Long-term outcomes after surgical and nonsurgical management of chronic pelvic pain: one year after evaluation in a pelvic pain specialty clinic. Assessing chronic pain in general practice: Are guidelines relevant? A cluster randomized controlled trial Comparison of clinical and evoked pain measures in fibromyalgia. Postsurgical pain outcome assessment Intravaginal electrical stimulation for the treatment of chronic pelvic pain. Comparative Responsiveness of Pain Outcome Measures Among Primary Care Patients With Musculoskeletal Pain Use of intravaginal electrical stimulation for the treatment of chronic pelvic pain: a randomized, double-blind, crossover clinical trial. A comparison of pain-assessment tools for use with elderly long-term-care residents. Comparative Responsiveness of the PROMIS Pain Interference Short Forms, Brief Pain Inventory, PEG, and SF-36 Bodily Pain Subscale Implementation of cancer pain guidelines by acute care nurse practitioners using an audit and feedback strategy Protocol for the development of a core outcome set for pelvic girdle pain, including methods for measuring the outcomes: the PGP-COS study Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale Premature Infant Pain Profile: development and initial validation. The development and preliminary validation of the Profile of Chronic Pain: Extended Assessment Battery Determining the effectiveness of a clinical‐practice intervention in improving the control of pain in outpatients with cancer Comparison of Pain Measures in Surgical Patients Comparing the psychometric properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) instruments.
OBJECTIVE The purpose of this study was to describe long-term outcomes for women with chronic pelvic pain ( CPP ) after evaluation in a CPP specialty clinic . STUDY DESIGN This was a prospect i ve observational cohort study of women treated for CPP at the UNC Pelvic Pain clinic between 1993 and 2000 . The primary outcome was improvement in pain and the main exposure was treatment group : primarily medical ( pharmacotherapy , psychotherapy , physical therapy , or combinations of the 3 ) or surgical ( hysterectomy , resection or ablative procedures , oophrectomy , diagnostic surgery , pain mapping , vulvar or vestibular repair ) . Univariate , bivariate , and multivariable analyses were performed to look for relationships between background characteristics , treatment group , and improvement in pain . RESULTS Of 370 participants ; 189 had surgical treatment and 181 had medical treatment . One year after evaluation , 46 % reported improvement in pain and 32 % improvement in depression . Improvement in pain was similar in both treatment groups and odds of improvement were equal even after adjusting for background characteristics , psychosocial comorbidity , and previous treatments . CONCLUSION One year after evaluation in a CPP specialty clinic , women experienced modest improvements in pain and depression after recommended surgical or nonsurgical treatment Objectives : To evaluate the impact of using pain assessment scales on the management of musculoskeletal chronic pain . Methods : Cluster-r and omized controlled multicentre trial in French general practice setting s. Practice s were r and omized by region before patient recruitment . The inclusion concerned patients suffering from musculoskeletal chronic pain . General practitioners assigned to the scale group used two vali date d assessment instruments ; those assigned to the control group cared for their patients according to their usual practice . The primary end-point was the level of relief obtained and the secondary changes in prescription of painkilling modalities . Results : A total of 155 general practitioners included 772 successive patients suffering from musculoskeletal chronic pain . The control group reported a mean level of relief of 50.7 % compared with one of 41.1 % in the scale group ( p<0.0001 ) . In the intervention group , physicians decreased significantly their prescription of  level two painkillers .  Conclusions . In general practice , the use of pain assessment scales is not associated with greater pain relief . The lesser level of pain relief obtained in the scale group does provide evidence that using pain assessment scales does not enhance the relief of chronic pain in patients in primary care . Guidelines which recommend the systematic use of scales for the assessment and monitoring of chronic pain are not tailored to either the context or the patients encountered in the primary care setting UNLABELLED Evoked pain measures such as tender point count and dolorimetry are often used to determine tenderness in studies of fibromyalgia ( FM ) . However , these measures frequently do not improve in clinical trials and are known to be influenced by factors other than pain such as distress and expectancy . The purpose of this investigation was to determine whether evoked pain paradigms that present pressure stimuli in a r and om fashion ( eg , Multiple R and om Staircase [ MRS ] ) would track with clinical pain improvement in patients with FM better than traditional measures . Sixty-five subjects enrolled in a r and omized clinical trial of acupuncture were observed longitudinally .  