Chronic Pain Grade Scale (CPGS): Difference between revisions
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== Scoring == | == Scoring == | ||
All items are scored on an 11-point Likert scale, with responses ranging from 0–10. Scores are calculated for 3 subscales: the characteristic pain intensity score, which ranges from 0–100, is calculated as the mean intensity ratings for reported current, worst, and average pain; the disability score, which ranges from 0–100, is calculated as the mean rating for difficulty performing daily, social, and work activities; and the disability points score, which ranges from 0–3, is derived from a combination of ranked categories of num-ber of disability days and disability score <ref name="main" /> | All items are scored on an 11-point Likert scale, with responses ranging from 0–10. Scores are calculated for 3 subscales: the characteristic pain intensity score, which ranges from 0–100, is calculated as the mean intensity ratings for reported current, worst, and average pain; the disability score, which ranges from 0–100, is calculated as the mean rating for difficulty performing daily, social, and work activities; and the disability points score, which ranges from 0–3, is derived from a combination of ranked categories of num-ber of disability days and disability score <ref name="main" /> | ||
== Interpretation == | == Interpretation == | ||
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===== Development ===== | ===== Development ===== | ||
<div>Interviews were conducted with primary care patients with back pain, headache, and temporomandibular disorder <ref name="96">Von Korff M, Dworkin SF, Le RL. Graded chronic pain status: an epidemiologic evaluation. Pain 1990;40:279–91</ref>. The development of the graded classification drew on concepts by Turk and Rudy of chronic pain severity <ref name="97">Turk DC, Rudy TE. Towards a comprehensive assessment of chronic pain patients. Behav Res Ther 1987;25:237–49</ref> <ref name="98">Turk DC, Rudy TE. Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment data. J Consult Clin Psychol 1988;56:233–8.</ref>. Two of the items<br>used in the disability score were adapted from their Multidimensional Pain Inventory <ref name="99">Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985;23:345–56.</ref>. The Guttman scaling<br>method was used to develop the graded classification of chronic pain <ref name="90" />.</div><div></div> | <div>Interviews were conducted with primary care patients with back pain, headache, and temporomandibular disorder <ref name="96">Von Korff M, Dworkin SF, Le RL. Graded chronic pain status: an epidemiologic evaluation. Pain 1990;40:279–91</ref>. The development of the graded classification drew on concepts by Turk and Rudy of chronic pain severity <ref name="97">Turk DC, Rudy TE. Towards a comprehensive assessment of chronic pain patients. Behav Res Ther 1987;25:237–49</ref> <ref name="98">Turk DC, Rudy TE. Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment data. J Consult Clin Psychol 1988;56:233–8.</ref>. Two of the items<br>used in the disability score were adapted from their Multidimensional Pain Inventory <ref name="99">Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985;23:345–56.</ref>. The Guttman scaling<br>method was used to develop the graded classification of chronic pain <ref name="90" />.</div><div></div> | ||
===== Acceptability ===== | ===== Acceptability ===== | ||
The CPGS is easy to understand and complete based on a high response rate (76.3%) to a postal survey sent to general practice patients in the UK <ref name="94">Smith BH, Penny KI, Purves AM, Munro C, Wilson B, Grimshaw J,et al. The Chronic Pain Grade questionnaire: validation and reliability in postal research. Pain 1997;71:141–7</ref>. Among MSK chronic pain patients, missing values were only noted in<3% of each of the questions in an Italian version of the CPGS <ref name="100">Krebs EE, Bair MJ, Damush TM, Tu W, Wu J, Kroenke K. Comparative responsiveness of pain outcome measures among primary care pa-tients with musculoskeletal pain. Med Care 2010;48:1007–14.</ref>. | The CPGS is easy to understand and complete based on a high response rate (76.3%) to a postal survey sent to general practice patients in the UK <ref name="94">Smith BH, Penny KI, Purves AM, Munro C, Wilson B, Grimshaw J,et al. The Chronic Pain Grade questionnaire: validation and reliability in postal research. Pain 1997;71:141–7</ref>. Among MSK chronic pain patients, missing values were only noted in<3% of each of the questions in an Italian version of the CPGS <ref name="100">Krebs EE, Bair MJ, Damush TM, Tu W, Wu J, Kroenke K. Comparative responsiveness of pain outcome measures among primary care pa-tients with musculoskeletal pain. Med Care 2010;48:1007–14.</ref>. | ||
