Carol S. Burckhardt and Kim D. Jones. MCGILL PAIN QUESTIONNAIRE (MPQ) General Description. Administration. Scoring MEASURES OF PAIN. Other uses. None.

Transcription

1 Arthritis & Rheumatism (Arthritis Care & Research) Vol. 49, No. 5S, October 15, 2003, pp S96 S104 DOI /art , American College of Rheumatology MEASURES OF PAIN Adult Measures of Pain The McGill Pain Questionnaire (MPQ), Rheumatoid Arthritis Pain Scale (RAPS), Short-Form McGill Pain Questionnaire (SF-MPQ), Verbal Descriptive Scale (VDS), Visual Analog Scale (VAS), and West Haven-Yale Multidisciplinary Pain Inventory (WHYMPI) Carol S. Burckhardt and Kim D. Jones MCGILL PAIN QUESTIONNAIRE (MPQ) Purpose. To measure the different qualities of the subjective experience (1). Content. Three classes of words (total of 78) that describe the sensory, affective and evaluative aspects of, and a 5-point intensity scale (present intensity [PPI]). Developer/contact information. Ronald Melzack, PhD, Department of Psychology, Stewart Biology Building, McGill University, Montreal, Quebec, Canada H3A 2K6. rmelzack@ego.psych. mcgill.ca. Versions. English, French, German, Swedish, Norwegian, Danish, Arabic, Italian, and Japanese. Number of items in scale. There are 20 subclasses, each containing 2 6 words, and 1 intensity scale consisting of 1 item. Subscales. Pain Rating Index (PRI) contains 4 subscales (sensory, affective, evaluative, and a miscellaneous category). Populations. Developmental/target. Developed for use in adult populations with a variety of chronic problems. Carol S. Burckhardt, RN, PhD, Kim D. Jones, RN, PhD: Oregon Health and Science University, Portland. Address correspondence to Carol S. Burckhardt, RN, PhD, School of Nursing SN-5N, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR burckhac@ohsu.edu. Submitted for publication July 28, 2003; accepted July 30, Other uses. None. WHO ICF Components. Body function. Method. The respondent is given the questionnaire with the words grouped into 20 subclasses. An interviewer then instructs respondents to choose 1 word from each subclass if a word within that class fits their present. If no word fits, then no word should be chosen from that subclass. The interviewer defines any words that the respondent does not understand. Training. The interviewer must be able to define each word. Time to administer/complete minutes. Equipment needed. Pencil and paper. Cost/availability. The MPQ is available at no cost from the author. Also available on line at by paying a membership fee. Responses. Scale. Each word within the PRI has an assigned value based on its placement within the subclass. The PPI is a 5-point scale. Score range. Scores on the PRI can range from 0 to 20 words chosen (number of words chosen [NWC]), 0 78 for the total score based on rank value. Scores on the PPI can range from 0 to 5. Interpretation of scores. The PRI is interpreted both in terms of quantity of as evidenced by the number of words used and the rank values of the words, as well as the quality of as evidenced by the particular words that are S96

2 Adult Pain S97 selected. A meta-analysis (2) concluded that normative scores across ful conditions range from 24 to 50% of the maximum scores. Method of scoring. The MPQ is scored by hand by first counting the number of words used to obtain a total word score (number of words chosen). Then the rank values of the words chosen are summed to give a total PRI score and scores on each of the 4 subscales. The PPI is scored by noting the number-word combination chosen by the respondent. Time to score. 1 2 minutes. Training to score. None. Reliability. Retest over 3 to 7 days showed that respondents tended to choose the same words in the PRI and report the same PPI level. Validity. Content. Validity is indicated by respondents tendency to use all 20 subclasses of words. Work by Burckhardt (3) found that patients used similar sets of words to describe their and that a substantial affective dimension underlies their responses. Papageorgiou and Badley (4) found that MPQ words differentiated 4 different circumstances of rheumatoid (i.e., overall at rest, overall on movement, joint at rest, and joint on movement). The number of words chosen correlated significantly with a visual analog scale (VAS) score. Sensitivity/responsiveness to change. Early work by Melzack (1) indicated that the MPQ was sensitive to change as a result of biofeedback or hypnotic training. Language versions other than English may not match exactly the words on the original English version. Therefore, one must be cautious about comparing populations across language and cultural groups. The MPQ requires a fairly sophisticated vocabulary and may not be appropriate for low literacy respondents. Research on both adults and children indicates that there may be sex and ethnic differences in the selection of descriptors (5,6). 