Clinical pain was measured on a 101-point numerical rating scale ( NRS ) and the Short Form McGill Pain Question naire ( SF-MPQ ) , whereas evoked pressure sensitivity was assessed via manual tender point count , dolorimetry , and MRS methods . Improvements in clinical pain and evoked pain were assessed irrespective of group assignment . Improvement was seen in clinical pain during the course of the trial as measured by both NRS ( P = .032 ) and SF-MPQ ( P = .001 ) . The MRS was the only evoked pain measure to improve correspondingly with treatment ( MRS , P = .001 ; tender point count and dolorimeter , P > .05 ) . MRS change scores were correlated with changes in NRS pain ratings ( P = .003 ) ; however , this association was not stronger than tender point or dolorimetry correlations with clinical pain improvement ( P > .05 ) . Pain sensitivity as assessed by r and om paradigms was associated with improvements in clinical FM pain . Sophisticated pain testing paradigms might be responsive to change in clinical trials . PERSPECTIVE Trials in fibromyalgia often use both clinical and experimental methods of pain assessment ; however , these two outcomes are often poorly correlated . We explore the relationship between changes in clinical and experimental pain within FM patients .  Pressure pain testing that applies stimuli in a r and om order is associated with improvements in clinical pain , but this association was not stronger than other experimental techniques & NA ; Reliable and valid measures of pain are essential for conducting clinical trials of pain treatments . Perhaps the most important aspect of a pain measure 's validity is its sensitivity , or ability to detect changes in pain over time and due to treatment . Several factors may affect a measure 's sensitivity , including the complexity of the rating task for the measure , the number of pain intensity levels assessed by the measure , the dimension of pain assessed ( e.g. pain intensity vs. pain relief ) , and the number of individual ratings ( e.g. single rating vs. composite score ) used to create the measure . The purpose of this study was to compare the relative sensitivity of three measures of outcome and a composite made up of all three measures for detecting analgesic effects in two sample s of persons participating in a r and omized controlled trial . One hundred and twenty‐three patients who had undergone knee surgery and 124 women who had undergone a laparotomy were given one of three medications in the day after their surgery : morphine , ketorolac , or placebo . Two measures of pain intensity ( a visual analog scale ( VAS ) and a 4‐point verbal rating scale ( VRS ) ) were administered at baseline , and these measures plus a 5‐point VRS of pain relief were administered at 16 additional time points up to 24 h following surgery . As predicted , we found variability in the sensitivity of the outcome measures used in these studies , with the 4‐point VRS showing less sensitivity than the VAS or relief ratings . However , contrary to our prediction , a composite measure of outcome made up of all three measures was not consistently superior to the individual measures for detecting treatment effects . Finally , we found that pain relief ratings were related to , but also distinct from , change in pain intensity as measured by changes in pain intensity ratings from baseline to each postmedication assessment point . These findings have important implication s for the assessment of pain in clinical trials OBJECTIVE To evaluate the efficacy of intravaginal electrical stimulation in women with chronic pelvic pain ( CPP ) . STUDY DESIGN Between May 2002 and February 2004 , 24 women with CPP with no apparent cause were evaluated . They underwent 10 sessions of intravaginal electrical stimulation . A program for measuring chronic diffuse pain , with a frequency of 8 Hz , variation in intensity and frequency , pulse length of 1 msec , and adjustment to the bearable intensity of each individual patient ( in milliamps ) was utilized . Treatment consisted of 30-minute applications , 2 or 3 times per week , and the pain was evaluated using a visual analog scale before and after each session and immediately after completion of the total treatment . The women were asked to evaluate the pain 2 weeks , 4 weeks and 7 months following the end of treatment . RESULTS Intravaginal electrical stimulation was effective in alleviating pain in women with CPP , as evaluated at the end of treatment and 2 weeks , 4 weeks and 7 months after completion of treatment ( p<0.05 ) . There were significantly fewer complaints of dyspareunia following treatment ( p = 0.0005 ) . CONCLUSION Intravaginal electrical stimulation is effective in the alleviation of pain in women with CPP Background : Comparative responsiveness data are needed to inform choices about pain outcome measures . Objectives : To compare responsiveness of pain intensity , pain-related function , and composite measures , using data from a r and omized trial and observational study . Research Design : Analysis of responsiveness . Subjects : A total of 427 adults with persistent back , hip , or knee pain were recruited from primary care . Methods : Participants completed  Brief Pain Inventory , Chronic Pain Grade ( CPG ) , Rol and disability ,  SF-36 bodily pain  , and pain global rating of change measures . We used the global rating as the anchor for st and ardized response mean and receiver operating characteristic curve analyses . We used the distribution-based st and ard error of measurement to estimate minimally important change . To assess responsiveness to the trial intervention , we evaluated st and ardized effect size statistics stratified by trial arm . Results : All measures were responsive to global improvement and all had fair-to-good accuracy in discriminating between participants with and without improvement . SF bodily pain was less responsive than other measures in several analyses . The 3-item PEG was similarly responsive to full Brief Pain Inventory scales . CPG and SF bodily pain were less responsive to the trial intervention and did not perform well among participants with hip/knee pain . Agreement between anchor and distribution-based methods was modest . Conclusions : If a brief measure is desired , the 3-item PEG is more responsive than the SF bodily pain scale . CPG and SF bodily pain scales may be relatively poor choices for trial outcome assessment . Both anchor and distribution-based methods should be considered when determining clinical ly important change OBJECTIVE To assess the efficacy of intravaginal electrical stimulation ( IVES ) or placebo in women with chronic pelvic pain ( CPP ) with no apparent cause . STUDY DESIGN A double-blind , crossover , r and omized clinical trial in which 26 women were r and omly allocated to active ( group I , n = 15 ) or placebo ( group II , n = 11 ) IVES . All women underwent 10 30-minute , twice-weekly sessions . The groups were then crossed over for a further 10 sessions . Pain was evaluated using a visual analog scale ( VAS ) before and after each series . RESULTS At the end of the first series , 5 of 11 women who initiated with the placebo had a VAS pain score > 3 ( p = 0.0253 ) ; however , when they crossed over to active IVES , only 1 had a VAS pain score > 3 at the end of the series ( p = 0.0143 ) . In the 15 women who initiated with active IVES , 2 had a score > 3 at the end of the series ( p = 0.0005 ) ; however , when they crossed over to the placebo , 3 had a VAS pain score > 3 at the end of treatment ( p = 0.0833 ) . After the 2 sessions , 54.6 % who initiated with placebo and 80 % who initiated with active IVES had a VAS pain score < 3 . CONCLUSION Intravaginal electrical stimulation was more effective than a placebo in alleviating pain in women with CPP The purpose of this study was to examine the psychometric properties ( test-retest and interrater reliability , criterion concurrent validity ) of 3 verbal pain- assessment tools ( Faces Pain Scale , Numerical Rating Scale , Present Pain Intensity Scale )  and a behavioural pain- assessment scale for use with an elderly population . The study used a repeated- measures design to examine the reliability and validity of the tools across 4 groups of participants with varying levels of cognitive impairment using a non-r and om stratified sample of 130 elderly long-term-care residents . The findings support the test-retest and interrater reliability of the  behavioural pain- assessment tool  across all levels of cognitive impairment , whereas the same measures of reliability for the verbal-report tools decreased with increasing cognitive impairment ; however , the majority of elderly with mild to moderate cognitive impairment were able to complete at least 1 of these tools . The findings are discussed in relation to their clinical and research implication Purpose : To compare the sensitivity to change and the responsiveness to intervention of the PROMIS Pain Interference short forms , Brief Pain Inventory ( BPI ) , 3-item PEG scale , and SF-36 Bodily Pain subscale in a sample of patients with persistent musculoskeletal pain of moderate severity . Methods : St and ardized response means , st and ardized effect sizes , and receiver operating curve analyses were used to assess change between baseline and 3-month assessment s in 250 participants who participated in a r and omized clinical effectiveness trial of collaborative telecare management for moderate to severe and persistent musculoskeletal pain . Results : The BPI , PEG , and SF-36 Bodily Pain measures were more sensitive to patient-reported global change than the PROMIS Pain Interference short forms , especially for the clinical ly improved group , for which the change detected by the PROMIS short forms was not statistically significant . The BPI was more responsive to the clinical intervention than the SF-36 Bodily Pain and PROMIS Pain Interference measures . Post hoc analyses exploring these findings did not suggest that differences in content