===== Reliability ===== | ===== Reliability ===== | ||
<div>For internal consistency, Cronbach’s alpha was shown to be = 0.74 among patients with chronic back pain <ref name="90" />. In an Italian version of CPGS, Cronbach’s alpha ranged from 0.81–0.89 for subscales and global scores in patients with chronic MSK pain <ref name="95" />. In UK<br>general practice patients with low back pain, test–retest reliability was high after a 2-week interval. <br></div> | <div>For internal consistency, Cronbach’s alpha was shown to be = 0.74 among patients with chronic back pain <ref name="90" />. In an Italian version of CPGS, Cronbach’s alpha ranged from 0.81–0.89 for subscales and global scores in patients with chronic MSK pain <ref name="95" />. In UK<br>general practice patients with low back pain, test–retest reliability was high after a 2-week interval. <br></div> | ||
===== Validity ===== | ===== Validity ===== | ||
<div>For construct validity, cross-sectional and lon-gitudinal studies of general practice patients have shown that higher scores on the CPGS, indicating greater chronic pain, are significantly associated with higher rates of un-employment, greater pain impact scale scores, greater use of opioid analgesics and physician visits, depressed mood, and lower self-rated health status (90,94,102). Compari-sons of CPGS scores with the Short Form 36 Health Survey (SF-36) indicate that a higher chronic pain grade using the CPGS is associated with poorer physical, psychological, social, and general health as measured by the SF-36 (P= 0.001) (102) and worse scores on the SF-36 bodily pain scale (p = 0.545,P<0.0001) (95). Spearman’s correla-tion coefficients for the CPGS scores and the various di-mensions of SF-36 were highest for the pain dimension (r = -0.71 to -0.84) and lowest for the mental health dimension (r=-0.28 to-0.38) (94).<br></div> | <div>For construct validity, cross-sectional and lon-gitudinal studies of general practice patients have shown that higher scores on the CPGS, indicating greater chronic pain, are significantly associated with higher rates of un-employment, greater pain impact scale scores, greater use of opioid analgesics and physician visits, depressed mood, and lower self-rated health status (90,94,102). Compari-sons of CPGS scores with the Short Form 36 Health Survey (SF-36) indicate that a higher chronic pain grade using the CPGS is associated with poorer physical, psychological, social, and general health as measured by the SF-36 (P= 0.001) (102) and worse scores on the SF-36 bodily pain scale (p = 0.545,P<0.0001) (95). Spearman’s correla-tion coefficients for the CPGS scores and the various di-mensions of SF-36 were highest for the pain dimension (r = -0.71 to -0.84) and lowest for the mental health dimension (r=-0.28 to-0.38) (94).<br></div> |
Revision as of 19:59, 17 March 2014
Original Editor - Venus Pagare
Top Contributors - Venus Pagare, Laura Ritchie, 127.0.0.1, Evan Thomas, WikiSysop, Kim Jackson and Melissa Coetsee
Introduction[edit | edit source]
Purpose[edit | edit source]
The CPGS is a multidimensional measure that assesses 2 dimensions of overall chronic pain severity: pain intensity and pain-related disability. It is suitable for use in all chronic pain conditions, including chronic mus-culoskeletal (MSK) and low back pain Cite error: Invalid <ref>
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Content [edit | edit source]
Subscale scores for pain intensity and dis-ability are combined to calculate a chronic pain grade that enables classification of chronic pain patients into 5 hierarchical categories: grades 0 (no pain) to IV (high disability-severely limiting) Cite error: Invalid <ref>
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Items[edit | edit source]
The CPGS is comprised of 7 items[1]:
1- How would you rate your pain on a 0-10 scale at the present time, this is right now, where 0 is 'no pain' and 10 is 'pain as bad as it could be'?
2- In the past 6 months, how intense was your worse pain rated on a 0-10 scale (rated as above)?
3- In the past 6 months, on average, how intense was your pain rated on a 0-10 scale (rated as above)? (That is your usual pain at times you were experiencing pain.)
4- About how many days in the last 6 months have you been kept from your usual activities (work, school, housework) because of this pain?
