Short-form McGill Pain Questionnaire

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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. Thanks to the MPQ the qualitative aspect of pain became also, besides the intensity of pain an important subject in the pain research. Words related to pain where brought together and categorized in three dimensions of pain experience: words that describe the sensory qualities of the experience in terms of temporal, spatial, pressure, thermal, and other properties; words that describe affective qualities in terms of tension, fear, and autonomic properties that are part of the pain experience; and evaluative words describing the subjective overall intensity of the total pain experience.[2]

The MPQ may be used in the first place for a standard registration and evaluation of the complaints of pain in an individual patient. Furthermore, it can also be used for diagnostics and to control the effects of therapies and/ or pain reliefs in individual patients.[1]
The short-form McGill Pain Questionnaire is a shorter version of the original MPQ. The pain rating index has 2 subscales: 1) the sensory subscale with 11 words and 2) the 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.[4]
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.[4]

Intended Population

The SF-MPQ has been developed for adults with chronic pain, including pain due to rheumatic diseases.[4] But recent research has proven the usefulness of the SF-MPQ-2 in patients with acute low back pain too.[10]

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 is translated in 26 languages, the reliability varies depending on the language. [4]

When evaluating the test-retest reliability of the SF MPQ in patients with musculoskeletal pain, the results were adequate ( r>70 ).[5] When examining the same questionnaire in patients with rheumatic pain, the results are significantly higher ( r>85). Only the subscale ‘current pain’ demonstrated a lower intraclass correlation coefficient of 0.75. [3] For the internal consistency reliability a cronbach’s alpha of r>0.75 has been reported by Melzack et al.[1]

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. [4]

The SF-MPQ is translated in a lot of 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. Which showed high internal consistency. There was also a high correlation between the mean VAS and the mean total score (r = 0.926).[7]

The SF-MPQ was also translated in Swedish. Results 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. [8]

We can conclude that the SF-MPQ is a highly valid instrument to evaluate pain in patients with and without neuropathic etiology. [7]

The revised version of the SF-MPQ, the SF-MPQ-2 has been validated for use in chronic pain populations. For example: T.I. Lovejoy et al. have shown 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 nonneuropathic pain.[9],[10]

J. Trudeau et al. conclude that the SF-MPQ-2 is a valid instrument to assess pain qualities in patients with acute low back pain.[10]

Responsiveness

The purpose of the questionnaire is rather descriptive than to objectively detect change in time because pain is a subjective concept.[11] Nevertheless the SF- MPQ has been found to be responsive to change and indicated a clinically valuable difference in a population with musculoskeletal conditions.[4] But the measurement properties vary between groups of patients with pain. [5]

For the osteoarthritis population a prospective observational cohort study demonstrated however no significant changes over time. The coefficient was calculated as an estimation of the minimum metrically detectable change. [3]

Another study showed a comparison of the responsiveness of the VAS and the Mc Gill pain questionnaire.

Scoring

The Pain Rating index can be scored in several ways.

• "Pain Rating Index - rank value" : The adjectives are ranked according increasing intensity so we can assign each descriptor 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 paindescriptor 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 paindescriptor. • "Number of words chosen '(NWC): The number of words chosen by the patient.

àThe higher the total score on the MPQ, the more the pain experience for the patient increases.

Miscellaneous

Dworkin et al 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.

Contact

Recent Related Research (from Pubmed)

References

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Databases searched: PubMed, Vubis, PEDro, Google scholar
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Search timeline: april 30, 2013 – may 1, 2013 – may 3, 2013 – may 20, 2013 – may 29, 2013