1. (Original) Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1975;1: Wilkie DJ, Savedra MC, Holzemer WL, Tesler MD, Paul SM. Use of the McGill Pain Questionnaire to measure : a meta-analysis. Nurs Res 1990;39: Burckhardt CS. The use of the McGill Pain Questionnaire in assessing. Pain 1984; 19: Papageorgiou AC, Badley EM. The quality of in : the words patients use to describe overall and in individual joints at rest and on movement. J Rheumatol 1989;16: Seymour RA, Charlton JE, Phillips ME. An evaluation of dental using visual analog scales and the McGill Pain Questionniare. J Oral Maxillofac Surg 1983;41: Tesler M, Savedra M, Ward J, Hoszemer WL, Wilkie DJ. Children s language of. In: Dubner R, Gebhart GF, Bond MR, editors. Pain research and clinical management. Amsterdam:Elsevier; p RHEUMATOID ARTHRITIS PAIN SCALE (RAPS) Purpose. Measurement of in adults with rheumatoid (1). Content. There are 24 items that measure descriptions of, severity, and interference. These items constitute the RAPS scale. There is also 1 numerical rating scale of severity, and 1 total joint score rated by a physician that were used as measures against which the RAPS was validated and are part of the clinical evaluation but not part of the RAPS. Developer/contact information. Diana L. Anderson, PhD, Rheumatology Research International, 5939 Harry Hines Boulevard, Suite 545, Dallas, TX (214) Versions. One version, American English original. Number of items in scale. There are 24 items. Subscales. There are 4 subscales: physiologic, affective, sensory-discriminative, and cognitive. Populations Developmental/target. Adults with rheumatoid. Other uses. None.

3 S98 Burckhardt and Jones WHO ICF Components. Body function, Body structure, Impairment, Activity limitation. Method. Self-administered, paper and pencil test. Training. None, self-explanatory. Subjects should be given the questionnaire and asked to complete it. Time to administer/complete. Approximately 5 minutes. Equipment needed. Paper and pencil. Cost/availability. Available from the author. Copy available at the Arthritis Care & Research Web site at jpages/ :1/suppmat/index.html. Responses. Scale. RAPS has a 0 6 point scale anchored by 0 always and 6 never. The Numerical Rating Scale (NRS) has a 0 10 point scale anchored by 0 none to 10 severe. Score range. RAPS can range from 0 to 144 with a lower score indicating more. NRS scale range is 0 10 with a higher score indicating more. Interpretation of scores. The RAPS is a new instrument. No cut-off points or critical score points have been established. Method of scoring. RAPS score is calculated by adding up the scores on each item. Time to score. 1 2 minutes. Training to score. Minimal, self-explanatory. Training to interpret. Minimal, self-explanatory. Reliability. Cronbach s alpha for the total RAPS was Item to total correlations range from 0.3 to 0.7. Subscale alpha coefficients ranged from 0.64 to Validity. Concurrent criterion. Correlation between the RAPS and the modified VAS (NRS) was 0.67 and between the RAPS and total joint count Construct. A factor analysis indicated that 3 of the 4 conceptual subscales are present in the instrument. The affective subscale did not appear as a separate factor. Sensitivity/responsiveness to change. No data available. This is a new instrument designed specifically to measure the physiological, affective, sensorydiscriminative and cognitive aspects of rheumatoid. Further use of the instrument is needed to determine its usefulness. Reference 1. (Original) Anderson DL. Development of an instrument to measure in rheumatoid : Rheumatoid Arthritis Pain Scale (RAPS). Arthritis Rheum (Arthritis Care Res) 2001;45: SHORT-FORM MCGILL PAIN QUESTIONNAIRE (SF-MPQ) Purpose. To measure the different qualities of the subjective experience using a shorter, less time-consuming version of the MPQ. Content. Contains 15 words from the original MPQ. There are 11 sensory words and 4 affective words. Developer/contact information. Ronald Melzack, PhD, Department of Psychology, Stewart Biology Building, McGill University, Montreal, Quebec, Canada H3A 2K rmelzack@ego.psych.mcgill.ca. Versions. English. Validated versions in French and Swedish. Number of items in scale. There are 15 words in the Pain Rating Index (PRI), 1 item present intensity (PPI), 1 item visual analog scale (VAS). Subscales. There are 2 subscales (sensory and affective) within the PRI. Populations. Developmental/target. Adult populations with chronic. Other uses. None.

