4-Item Pain Intensity Measure (P4): Difference between revisions

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'''Original Editor '''- [[User:Evan Thomas|Evan Thomas]]  
'''Original Editor ''' - [[User:Evan Thomas|Evan Thomas]]  
 
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
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'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;
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== Summary  ==
== Summary  ==


The P4 consists of 4 items that address pain intensity in the morning, afternoon, evening, and with activity over the past 2 days. Each item is scored on a 0-to-10 NPRS, therefore the total P4 scores can vary from 0 (no pain) to 40 (the highest possible pain level). Most patients can complete the P4 in less than a minute and clinicians can score the measure in 5 seconds without the use of computational aids.<ref name="Spadoni 2004">Spadoni GF, Stratford PW, Solomon PE, Wishart LR. The Evaluation of Change in Pain Intensity: A Comparison of the P4 and Single-Item Numeric Pain Rating Scales. J Orthop Sports Phys Ther, 2004: 34(4): 187-93.</ref>  
The P4 consists of 4 items that address pain intensity in the morning, afternoon, evening, and with activity over the past 2 days. Each item is scored on a 0-to-10 NPRS, therefore the total P4 scores can vary from 0 (no pain) to 40 (the highest possible pain level). Most patients can complete the P4 in less than a minute and clinicians can score the measure in 5 seconds without the use of computational aids.<ref name="Spadoni 2004">Spadoni GF, Stratford PW, Solomon PE, Wishart LR. The Evaluation of Change in Pain Intensity: A Comparison of the P4 and Single-Item Numeric Pain Rating Scales. J Orthop Sports Phys Ther, 2004: 34(4): 187-93.</ref>  


The purpose of developing this questionnaire was to attempt assessing change better than the two difference versions of a single-item NPRS.<ref name="Spadoni 2004" />  
The purpose of developing this questionnaire was to attempt assessing change better than the two different versions of a single-item NPRS.<ref name="Spadoni 2004" />  


= Intended Population =
== Intended Population ==


Those over the age of 16 with non-chronic musculoskeletal pain.<ref name="Spadoni 2004" /> It has also been shown to be valid when used in conjunction with the WOMAC in people with osteoarthritis awaiting total knee or total hip replacements.<ref name="Stratford 2009">Stratford PW, Dogra M, Woodhouse L, Kennedy DM, Spadoni GF. Validating Self-Report Measures of Pain and Function in Patients Undergoing Hip or Knee Arthroplasty. Physiother Can, 2009: 61; 189-194.</ref>  
Those over the age of 16 with non-chronic musculoskeletal pain.<ref name="Spadoni 2004" /> It has also been shown to be valid when used in conjunction with the WOMAC in people with osteoarthritis awaiting total knee or total hip replacements.<ref name="Stratford 2009">Stratford PW, Dogra M, Woodhouse L, Kennedy DM, Spadoni GF. Validating Self-Report Measures of Pain and Function in Patients Undergoing Hip or Knee Arthroplasty. Physiother Can, 2009: 61; 189-194.</ref>  


= Descripation =
== Method of Use  ==
 
The DN4 (which stands for Douleur Neuropathique 4) is one of the questionnaires that can be usefu in diagnosing neuropathic pain. It has components of how the pain feels to the patient but also requires the examining health professional to assess whether there is reduced sensation (hypoaesthesia) to touch or pinprick, and whether light brushing increases or causes pain (allodynia).
 
This questionnaire has been well validated in a number of studies.<ref>http://www.gloshospitals.nhs.uk/en/Wards-and-Departments/Departments/Pain-Management/Different-Pains/Nerve-Pain/Assessment-of-Nerve-Pain/DN4-Draft/</ref>
 
= DN4 Questionnaire  =
 
http://www.cheo.on.ca/uploads/1199%20DN4NeuropathicDiagnosticQuestionnaireFinal.pdf<br>
 
= Method of Use  =


[[Image:P4 Questionnaire.png|center|500x178px]]  
[[Image:P4 Questionnaire.png|center|500x178px]]  
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Patients are asked to circle a single number that corresponds to their pain at each time of day and with activity over the previous 2 days. The numbers are then totaled to yield a score out of 40.  
Patients are asked to circle a single number that corresponds to their pain at each time of day and with activity over the previous 2 days. The numbers are then totaled to yield a score out of 40.  