or rating scale structure ( number of response options or anchoring language ) adequately explained the observed differences in the detection of change . Conclusions : In this clinical trial , the BPI and PEG measures were better able to detect change than the SF-36 Bodily Pain and PROMIS Pain Interference measures Purpose : Despite the availability of clinical practice guidelines ( CPGs ) for cancer pain , consistent integration of these principles into practice has not been achieved . The optimal method for implementing CPGs and the impact of guidelines on healthcare outcomes remain uncertain . This study evaluated the effect of an audit and feedback ( A/F ) intervention on  nurse  practitioner ( NP ) implementation of cancer pain CPGs and on hospitalized patients ' self‐report of pain and satisfaction with pain relief . Data sources : Eight NPs and two groups of 96 patients were the sources of data . Eligible patients in both groups completed the Brief Pain Inventory‐Short Form ( BPI‐SF ) within 24 h of admission and every 48 h until discharge . During A/F , NPs received weekly feedback on pain scores and guideline adherence . Conclusions : Nurse practitioner adherence to CPGs increased during A/F. Pain intensity did not significantly differ between groups . Intervention group patients reported significantly less overall pain interference ( p < .0001 ) , interference with general activity ( p = .0003 ) , and sleep ( p = .006 ) . Satisfaction with pain relief increased from 68.4 % to 95.1 % during A/F ( p < .0001 ) . Implication s for practice : A/F is an effective strategy to promote CPG use . Improved functional status in the absence of decreased pain severity underscores the need to consider symptom clusters when study ing pain Background Pelvic Girdle Pain ( PGP ) is an important cause of disability and economic cost worldwide . There is a need for effective preventative and management strategies . Emerging studies measure a variety of outcomes rendering synthesis and translation to clinical practice difficult . A Core Outcome Set ( COS ) can address this problem by ensuring that data are relevant , useful and usable for making well-informed healthcare choices . The aim of this study is to develop a consensus-based PGP-COS , including agreement on methods ( e.g. instruments ) for measuring the construct outcomes in the COS for use in research and clinical practice . Furthermore , as there is uncertainty as to whether incorporating stakeholder interviews in addition to conducting a systematic review to determine an initial list of outcomes for the Delphi survey , or , whether using different rating scales in a Delphi survey impacts on the final COS , we propose to embed two method ological studies within the PGP-COS development process to address these questions . Methods The PGP-COS study will include five phases : ( 1 ) A systematic review of the literature and semi-structured interviews with 15 patients ( three countries ) to form the initial list of outcomes for the Delphi survey ; ( 2 ) A 3-round Delphi including patients , clinicians , research ers and service providers ; ( 3 ) A systematic review of methods for measuring the outcomes in the preliminary PGP-COS identified in the Delphi survey ; ( 4 ) A face-to-face consensus meeting to agree on the final PGP-COS and methods for measuring the COS ; ( 5 ) Global dissemination . To address the method ological questions , we will assess the number and type of outcomes , in the final PGP-COS , that were exclusively derived from the interviews . Secondly , we will r and omise Delphi survey participants to either a 5-point or 9-point importance rating scale , and examine potential differences in ‘ important ’ ratings between the groups . Discussion There is currently no COS for measuring/monitoring PGP in trials and clinical practice . A PGP-COS will ensure that relevant outcomes are measured using appropriate measurement instruments for patients with PGP globally . Core outcome set registration This PGP-COS was registered with COMET ( Core Outcome Measures for Effectiveness Trials ) in January 2017 ( http://www.comet-initiative.org/ studies /details/958 ) & NA ;  Pain intensity is frequently measured on an 11‐point pain intensity numerical rating scale ( PI‐NRS ) , where 0=no pain and 10=worst possible pain . However , it is difficult to interpret the clinical importance of changes from baseline on this scale ( such as a 1‐ or 2‐point change ) . To date , there are no data driven estimates for clinical ly important differences in pain intensity scales used for chronic pain studies . We have estimated a clinical ly important difference on this scale by relating it to global assessment s of change in multiple studies of chronic pain . Data on 2724 subjects from 10 recently completed placebo‐controlled clinical trials of pregabalin in diabetic neuropathy , postherpetic neuralgia , chronic low back pain , fibromyalgia , and osteoarthritis were used . The studies had similar design s and measurement instruments , including the PI‐NRS , collected in a daily diary , and the st