4 Adult Pain S99 WHO ICF Components. Body function. Method. Self-administered by questionnaire. Training. None. Time to administer/complete. 2 5 minutes. Equipment needed. Pencil and paper. Cost/availability. Available from the author at no cost. Responses. Scale. Each word in the PRI is rated on a 4-point scale from 0 (none) to 3 (severe). Score range. Score for the questionnaire can range from 0 to 45 on the PRI, from 0 to 5 on the PPI, and from 0 to 10 centimeters on the VAS. Interpretation of scores. No established cutpoints or other critical score points. Method of scoring. Items on the PRI are added up to form a total score. Time to score. One minute. Training to score. None. Reliability. Correlations between the short and long forms ranged between 0.67 and 0.87 in 2 groups of patients with either post-surgical or dental (1). Internal consistency reliability was 0.73 to 0.89 in repeated testing of rheumatoid and fibromyalgia patients (2). Validity. Content. Content validity has been described in a study of adult patients with postoperative who used exact SF-MPQ sensory or affective words or synonyms during an interview to describe their (3). Convergent construct. Convergent construct validity was demonstrated by significant correlations between the Short Form and other measurements. A principal components analysis showed that the 15-item descriptor section had 3 distinct factors: acute sensory, chronic sensory and affective (2). A more recent factorial validity study indicated that the scale has two factors consistent with the original conceptual structure (4). Sensitivity/responsiveness to change. SF-MPQ was sensitive to change in 3 groups of patients given different types of analgesia: epidural anesthetic for labor, transcutaneous nerve stimulation for musculoskeletal, and analgesic drugs for post-surgical (1). The SF-MPQ is a reliable and valid instrument that is easier and quicker to use in clinical research than the MPQ. One study (2) found the Short Form more content valid for patients with fibromyalgia than for those with rheumatoid. 1. (Original) Melzack R. The short-form McGill Pain Questionnaire. Pain 1987;30: Burckhardt CS, Bjelle A. A Swedish version of the Short-form McGill Pain Questionnaire. Scand J Rheumatol 1994;23: McDonald DD, Weiskopf CS. Adult patients postoperative descriptions and responses to the Short-Form McGill Pain Questionnaire. Clin Nurs Res 2001;10: Wright KD, Asmundson GJG, McCreary DR. Factorial validity of the short-form McGill questionnaire (SF-MPQ). Eur J Pain 2001;5: VERBAL DESCRIPTIVE SCALE (VDS) Purpose. Measurement of severity (1). Content. The scale consists of one item with numbers, each of which has a verbal descriptor (e.g., no, slight, mild, moderate, severe, very severe, the most intense imaginable). Developer/contact information. Unknown, in the public domain. Versions. The number of verbal descriptors may vary. Number of items in scale. One. Subscales. Not applicable. Populations. Developmental/target. Numerous adult populations.

