terms
- Adult, Depression, Female, Humans, Male, Middle Aged, Pain Measurement, Quality of Life, Principal Component Analysis, Chronic Pain
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