Short-form McGill Pain Questionnaire

Original Editor - Eva Huysmans

Top Contributors - Eva Huysmans, Evan Thomas, Rachael Lowe, Tony Lowe and Louis Curtil  

Summary

The publication of the McGill Pain Questionnaire (Melzack, 1975) represented a major (r)evolution in pain research. Pain was mainly described and measured in terms of intensity, but thanks to the MPQ, the qualitative aspect of pain became an important subject in pain research. Pain descriptors were brought together and categorized in three dimensions of pain experience:

  • words that described the sensory qualities of the experience in terms of temporal, spatial, pressure, thermal, and other properties
  • words that described affective qualities in terms of tension, fear, and autonomic properties that are part of the pain experience
  • evaluative words that subjectively described the overall intensity of the total pain experience[1]

The MPQ may be used for a standard registration and evaluation of the complaints of pain in a patient. Furthermore, it can also be used for diagnostics and to control the effects of therapies and/ or pain relief in individual patients.[2]

The short-form McGill Pain Questionnaire (SF-MPQ) is a shorter version of the original MPQ, and was developed later in 1987.

The pain rating index has 2 subscales:

  1. Sensory subscale with 11 words, and
  2. Affective subscale with 4 words from the original MPQ.

These words or items are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate and 3 = severe. There’s also one item for present pain intensity and one item for a 10 cm visual analogue scale (VAS) for average pain.[3] The SF-MPQ was further revised in 2009 for the use in neuropathic and non-neuropathic pain conditions (SF-MPQ-2). This new version includes 7 additional symptoms related to neuropathic pain, for a total of 22 items with 0-10 numerical response options.[3]

Mcgill questionnaire.jpg

                                             

Intended Population

The SF-MPQ has been developed for adults with chronic pain, including pain due to rheumatic conditions,[3] but recent research has also proven usefulness of the SF-MPQ-2 in patients with acute low back pain.[4]

Scoring

The Pain Rating Index can be scored in several ways:

  • "Pain Rating Index - rank value": The adjectives are ranked according increasing intensity so each descriptor can be assigned a higher score.
    • 0 = no pain
    • 1 = mild
    • 2 = discomforting
    • 3 = distressing
    • 4 = horrible
    • 5 = excruciating
  • "Pain Rating Index - scale value (VAS)": The pain intensity of each pain descriptor was assessed on a numeric scale in previous research (Melzack and Torgerson in Melzack, 1975). The assigned rating can also be accepted as the score for the pain descriptor.
  • "Number of words chosen (NWC)": The number of words chosen by the patient. The higher the total score on the MPQ, the more the pain experience for the patient increases.

Evidence

Reliability

The test-retest reliability of the questionnaire has been evaluated in populations with a variety of conditions, such as osteoarthritis and musculoskeletal pain. For an estimate of the reliability, the intraclass correlation coefficient was used. Since the questionnaire has been translated into 26 languages, the reliability varies depending on the language[3]

When evaluating the test-retest reliability of the SF-MPQ in patients with musculoskeletal pain, the results were adequate (r>70).[3] When examining the same questionnaire in patients with rheumatic pain, the results were significantly higher (r>85). Only the subscale ‘current pain’ demonstrated a lower intraclass correlation coefficient of 0.75.[5] For the internal consistency reliability, a Cronbach’s alpha of r>0.75 has been reported by Melzack et al.[2]

Validity

It was found that the SF-MPQ has more content validity among patients with fibromyalgia than for those with RA. [4] Percentage of use of 15 pain descriptors in 2 groups was significantly different for all words except “throbbing” and “punishing-cruel.” The mean intensity score for each word ranged from 1.69 for “sickening” to 2.60 for “tender” in the fibromyalgia group and 1.57 for “fearful” to 2.18 for “aching” in the RA group.[3]

The SF-MPQ has been translated into many different languages. Some studies have demonstrated the validity of the translated versions of the SF-MPQ. The results of the Persian version give a Cronbach’s alpha of 0.906, also showing a high internal consistency. There was also a high correlation between the mean VAS and the mean total score (r = 0.926)[6]

Results of the Swedish version indicated that the MPQ 15-item descriptor section was internally consistent (Cronbach's alphas: 0.73-0.89), but lacked content validity in the RA sample. Convergent construct validity was demonstrated by significant correlations between the SF-MPQ and other pain measurements[7]

It this point, one can conclude that the SF-MPQ is a highly valid instrument to evaluate pain in patients with and without neuropathic etiology.[6]