5 S100 Burckhardt and Jones Other uses. None. WHO ICF Components. Body function. Method. Self-administered by questionnaire. Respondents are asked to circle the number next to the descriptor that most accurately describes their at the present time. Training. None. Time to administer/complete. One minute. Equipment needed. Pencil and paper. Cost, availability. None. Can be readily devised by the researcher. Available in PDF format at the following site: whitepapers/hospiceinltc/appendix-a.pdf. Responses. Scale. The response scale is in continuous numbers. Score range. Usual range is 0 5 or 0 7. Interpretation of scores. Higher scores reflect greater. Method of scoring. The number circled by the respondent is entered. Time to score. One minute. Training to score. None. Reliability. A study of 66 literate patients with rheumatoid showed a high test-retest reliability coefficient (r 0.90) before and after a regular clinic visit. Illiterate patients (n 25) had test-retest correlation coefficients of 0.82 (2). Validity. Correlations between the VDS and VAS are in the range of (3). Sensitivity/responsiveness to change. The VDS is sensitive to change as a result of both drug and non-drug treatments. As with the VAS, the researcher must determine from previous research in the area what constitutes a clinically important change. VDS is considered easier than the VAS for some groups to score and more reliable to interpret. A variation of this scale uses only numbers (numeric rating scale) with verbal anchors at either end. It may be the most reliable for lowliteracy populations. The RAPS contains a point numerical scale. The Health Assessment Questionnaire (HAQ) includes a numeric rating scale from 0 to (Original) Keefe KD. The chart. Lancet 1948;2: Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Reliability of scales in the assessment of literate and illiterate patients with rheumatoid. J Rheumatol 1990;18: Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies in rating scales. Ann Rheum Dis 1978;37: Additional Machin D, Lewith GT, Wylson S. Pain measurement in randomized clinical trials: a comparison of two scales. Clin J Pain 1988;4: Reading AE. A comparison of rating scales. J Psychosomatic Res 1980;24: Scott J, Huskinsson EC. Graphic representation of. Pain 1976;2: VISUAL ANALOG SCALE (VAS) Purpose. Measurement of severity (1). Content. The scale consists of one horizontal or vertical line, usually 10 centimeters in length, that is anchored with verbal descriptors of no and as bad as it could be. Developer/contact information. Unknown. In the public domain. Versions. Slight differences in the verbal end points are seen in the literature. The instructions may vary by asking respondents to rate their severity at different time points. Number of items in scale. One. Subscales. Not applicable.

6 Adult Pain S101 Populations. Developmental/target. Used in numerous adult populations. WHO ICF Components. Body function. Method. Self-administered by questionnaire. Respondents are asked to place a line perpendicular to the VAS line at the point that best indicates their at the present time. Training. None required. Time to administer/complete. One minute. Equipment needed. Pencil and paper. The VAS is also available as a plastic slide ruler and on colored cards that can be given to the respondent. Cost/availability. None. Researchers can easily create their own VAS. Available in PDF format at the following site: whitepapers/hospiceinltc/appendix-a.pdf. Responses. Scale. A numeric continuous scale with the higher score usually anchored with a severe descriptor so that a higher score indicates more. Score range. Range is Scored in millimeters, although scores are often recorded in tenths of centimeters (10-point scale). Interpretation of scores. Commonly a score below 40 millimeters (or 4 if recorded in centimeters) is considered desirable for chronic management. Method of scoring. A metric ruler is placed along the line with the 0 end of the ruler at the 0 (no ) end of the scale. The point along the ruler that corresponds to the line the respondent has placed on the VAS indicates the score for that respondent. Time to score. One minute. Training to score. Ability to measure using a metric ruler. Reliability. A study of 66 literate patients with rheumatoid, showed a high test-retest reliability coefficient (r 0.93) before and after a regular clinic visit. Illiterate patients (n 25) had test-retest correlation coefficients of 0.71 (2). Validity. Correlations between the VAS and a verbal descriptor scale are in the range of (3). VAS scales have been compared in both vertical and horizontal formats. They are highly correlated although in one study the scores from horizontal scales tended to be slightly lower than those from vertical scales (4). Sensitivity/responsiveness to change. The VAS is sensitive to change in drug and non-drug clinical trials. The researcher must determine what a clinically important change would be. The researcher should be careful to determine whether the VAS is appropriate for the population being studied and that the population being tested understands the concept of marking along a nonverbal line. Some elderly persons, low-literacy populations, and cultural groups do not conceptualize in this manner. The Numerical Rating Scale (NRS) is a variation of the VAS scale where each 10 millimeters on the scale is given a number and the respondent is asked to choose a number, such as the NRS following the RAPS scale. Other variations on the VAS include different size lines. The VAS may also be used as a verbal analog scale in which the respondent is told to anchor no as a 0 and worst possible or other descriptor as a 10 or 100, and then asked to give current a number rating between the two extremes. 1. Keefe KD. The chart. Lancet 1948;2: Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Reliability of scales in the assessment of literate and illiterate patients with rheumatoid. J Rheumatol 1990;18: Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies in rating scales. Ann Rheum Dis 1978;37: Scott J, Huskisson EC. Vertical or horizontal visual analogue scales. Ann Rheum Dis 1979;38:560. Additional Reference Machin D, Lewith GT, Wylson S. Pain measurement in randomized clinical trials: a comparison of two scales. Clin J Pain 1988;4:161 8.

