Measures for the Assessment of Pain in Adults

An overview is provided regarding some of the most commonly used measures to assess pain in adults. These measures are appropriate for both general and rheumatologic pain populations. Most measures are easy to use in clinical settings and all are validated for use in research. A number of well-known measures such as the Visual Analog Scale, Numeric Rating Scale, McGill Pain Questionnaire, and the Short Form 36 bodily pain subscale were described in a previous issue (1). Pain is complex, and thus it is important to conduct a comprehensive assessment. Here, we discuss several other measures that are helpful for assessing the severity, location, and quality of pain as well as pain-related interference in functioning. Further, knowing whether the pain is
focal (ie, isolated to one area of the body) or more widespread can indicate the degree to which the pain is centralized in nature (2–5) and thus inform the treatment approach to the care of rheumatology patients. However, the assessment of pain (location, severity, and quality) and its impact on functioning cannot possibly tell the full story. Pain is a biopsychosocial phenomenon in which thoughts, emotions, and behavior contribute significantly to pain perception and pain outcomes. Although it is beyond the scope of this review to discuss all the possible contributing and potentially ameliorating factors and their measurement, a comprehensive assessment of pain for interdisciplinary treatment could also include an assessment of underlying pain mechanisms, the perceived meaning of the pain, the level of pain acceptance, pain coping strategies, pain-related behavioral avoidance and/or fear (eg, kinesiophobia),
and even resilience factors, including high levels of positive affect, strong social support, internal locus of control, and a sense of purpose in life.
Questionnaires presented here include the pain severity and pain interference subscales from the Brief Pain Inventory (BPI), the Defense and Veterans Pain Rating Scale (DVPRS), the Michigan Body Map (MBM), the painDETECT questionnaire (PD-Q), the Patient-Reported Outcomes Measurement Information SystemPain Interference (PROMIS-PI) scales, and ambulatory assessment of pain intensity, including the use of Ecological Momentary Assessment and daily pain diaries. The description of ambulatory assessments deviates from that of the other measures, given that this methodology diverges from the standard patient-reported outcome format. This form of pain measurement, however, is becoming the gold standard and, as such, is critical for clinicians and researchers to understand. Please see Tables 1 and 2 for an overview of psychometrics and practical applications, respectively. The importance of considering other co-occurring symptoms such as sleep, mood, and fatigue will be described briefly, although their measurement will be covered in other sections of this special edition. More comprehensive measures of functional status are also described in other sections of this issue. respectively.