and ard seven‐point patient global impression of change ( PGIC ) , collected at the endpoint . The changes in the PI‐NRS from baseline to the endpoint were compared to the PGIC for each subject . Categories of ‘ much improved ’ and ‘ very much improved ’ were used as determinants of a clinical ly important difference and the relationship to the PI‐NRS was explored using graphs , box plots , and sensitivity/specificity analyses . A consistent relationship between the change in PI‐NRS and the PGIC was demonstrated regardless of study , disease type , age , sex , study result , or treatment group . On average , a reduction of approximately two points or a reduction of approximately 30 % in the PI‐NRS represented a clinical ly important difference . The relationship between percent change and the PGIC was also consistent regardless of baseline pain , while higher baseline scores required larger raw changes to represent a clinical ly important difference . The application of these results to future studies may provide a st and ard definition of clinical ly important improvement in clinical trials of chronic pain therapies . Use of a st and ard outcome across chronic pain studies would greatly enhance the comparability , validity , and clinical applicability of these studies OBJECTIVE Inadequate assessment of  pain in premature infants is a persistent clinical problem . The objective of this research was to develop and vali date a measure for assessing pain in premature infants that could be used by both clinicians and research ers . DESIGN The  Premature Infant Pain Profile ( PIPP ) was developed and vali date d using a prospect i ve and retrospective design . Indicators of pain were identified from clinical experts and the literature . Indicators were retrospectively tested using four existing data sets . PATIENTS AND SETTING S Infants of varying gestational ages undergoing different painful procedures from three different setting s were utilized to develop and vali date the measure . METHODS AND RESULTS The largest data set ( n = 124 ) was used to develop the PIPP . The development process included determining the factor structure of the data , developing indicators and indicator scales and establishing internal consistency . The remaining three data sets were utilized to establish beginning construct validity . CONCLUSIONS The PIPP is a newly developed pain assessment measure for premature infants with beginning content and construct validity . The practicality and feasibility for using the PIPP in clinical practice will be determined in prospect i ve research in the clinical setting & NA ; The aim of the present research was the development and validation of a set of instruments , collectively called the Profile of Chronic Pain : Extended Assessment Battery ( PCP : EA ) , design ed to be administered to adults ( between the ages of 25 to 80 ) after establishing the existence of a chronic pain problem . The final 86‐item version of the PCP : EA consisted of 33 single items assessing : pain location and severity , pain characteristics ( e.g. worst daily pain ) , medication use , health care status , the identity of the most important person in the patient 's life , and functional limitations in 10 areas of daily living . In addition , the PCP : EA includes 13 multi‐item subscales addressing aspects of coping ( guarding , ignoring , task persistence , and positive self‐talk ) , catastrophizing , pain attitudes and beliefs ( including disability beliefs , belief in a medical cure for pain , belief in pain control , and pain‐induced fear ) , and positive ( tangible and emotional ) and negative ( insensitivity and impatience ) social responses . Data were obtained from two national sample s which were recruited and screened via a r and om‐digit dialing telephone interview procedure . Stratified sampling was employed to assure equal gender and age group representation across three age groupings ( 25–44 ; 45–64 ; 65–80 ) . Two survey studies provided strong evidence for the hypothesized factor structure , internal consistency , independence from response bias , and validity of the PCP : EA . Moreover , the presence of normative data enhance the diagnostic and prescriptive utility of the instrument PURPOSE : To determine the effectiveness of a clinical - practice intervention in improving the control of pain in out patients with cancer . METHOD : Between July 5 and September 30 , 1995 , a r and omized , controlled trial of 510 cancer out patients and 13 oncologists was conducted at 23 clinics in Indiana . All the patients completed assessment s of their pain , their pain regimens , and the degrees of relief received ; they were surveyed again by mail four weeks after their clinic visits . The intervention group 's clinical charts contained a summary of the completed pain scales ; the oncologists who treated these patients were instructed to review the summary sheet prior to an evaluation . This summary was not available for the oncologists treating the patients in the control group . Each patient 's pain management index ( PMI ) was