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McGill Pain Questionnaire Short-Form

McGill Pain Questionnaire Short-Form

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Purpose

The short-form McGill Pain Questionnaire was created to assess both the intensity and quality of pain.

Link to Instrument

Instrument Details

Acronym MPQ

Area of Assessment

Cognition
Communication
Language
Negative Affect
Pain
Positive Affect

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Cancer Rehabilitation
  • Pain Management
  • Sports Medicine

Key Descriptions

  • The short-form McGill Pain Questionnaire consists of 15 descriptors of pain including 11 from sensory categories and 4 from affective categories.
  • Descriptors are rated on an intensity scale of:
    0 = none
    1 = mild
    2 = moderate
    3 = severe
  • Three pain scores are derived from the sum of the intensity rank values of the chosen for sensory, affective, and total descriptors.
  • The SF-MPQ-2 expanded the MPQ and includes a neuropathic qualities section, so this test includes 22 descriptors of pain.
  • The SF-MPQ-2 also had an 11-point pain scale, with 0 being no pain and 10 being the worst pain.

Number of Items

15
Short: 22

Time to Administer

2-5 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Joshua Miller, Nicole Neill, Blair Losak, Adrienne Fox, Meg Hornsby, Sam Van Gorder, Sam Parlier, Stephanie Babiarz, Julia Murhammer, Leigh Martino, Kathryn Haynes, and Jack Friesen in 5/2014.

Body Part

Head
Neck
Upper Extremity
Back
Lower Extremity

ICF Domain

Body Structure

Measurement Domain

Emotion
Sensory

Considerations

Cognitive status, language barriers, culture, inability to read or write.

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Osteoarthritis

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Standard Error of Measurement (SEM)

Hip and knee OA: (Strand, 2008; n=40; mean age = 73.9 (7.8) years) 

  • Standard error of measurement indicating absolute agreement was 4.28 on the 0-45 total score. The difference between one subject’s measurement and the true value is, accordingly, expected to be within the limit of 8.4 (1.96 standard error of measurement) of the score.

Minimal Detectable Change (MDC)

Hip and knee OA: (Strand, 2008; n=40; mean age = 73.9 (7.8) years) 

  • The smallest detectable difference for two repeated measures of the same individual is 11.9 points (2.77 standard error), indicating the limit of change an individual has to exceed to demonstrate change above measurement error.

Minimally Clinically Important Difference (MCID)

Hip and knee OA: (Strand, 2008; n=40; mean age = 73.9 (7.8) years) 

  • The mean change of these improved patients varied between the groups but was greater than five for the total score in all groups, suggesting a minimally clinically important change.

Cut-Off Scores

Hip and knee OA: (Strand, 2008; n=40; mean age = 73.9 (7.8) years) 

  • The cut-off value of change was calculated where the sum of the percentages of false positives and false negatives was minimal.

Normative Data

Hip and knee OA: (Strand, 2008; n=40; mean age = 73.9 (7.8) years) 

  • Across the painful conditions, all of the estimated normative mean scores were no more than 50% of the maximum score, suggesting that scores may be skewed to the left. Higher affective scores appear to differentiate chronic painful conditions from acute painful conditions.

Test/Retest Reliability

Hip and knee OA: (Strand, 2008; n=40; mean age = 73.9 (7.8) years) 

  • Values for test-retest reliability assessed 1-3 days apart for total, sensory, and affective scores were respectively 0.75, 0.76, and 0.62 in patients with musculoskeletal pain, and 0.93, 0.95, and 0.79 in patients with rheumatic pain. The variability in patients with rheumatic pain was less than in patients with musculoskeletal pain.

Criterion Validity (Predictive/Concurrent)

Hip and knee OA: (Strand, 2008; n=40; mean age = 73.9 (7.8) years) 

  • Short form McGill has been supported to have concurrent validity with the long McGill in patients with postsurgical (r=.77), labor pain (r=.81), musculoskeletal pain (r=.70), and cancer pain (r=.77 to .88)

Construct Validity

Hip and knee OA: (Strand, 2008; n=40; mean age = 73.9 (7.8) years) 

Convergent construct validity was demonstrated with moderate to very high correlations between the various pain scales of the NSF-MPQ (0.68 – 0.97), but no correlation between the NSF-MPQ and a disability measure (0.05 – 0.30).