The revised version of the SF-MPQ, the SF-MPQ-2, has been validated for use in chronic pain populations. For example, Lovejoy et al demonstrated an excellent reliability and validity for the use of the SF-MPQ-2 in a group of U.S. veteran patients with chronic neuropathic and non-neuropathic pain.[8][4]

Trudeau et al. conclude that the SF-MPQ-2 is a valid instrument to assess pain qualities in patients with acute low back pain.[4]

Responsiveness

The purpose of the questionnaire is to obtain descriptive values rather than to objectively detect change in time since pain is a subjective concept.[9] Nevertheless, the SF- MPQ has been found to be responsive to change and indicated a clinically valuable difference in a population with musculoskeletal conditions,[3] but the measurement properties vary between groups of patients with pain.[10]

For the osteoarthritis population, however, a prospective observational cohort study demonstrated no significant changes over time. The coefficient was calculated as an estimation of the minimum detectable change.[5]

Another study showed a comparison of the responsiveness of the VAS and the MPQ.

Interpretation of Results

  • Clinically important change (CIC): mean improvement in total scores >5 on the 0–45 Norwegian SF-MPQ scale[3]
  • Minimum detectable change (MDC) for total, sensory, affective, average, and current pain: 5.2cm, 4.5cm, 2.8cm, 1.4cm, and 1.4cm, respectively[3]

Miscellaneous

Dworkin et al.[11] amended the SF-MPQ to produce a measure (the SF-MPQ-2) that has excellent reliability and validity and provided support for four readily interpretable subscales—continuous pain, intermittent pain, predominantly neuropathic pain, and affective descriptors.

Resources

View the Melzack 1987 paper that includes the SF-MPQ

SF-MPQ-2

Recent Related Research (from Pubmed)

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References

  1. Melzack R., Ph.D.*: “The McGill Pain Questionnaire”, American Society of Anesthesiologists, 2005; 103:199–202. (evidence level = 5)
  2. 2.0 2.1 Melzack R, Katz J: “The McGill Pain Questionnaire: Appraisal and current status”,Handbook of Pain Measurement, 2nd edition. Edited by Turk DC, Melzack R. NewfckLRYork, Guilford Press, 2001, pp 35–52 (evidence level = 5)
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Gillian A. Hawker:“ Measures of adult pain.”, Arthritis Care & Research 2011; 63 (11): 20-252 (Evidence level = 2C)
  4. 4.0 4.1 4.2 J. Trudeau et al., “Validation of the revised short form McGill Pain Questionnaire (SF-MPQ-2) for self-report of pain qualities in patients with acute low back pain”, The Journal of Pain, Volume 13, Issue 4, Supplement, April 2012, Pages S4 (Evidence level = 1B)
  5. 5.0 5.1 Grafton KV: “Test-retest reliability of the Short-Form McGill Pain Questionnaire: Rassessment of intraclass correlation coefficients and limits of agreement in patients with osteoarthritis.”, Clin J Pain. 2005 Jan-Feb;21(1):73-82 (evidence level= 2B)
  6. 6.0 6.1 Farhad Abelmanesh:’’Reliability, Validity, and Sensitivity Measures of Expanded and Revised Version of the Short-Form McGill Pain Questionnaire in Iranian Patients with Neuropathic and Non-Neuropathic Pain’’, Pain Medicine,2012 (evidence level = 1B)
  7. C.S. Burckhardt, “A Swedish Version of the Short-Form McGill Pain Questionnaire”, 1994fckLRp 77-81, Gothenburg Sweden (evidence level = 1B)
  8. T.I. Lovejoy et al., “Evaluation of the Psychometric Properties of the Revised Short-Form McGill Pain Questionnaire”, The Journal of Pain, Vol 13, No 12 (December), 2012: pp 1250-1257 (Evidence level = 1B)
  9. A. Chauffe et al., “Responsiveness of the VAS and McGill pain questionnaire in measuring changes in musculoskeletal pain”, J Sport Rehabil. 2011 May;20(2):250-5. (evidence level= 2C)
  10. Strand LI.: “The Short-Form McGill Pain Questionnaire as an outcome measure: testretest Rreliability and responsiveness to change.”, Eur J Pain. 2008 Oct;12(7):917-25. (evidence level= 2C)
  11. Robert H. Dworkin, Dennis C. Turk, Dennis A. Revicki, Gale Harding, Karin S. Coyne, Sarah Peirce-Sandner, Dileep Bhagwat, Dennis Everton, Laurie B. Burke, Penney Cowan, John T. Farrar, Sharon Hertz, Mitchell B. Max, Bob A. Rappaport and Ronald Melzack. Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). Pain, July 2009, 144(1-2):35-42