4-Item Pain Intensity Measure (P4)

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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.

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

Intended Population

Those over the age of 16 with non-chronic musculoskeletal pain. 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.

Method of Use

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

Reliability

Test-retest reliability = 0.78

Validity

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.

Responsiveness

MDC₉₀ = 9.1 points or 22.2% of the scale range