Face Validity

Osteoarthritis: (Grafton, 2005: n = 71; mean age = 64.8 (10.4) years) The SFMPQ was associated with completion problems, and a high number of these errors may reflect poor face validity, but if so, a low response rate would also be expected. This was not the case, as a 92% response rate was achieved in this particular study.

Responsiveness

Hip and knee OA: (Strand, 2008; n=40; mean age = 73.9 (7.8) years) 

  • All scale scores were found responsive to change showing mostly large SRM values in patients who reported to have improved. The total score was most responsive to improvement within patients with rheumatic and musculoskeletal pain while the affective score was the least. 

The NSF-MPQ scores were found to be responsive to clinically important change with large SRM values of >0.80 for most scores.

Cancer

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Internal Consistency

Scar Pain: Surgical, Breast Cancer: (Truong, 2005: n=59; median age=63 years; median time since surgery=152 days): Acceptable internal consistency: (Cronbach’s alpha=0.72) 

 

Pain in Older and Younger Cancer Patients: (Gauthier, 2014; n=244; mean age = 57.79 (11.51) years; mean time of cancer duration: 23.5 (11, 49.8) months): no age differences in internal consistency reliability of the subscales of the SF-MPQ (Cronbach alpha = 0.89 and 0.93 for younger and older cancer patient’s, respectively)

Construct Validity

Pain in Older and Younger Cancer Patients: (Gauthier, 2014; n=244; mean age = 57.79 (11.51) years; mean time of cancer duration: 23.5 (11, 49.8) months): For the SF_MPQ-2: Convergent validity with the BPI Average Pain Intensity, BPI Pain Interference, CES-D, PMI, Pain Relief, KPS, SF-36 PHC, SF-36 MHC (r=0.67 (young) and 0.55 (old); 0.63 (young) and 0.56 (old); 0.27 (young) and 0.35 (old); -0.32 (young) and -0.13(old); -0.34 (young) and -0.30 (old); -0.25 (young) and -0.29 (old); -0.23 (young) and -0.32 (old); -0.13 (young) and -0.36 (old), respectively). The SF-MPQ-2 has a moderate-to-strong correlation with the BPI average pain. The scale is associated with higher BPI pain interference and CES-D depressive symptoms, lower SF-46 physical health QOL and Pain Relief, and worse KPS functional status. 

 

Cancer: Dudgeon, 1993; n = 24; mean age = 57.8 (25.0) years; mean time post cancer diagnosis = not provided). All domains of the SF-MPQ correlate very highly, demonstrating convergent construct validity, with the LF-MPQ scores in patients with chronic pain due to cancer. When testing changes over 3-4 weeks, the correlation between the SF-MPQ and the LF-MPQ in the sensory, affective, total score, and compared to the PPI were 0.53, 0.35, 0.59, 0.76 respectively. When testing changes over 6-8 weeks, the correlation in sensory, affective, total score, and compared to the PPI were 0.53, 0.20, 0.61, and 0.62 respectively. The total scores on both the LF-MPQ and the SF-MPQ correlate highly with the VAS. In changes after 3-4 weeks, the LF-MPQ and the VAS had a correlation of 0.52 and the SF-MPQ had a correlation of 0.45 with the VAS. In changes after 6-8 weeks, the LF-MPQ had a correlation of 0.63 and the SF-MPQ had a correlation of 0.39 with the VAS

Non-Specific Patient Population

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Internal Consistency

Diabetes: (Dworkin, 2009; n=226; mean age= 55.6 (10.2); mean time post Diabetes=8.8 (6.6) years, mean time post Diabetic Peripheral Neuropathy=2.4 years) Internal consistency reliability is high for the revised Short form McGill pain questionnaire (SF-MPQ-2). The ranges from four subscales was from acceptable to high.

