Brief Pain Inventory - Short Form
The Brief Pain Inventory - Short Form (BPI-sf) is a 9 item self-administered questionnaire used to evaluate the severity of a patient's pain and the impact of this pain on the patient's daily functioning. The patient is asked to rate their worst, least, average, and current pain intensity, list current treatments and their perceived effectiveness, and rate the degree that pain interferes with general activity, mood, walking ability, normal work, relations with other persons, sleep, and enjoyment of life on a 10 point scale. The BPI-sf is a modification of the Brief Pain Inventory - Long Form, which includes additional questions on demographics (date of birth, marital status, education, employment), pain history, aggravating and easing factors, treatment and medication, pain quality, and response to treatment.
The brevity of the BPI-sf makes it suitable for settings in which pain is assessed on a daily basis (e.g. in a randomized control trial), whereas the long-form may be more appropriate as a baseline measure.
The questionnaire exists within the biopsychosocial model of pain, as it addresses sensory, emotional, and functional aspects of the pain experience. Thus, the tool is responsive to changes in pain associated with both pharmacological, physical, and psychological interventions.
Originally intended for use in epidemiological studies and clinical trials involving patients with cancer-related pain, the BPI-sf is now widely used in a range of chronic cancer-related and non-malignant pain conditions, including HIV/AIDS, phantom limb pain, critical limb ischemia, neuropathy, low back pain, and osteoarthritis. The tool has also been used to assess individuals experiencing acute pain, for example post-operatively.
The questionnaire has been translated into numerous languages including Vietnamese, Chinese, Italian, German, Taiwanese, Greek, Norwegian, French, Hindi, Japanese, and Spanish.
Method of Use
The questionnaire can be completed via self-report or interview. The short form version takes 5 minutes for the patient to complete.
The psychometric properties of the tool have been analyzed in a range of populations with cancer and non-cancer related pain. Acceptable reliability has been reported in studies of patients with advanced cancer pain, osteoarthritis pain, and chronic pain in neuropathic and nociceptive pain patients (Turkish translation).
Kumar reports that the BPI has been validated in patient populations with bone metastases, breast cancer and postoperative cancer patients and in a variety of languages including Brazilian, Chinese, Greek, Hindi, Italian, Japanese, Korean, Malay, Norwegian, Polish, Russian, Spanish, Taiwanese and Thai.
A number of studies have utilized a confirmatory factor approach (CFA) to determine the construct validity of the BPI. A three factor representation (pain intensity, activity interference, and affective interference) was compared with a two factor (pain intensity, activity interference) and one-factor (pain intensity) approach. Research by Atkinson and colleagues supports both two- and three-factor representations in the HIV/AIDS and cancer populations. Lapane and colleagues and Tan and colleagues report that a two-factor model has greater validity for patients with non-cancer pain (including arthritis, back/neck pain, injury-/trauma-related pain, neuropathic pain, and fibromyalgia-related pain).
Studies have reported on the responsiveness of the BPI with respect to change in patient's self-reported pain over time and change with treatment. The tool was able to detect change in pain and impact of pain in patients with hip osteoarthritis up to one year following total hip replacement.
No minimum clinically important change (MCIC) has been reported in the literature regarding patients with cancer-related pain. Kumar suggests future studies employ a patient-rated global impression of change as a criterion measure to determine an MCIC in this population.
The BPI has been modified to reflect more inclusive language for individuals experiencing disability related pain. In this version, the “walking ability” item was replaced with “mobility (ability to get around)” and three additional domains (self-care, recreational activities, and social activities) were added to the interference items. It is unclear whether these modifications improve the psychometric properties of the tool.
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