The validity and reliability of pain measures in adults with cancer.

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.

[1]  J. D. Mann,et al.  Relationship of pain drawing scores to ratings of pain description and function. , 1991, The Clinical journal of pain.

[2]  Gregory K Brown,et al.  Validation of hourly pain intensity profiles with chronic pain patients , 1991, Pain.

[3]  P. Major,et al.  Evaluation of glucosamine sulfate compared to ibuprofen for the treatment of temporomandibular joint osteoarthritis: a randomized double blind controlled 3 month clinical trial. , 2001, The Journal of rheumatology.

[4]  B. Jones,et al.  Spatial distribution of pain: A descriptive characteristic of chronic pain , 1983, Pain.

[5]  Jesse A. Berlin,et al.  Defining the clinically important difference in pain outcome measures , 2000, PAIN.

[6]  R. Epstein,et al.  Area under the curve: A metric for patient subjective responses in episodic diseases , 1995, Quality of Life Research.

[7]  J. Farrar,et al.  Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale , 2001, PAIN.

[8]  Katherine R. Edwards,et al.  When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function , 1995, Pain.

[9]  B. Rapkin,et al.  The measurement of symptoms in children with cancer. , 2000, Journal of pain and symptom management.

[10]  C. Cleeland,et al.  Pain assessment: global use of the Brief Pain Inventory. , 1994, Annals of the Academy of Medicine, Singapore.

[11]  D. Osoba,et al.  The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. , 1993, Journal of the National Cancer Institute.

[12]  D. F. Moore,et al.  Enzyme replacement therapy in Fabry disease: a randomized controlled trial. , 2001, JAMA.

[13]  R. B. Margolis,et al.  A rating system for use with patient pain drawings , 1986, Pain.

[14]  P. Mcgrath,et al.  Pain assessment in children and adolescents. , 2001 .

[15]  R. Portenoy,et al.  Management of cancer pain , 1999, The Lancet.

[16]  J. Lemerle,et al.  Pain in children aged 2–6 years: A new observational rating scale elaborated in a pediatric oncology unit — preliminary report , 1987, Pain.

[17]  B. Galer,et al.  Development and preliminary validation of a pain measure specific to neuropathic pain , 1997, Neurology.

[18]  J. Nunnally.  Psychometric Theory (2nd ed), New York: McGraw-Hill. , 1978 .

[19]  R. B. Margolis,et al.  Pain extent: relations with psychological state, pain severity, pain history, and disability , 1990, Pain.

[20]  A. Nachemson,et al.  Quantified Pain Drawing in Subacute Low Back Pain: Validation in a Nonselected Outpatient Industrial Sample , 1996, Spine.

[21]  P. Hinds,et al.  Measuring Pain in Pediatric Oncology ICU Patients , 1994, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses.

[22]  R. Melzack.  The McGill Pain Questionnaire: Major properties and scoring methods , 1975, PAIN.

[23]  R. Gracely.  Evaluation of multi-dimensional pain scales , 1992, Pain.

[24]  Ronald Melzack,et al.  The short-form McGill pain questionnaire , 1987, Pain.

[25]  C. Rodary,et al.  The development of the DEGRR: A scale to assess pain in young children with cancer , 1999, European journal of pain.

[26]  H. Thaler,et al.  The measurement of symptoms in young children with cancer: the validation of the Memorial Symptom Assessment Scale in children aged 7-12. , 2002, Journal of pain and symptom management.

[27]  P. Jacobsen,et al.  Assessment of acute pediatric pain: do child self-report, parent ratings, and nurse ratings measure the same phenomenon? , 1992, Pain.

[28]  N. Polissar,et al.  Implementing guidelines for cancer pain management: results of a randomized controlled clinical trial. , 1999, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.