7 S102 Burckhardt and Jones WEST HAVEN-YALE MULTIDIMENSIONAL PAIN INVENTORY (WHYMPI) Purpose. To describe and how it affects the individual (1). Content. Scales to measure severity and interference of, as well as individual responses to and impact on daily activities. Developer/contact information. Robert D. Kerns, PhD, Psychology Service (116B), VA Connecticut Healthcare System, West Haven, CT Versions. Original version is in English. There are validated versions in German, Swedish, and Dutch. A significant-other version has been developed by Kerns and Rosenberg (2). Number of items in scale. Original version has 52 items divided into 3 parts, experience, significant others responses to communications of, and participation in common daily activities. Subscales. There are 12 subscales: interference, support, severity, self-control, negative mood, punishing responses, solicitous responses, distracting responses, household chores, outdoor work, activities away from home, and social activities. Populations. Developmental/target. Developed on an adult male, veteran population with chronic (low back, rheumatoid ). Other uses. Female and geriatric. WHO ICF Components. Body function, Participation restriction, Activity limitation. Method. Self-administered. Training. None required. Time to administer/complete minutes. Equipment needed. Pencil and paper. Cost/availability. Available from the first author. The WHYMPI is available from the quality of life instrument database at (requires a membership fee). Responses. Scale. Each item is rated on a 0 6- point scale with anchors that fit the item. Each subscale score is derived from the sum of the individual items in the subscale divided by the number of items in the subscale to yield a mean score. Score range. Range is 0 6. Interpretation of scores. Higher scores on the subscales of interference and severity indicate more and interference with life. No cutoff points or critical score points have been established. Method of scoring. Calculate total scores and divide by the number of items. Time to score. Five minutes. Training to score. None. Reliability. Internal consistency reliability coefficients for all the subscales ranged from Test-retest correlations ranged from for a 2-week period. Validity. The original research indicated that the WHYMPI had a 4-factor structure. Construct validity was estimated from correlations between the 4 factors and 9 well-known and established scales. The affective distress dimension correlated highly with measures such as the Beck Depression Inventory. The support from significant others dimension correlated with marital satisfaction. The severity and interference dimension correlated with the McGill Pain Questionnaire. The activity level dimension correlated moderately with the Multidimensional Health Locus of Control Scale. Sensitivity/responsiveness to change. Two studies (2,3) showed that the WHYMPI was sensitive to change as a result of treatment. Recent evidence suggests that the WHYMPI may be useful in predicting which patients will develop chronic (4). Some recent psychometric work (5) suggests that item-factor discrimination may be lacking for

8 Adult Pain S103 several items. Nonetheless, these researchers also suggest that changes to the WHYMPI would be premature at present. The WHYMPI can be used to classify individuals into dysfunctional, interpersonally distressed, or adaptive coping categories. These categories have shown some utility for tailoring treatment strategies (6). The WHYMPI is a useful instrument for capturing the multidimensionality of the chronic experience. 1. (Original) Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985;23: Kerns RD, Rosenberg R. Pain-relevant responses from significant others: development of a significantother version of the WHYMPI scales. Pain 1995;61: Flavell HA, Carrafa GP, Thomsa CH, Disler PB. Managing chronic back : impact of an interdisciplinary team approach. Med J Aust 1996; 165: Olsson I, Bunketorp O, Carlsson SG, Styf J. Prediction of outcome in whiplash-associated disorders using West Haven-Yale Multidimensional Pain Inventory. Clin J Pain 2002;18: Riley JL III, Zawacki TM, Robinson ME, Geisser ME. Empirical test of the factor structure of the West- Haven-Yale Multidimensional Pain Inventory. Clin J Pain 1999;15: Turk DC, Okifuji A, Sinclair JD, Starz TW. Differential responses by psychosocial subgroups of fibromyalgia syndrome patients to an interdisciplinary treatment. Arthritis Care Res 1998;11: Additional Reference Bernstein IH, Jaremko ME, Hinkley BS. On the utility of the West Haven-Yale Multidimensional Pain Inventory. Spine 1995;20:

9 S104 Burckhardt and Jones Summary Table for Adult Pain Measures Measure/scale Content Measure outputs No. of items Response format Method of administration Time for administration Validated populations Reliability Validity Responsiveness Evaluation McGill Pain Questionnaire (MPQ) Rheumatoid Arthritis Pain Scale (RAPS) Short-Form McGill Pain Questionnaire (SF-MPQ) Verbal Descriptor Scale (VDS) Visual Analog Scale (VAS) West Haven-Yale Multidimensional Pain Inventory (WHYMPI) Verbal qualities of the subjective experience 24 items. Descriptors of, severity, and interference Qualities of the subjective experience using words taken from the longer MPQ A one-item scale with numbers, each of which has a verbal descriptor One horizontal or vertical line Scales to measure severity and interference of as well as individual s responses to and impact on daily activities. 20 subclasses of words divided into 4 subscales: sensory, affective, evaluative, miscellaneous 4 subscales: Physiologic, Affective, Sensorydiscriminative, Cognitive 2 subscales: sensory (11 words); affective (4 words) 78 Respondent selects one word from each of the 20 subclasses. Each word has an associated value based on its placement within its subclass 24 Subscales: Physiologic (5); Affective (4); Sensorydiscriminative (9); Cognitive (6) 15 items in the Pain Rating Index; 1 Present Pain Intensity item; 1 VAS 7-point rating scale anchored with 0 (always) to 6 (never) Self or interview 5 15 minutes Adults with chronic including Self 5 minutes Adults with rheumatoid Same as the MPQ Self 5 minutes Adults with chronic including fibromyalgia and rheumatoid Pain severity Self 1 minute Adults with Pain severity Self 1 minute Adults with including 12 subscale scores (number of items in parentheses) Interference (9); Support (3); Pain severity (3); Self-control (2); Negative mood (3); Punishing responses (4); Solicitous responses (6); Distracting responses (4); Household chores (5); Outdoor work (5); Activities away from home (4); Social activities (4) 52 0 to 6 point scale Self 5 10 minutes Adult, male, veterans with chronic low back or rheumatoid Good Test-retest reliabilityover 3 to 7 days showed that individuals tended to choose the same words. Internal consistency reliability: 0.91 for the total scale; between 0.64 and 0.84 for the subscales. Good Content validity indicated by respondents tendency to use all 20 subclasses of words. Preliminary, Good Concurrent criterion validity: correlations between RAPS and total joint count (r 0.52); between RAPS and visual analog scale (r 0.67). Good Good High correlations between the short form and the original MPQ Psychometric properties are similar to the VAS. Test-retest reliability high Correlations between the VAS and a verbal descriptive scale range from 0.70 to 0.75 Reliability: range from 0.70 to 0.90 for the 12 subscales Test-retest correlations: for a 2-week period Good Responsiveness indicated by changes in number or words after biofeedback The MPQ is an excellent instrument for assisting individuals to describe their and noting changes in sensory and affective dimensions as a result of treatment. It is lengthy and requires respondents to have a good vocabulary if selfadministered Unknown This is a new scale with potential usefulness. The author suggests that more work needs to be done to confirm the factor structure and to develop a normative profile Fair Sensitive to change in patients treatment with different types of analgesia Adequate for use in fibromyalgia and some other chronic groups, but lacks content validity in rheumatoid sample This scale is an excellent way to measure severity and is considered easier to use than the VAS. VAS is sensitive to change in both drug and nondrug clinical trials Construct validity using factor analysis found a 4-factor solution of affective distress, support severity, activity level dimensions This is an excellent way to rate severity if a simple method is desired and the target population understands the concept of a visual line for rating. Good The WHYMPI has been used extensively in chronic populations and is considered acceptable