5- In the past 6 months, how much has this pain interfered with your daily activities on a 0-10 scale where 0 is 'no interference' and 10 is 'extreme change'?
6- In the past 6 months, how much has this pain changed your ability to take part in recreational, social, and family activities where 0 is 'no change' and 10 is 'extreme change'?
7- In the past 6 months, how has this pain changed your ability to work (including housework) where 0 is 'no change' and 10 is 'extreme change'?
Recall Period[edit | edit source]
Pain in the past 3–6 months
Obtaining the Scale[edit | edit source]
The scale is available in the original reference [1], as well as directly from the author.
Administration[edit | edit source]
Scoring[edit | edit source]
All items are scored on an 11-point Likert scale, with responses ranging from 0–10. Scores are calculated for 3 subscales: the characteristic pain intensity score, which ranges from 0–100, is calculated as the mean intensity ratings for reported current, worst, and average pain; the disability score, which ranges from 0–100, is calculated as the mean rating for difficulty performing daily, social, and work activities; and the disability points score, which ranges from 0–3, is derived from a combination of ranked categories of num-ber of disability days and disability score [2]
Interpretation[edit | edit source]
The 3 subscale scores (character-istic pain intensity, disability score, and the disability points score) are used to classify subjects into 1 of the 5 pain severity grades: grade 0 for no pain, grade I for low disability-low intensity, grade II for low disability-high
intensity, grade III for high disability-moderately limiting, and grade IV for high disability-severely limiting.
Merits and Demerits[edit | edit source]
- The CPGS is a valid and reliable tool that is useful for the evaluation of chronic MSK pain
- It allows for grading of the global severity of chronic pain and therefore analysis of the qualitative changes in chronic pain
over time. - Further, the CPGS assesses not only aspects of the pain itself, but also the impact of the pain on daily,
social, and work activities, which is a significant advantage over many other pain questionnaires. - Time to complete the CPGS does not exceed 10 minutes
- Easy to administe
- The CPGS has been adapted into UK English Cite error: Invalid
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- A limitation of the CPGS relative to the other scales is the complexity of scoring
- Additionally, further research is needed to be able to compare scoring methods and cut points.
Psychometric Information[edit | edit source]
Development[edit | edit source]
<ref>
tag; name cannot be a simple integer. Use a descriptive title. The development of the graded classification drew on concepts by Turk and Rudy of chronic pain severity Cite error: Invalid <ref>
tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref>
tag; name cannot be a simple integer. Use a descriptive title. Two of the itemsused in the disability score were adapted from their Multidimensional Pain Inventory Cite error: Invalid
<ref>
tag; name cannot be a simple integer. Use a descriptive title. The Guttman scalingmethod was used to develop the graded classification of chronic pain Cite error: Invalid
<ref>
tag; name cannot be a simple integer. Use a descriptive title.Acceptability[edit | edit source]
The CPGS is easy to understand and complete based on a high response rate (76.3%) to a postal survey sent to general practice patients in the UK Cite error: Invalid <ref>
tag; name cannot be a simple integer. Use a descriptive title. Among MSK chronic pain patients, missing values were only noted in<3% of each of the questions in an Italian version of the CPGS Cite error: Invalid <ref>
tag; name cannot be a simple integer. Use a descriptive title.
Reliability[edit | edit source]
<ref>
tag; name cannot be a simple integer. Use a descriptive title. In an Italian version of CPGS, Cronbach’s alpha ranged from 0.81–0.89 for subscales and global scores in patients with chronic MSK pain Cite error: Invalid <ref>
tag; name cannot be a simple integer. Use a descriptive title. In UKgeneral practice patients with low back pain, test–retest reliability was high after a 2-week interval.
Validity[edit | edit source]
Ability to detect change[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Diane Dixon, Beth Pollard, and Marie Johnston. What does the chronic pain questionnaire measure? In Pain. July 2007. Vol. 130. Pp. 249-253. available at: http://www.spineuniversity.com/chronic_pain_grade_questionnaire_combines_with_international_classification_of_functioning_disability
- ↑ 2.0 2.1 HAWKER GA. Measures of Adult Pain. Arthritis Care Research 2011; 63,S240–S252