calculated : the patient 's pain medication level was rated on a scale of 0 to 3 ; the patients 's pain level was rated on a scale of 0 to 3 and then subtracted from the first rating . A negative PMI was interpreted as representing insufficient treatment . Data were analyzed with several statistical tests . RESULTS : In all , only 320 patients who reported cancer-related pain were used in the analysis : 160 to 260 in the control group and 160 of 250 in the intervention group . The groups were similar with respect to demographics , cancer sites , and performance status . A significant difference ( p = .0162 ) in the physicians ' prescription patterns was found . In the control group , prescriptions for 86 % of the patients did not change , with no decrease in analgesic prescriptions ; for 14 % of the patients analgesic prescriptions increased . In the intervention group , analgesic prescriptions changed for 25 % of the patients , decreasing for 5 % and increasing for 20 % . A decrease in the incidence of pain described as more than life 's usual aches and pains was found for the intervention group ( p = .05 ) . No significant difference was found between the groups for the patients undertreated for pain , as measured by PMIs . CONCLUSION : Although analgesic regimens were altered significantly when the physicians understood more about the patient 's pain , cancer pain management remains a complex problem . Future studies should focus on the long-term systematic incorporation of simple pain- assessment tools into daily outpatient oncology practice s as well as on innovative ways to address other aspects of managing cancer pain Numerous instruments have been developed for the measurement of pain with various clinical population s. This study was design ed to compare pain measures for research in a sample of postoperative patients . The  Brief Pain Inventory-Short Form ( BPI-SF ) was administered along with the Short-Form McGill Pain Question naire ( SF-MPQ ) and two visual analogue scales , one for pain while at rest ( VAS-R ) and one for pain upon movement ( VAS-M ) , in r and om order , to 115 hospitalized patients twice following their surgery . An additional 29 patients completed the instruments once . Correlations between the visual analogue scales , BPI-SF , and SF-MPQ ranged from .33 to .76 ( p < .01 ) , suggesting that the instruments measure different aspects of pain and that instructions can influence the results . Recommendations for the selection of pain measures in patients experiencing acute pain and for future research are described OBJECTIVE To examine and compare the psychometric properties of two common observational pain assessment tools used in persons with dementia . DESIGN In a cross-sectional descriptive study nursing home ( NH ) residents  were videotaped at rest and during a structured movement procedure . Following one training session and one practice session , two trained graduate nursing research assistants independently scored the tapes using the two pain observation tools . SETTING Fourteen NHs in Western Washington State participating in a r and omized controlled trial of an intervention to enhance pain assessment and management .  PARTICIPANTS Sixty participants with moderate to severe pain were identified by nursing staff or chosen based on the pain items from the most recent Minimum Data Set assessment . MEASURES  Checklist of Nonverbal Pain Indicators ( CNPI ) and the Pain Assessment in Advanced Dementia ( PAINAD ) , demographic and pain-related data ( Minimum Data Set ) , nursing assistant reports of participants ' usual pain intensity , and Pittsburgh Agitation Scale . RESULTS Internal consistency for both tools was good except for the CNPI at rest for one rater . Inter-rater reliability for pain presence was fair ( K = 0.25 for CNPI with movement ; K = 0.31 for PAINAD at rest ) to moderate ( K = 0.43 for CNPI at rest ; K = 0.54 for PAINAD with movement ) . There were significant differences in mean CNPI and PAINAD scores at rest and during movement , providing support for construct validity . However , both tools demonstrated marked floor effects , particularly when participants were at rest . CONCLUSIONS Despite earlier studies supporting the reliability and validity of the CNPI and the PAINAD , findings from the current study indicate that these measures warrant further study with clinical users , should be used cautiously both in research and clinical setting s and only as part of a comprehensive approach to pain assessment
RESULTS The instruments most frequently used were single-item VAS and Biberoglu and Behrman pain score , while multidimensional inventories were used in few studies .
The results of clinical studies in CPP are more frequently based on one-dimensional measurements .
RATIONALE Many types of  pain assessment are available to research ers carrying out clinical trials in chronic pelvic pain ( CPP ) , ranging from a single-item scale to multidimensional inventories .
AIM Our objective was to investigate which assessment s of pain are more commonly used in clinical trials on CPP .