= Evidence  =
== Evidence  ==


=== Reliability  ===
=== Reliability  ===


Test-retest reliability = 0.78<ref name="Spadoni 2004" />  
Test-retest reliability = 0.78<ref name="Spadoni 2004" />  
it is a reliable component of the diagnostic work up for painful diabetic polyneuropathy.<ref name="1">Validation of DN4 as a screening tool for neuropathic pain in painful diabetic polyneuropathy.fckLRSpallone V1, Morganti R, D'Amato C, Greco C, Cacciotti L, Marfia GA.</ref>


=== Validity  ===
=== Validity  ===


Longitudinal validity = 0.63 and 0.57 between the retrospective rating of change and the P4 and 24-hour NPRS (z = 1.73, P<sub>1</sub> = .043), and 0.61 and 0.56 between the retrospective rating of change and the P4 and 2-day NPRS (z = 2.53, P<sub>1</sub> = .006), respectively.<ref name="Spadoni 2004" />  
Longitudinal validity = 0.63 and 0.57 between the retrospective rating of change and the P4 and 24-hour NPRS (z = 1.73, P<sub>1</sub> = .043), and 0.61 and 0.56 between the retrospective rating of change and the P4 and 2-day NPRS (z = 2.53, P<sub>1</sub> = .006), respectively.<ref name="Spadoni 2004" />


DN4 is valid for painful diabetic polyneuropathy, which supports its usefulness as a screening tool for neuropathic pain in diabetes.<ref name="1">Validation of DN4 as a screening tool for neuropathic pain in painful diabetic polyneuropathy.fckLRSpallone V1, Morganti R, D'Amato C, Greco C, Cacciotti L, Marfia GA.</ref>
=== Responsiveness  ===


=== Responsiveness  ===
MDC<sub>90</sub> = 9.1 points or 22.2% of the scale range<ref name="Spadoni 2004" />
 
== Resources ==


MDC<sub>90</sub> = 9.1 points or 22.2% of the scale range<ref name="Spadoni 2004" />
*[http://advantagephysio.ca/wp-content/uploads/2017/02/PainIntensity.pdf P4 Pain Questionnaire]


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
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<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1d3MTz8-QHM_GItNR_r6Sd2JMMeJ4TF7GCftDwN62bEDZ4oE-L|charset=UTF-8|short|max=10</rss>
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== References  ==
== References  ==


<references />  
<references />  


[[Category:Outcome_Measures]] [[Category:Pain]]
[[Category:Outcome_Measures]] [[Category:Pain]] [[Category:Assessment]]
[[Category:Pain - Outcome Measures]]

Latest revision as of 10:49, 26 July 2023

Original Editor - Evan Thomas

Top Contributors - Evan Thomas, Andeela Hafeez, WikiSysop and Melissa Coetsee

Summary[edit | edit source]

The P4 consists of 4 items that address pain intensity in the morning, afternoon, evening, and with activity over the past 2 days. Each item is scored on a 0-to-10 NPRS, therefore the total P4 scores can vary from 0 (no pain) to 40 (the highest possible pain level). Most patients can complete the P4 in less than a minute and clinicians can score the measure in 5 seconds without the use of computational aids.[1]

The purpose of developing this questionnaire was to attempt assessing change better than the two different versions of a single-item NPRS.[1]

Intended Population[edit | edit source]

Those over the age of 16 with non-chronic musculoskeletal pain.[1] It has also been shown to be valid when used in conjunction with the WOMAC in people with osteoarthritis awaiting total knee or total hip replacements.[2]

Method of Use[edit | edit source]

P4 Questionnaire.png


Patients are asked to circle a single number that corresponds to their pain at each time of day and with activity over the previous 2 days. The numbers are then totaled to yield a score out of 40.

Evidence[edit | edit source]

Reliability[edit | edit source]

Test-retest reliability = 0.78[1]

Validity[edit | edit source]

Longitudinal validity = 0.63 and 0.57 between the retrospective rating of change and the P4 and 24-hour NPRS (z = 1.73, P1 = .043), and 0.61 and 0.56 between the retrospective rating of change and the P4 and 2-day NPRS (z = 2.53, P1 = .006), respectively.[1]

Responsiveness[edit | edit source]

MDC90 = 9.1 points or 22.2% of the scale range[1]

Resources[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Spadoni GF, Stratford PW, Solomon PE, Wishart LR. The Evaluation of Change in Pain Intensity: A Comparison of the P4 and Single-Item Numeric Pain Rating Scales. J Orthop Sports Phys Ther, 2004: 34(4): 187-93.
  2. Stratford PW, Dogra M, Woodhouse L, Kennedy DM, Spadoni GF. Validating Self-Report Measures of Pain and Function in Patients Undergoing Hip or Knee Arthroplasty. Physiother Can, 2009: 61; 189-194.