Arthritis

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Standard Error of Measurement (SEM)

Rheumatic: (Strand, 2008; n=25; mean age = 56.0 (16.0) years)

Minimal Detectable Change (MDC)

Rheumatic: (Strand, 2008; n=25; mean age = 56.0 (16.0) years)

Minimally Clinically Important Difference (MCID)

Rheumatic: (Strand, 2008; n=25; mean age = 56.0 (16.0) years)

Cut-Off Scores

Rheumatic: (Strand, 2008; n=25; mean age = 56.0 (16.0) years)

Normative Data

Rheumatic: (Strand, 2008; n=25; mean age = 56.0 (16.0) years)

Test/Retest Reliability

Rheumatic: (Strand, 2008; n=25; mean age = 56.0 (16.0) years)

Criterion Validity (Predictive/Concurrent)

Rheumatic: (Strand, 2008; n=25; mean age = 56.0 (16.0) years)

Construct Validity

Rheumatic: (Strand, 2008; n=25; mean age = 56.0 (16.0) years)

Content Validity

Arthritis & Rheumatism: (Burckhardt, 1994) Content validity has been described in a study of adult patients with post-operative pain who used exact SF-MPQ sensory or affective words or synonyms during an interview to describe their pain. High correlation between the short form & the original MPQ.

Responsiveness

Rheumatic: (Strand, 2008; n=25; mean age = 56.0 (16.0) years)

Back Pain

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Content Validity

Chronic Low Back Pain:

(Wright, 2001; n = 188; mean age = 37.89 (11.45) years; mean time post injury = 27.99) One minor exception to Melzack’s model was the finding that item six (gnawing), originally designated as a sensory item, loaded onto the affective factor. This exception aside, these results confirm the factorial validity of the English SF-MPQ 

(Wright, 2001; n = 188; mean age = 37.89 (11.45) years; mean time post injury = 27.99)There are a number of potential explanations for the differences in these results and those of Burckhardt and Bjelle (1994). First, it is possible that differences stemming from Burckhardt and Bjelle's (1994) translation of the SF-MPQ from English to Swedish may have influenced the observed factor structure. It is equally possible that subtile cultural differences may have influenced SF-MPQ adjective selection and, consequently, underlying factor structure. Second, it is possible that the differences in sex distribution of participants used in each study influenced observed results. Finally and perhaps most important (Burckhardt 1994) relied on an EFA approach that had a number of notable procedural shortcomings,whereass (Wright 2001) robust CFA procedures were employed.

Chronic Pain

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Content Validity

Chronic Low Back Pain:

(Wright, 2001; n = 188; mean age = 37.89 (11.45) years; mean time post injury = 27.99) One minor exception to Melzack’s model was the finding that item six (gnawing), originally designated as a sensory item, loaded onto the affective factor. This exception aside, these results confirm the factorial validity of the English SF-MPQ

(Wright, 2001; n = 188; mean age = 37.89 (11.45) years; mean time post injury = 27.99)There are a number of potential explanations for the differences in these results and those of Burckhardt and Bjelle (1994). First, it is possible that differences stemming from Burckhardt and Bjelle's (1994) translation of the SF-MPQ from English to Swedish may have influenced the observed factor structure. It is equally possible that subtile cultural differences may have influenced SF-MPQ adjective selection and, consequently, underlying factor structure. Second, it is possible that the differences in sex distribution of participants used in each study influenced observed results. Finally and perhaps most important (Burckhardt 1994) relied on an EFA approach that had a number of notable procedural shortcomings,whereass (Wright 2001) robust CFA procedures were employed.

Floor/Ceiling Effects

Chronic Pain: (Dworkin et al., 2009; n = 882; mean experience of chronic pain >8 years; SF-MPQ-2) 

SF-MPQ-2 Floor and Ceiling Effects:

Dimension 

Mean (SD) score 

% Floor 

% Ceiling 

Total Score 

853 

4.93 (2.04) 

0.0 

0.0 

Continuous Pain 

867 

5.82 (2.28) 

0.2 

1.8 

Intermittent Pain 

863 

4.92 (2.72) 

3.9 

1.7 

Neuropathic Pain 

870 

4.26 (2.57) 

4.1 

0.9 

Affective Descriptors 

868 

5.46 (2.84) 

3.2 

6.5 

 

Musculoskeletal Conditions

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Standard Error of Measurement (SEM)

Musculoskeletal: (Strand, 2008; n=58; mean age = 40.6 (9.8) years)

Minimal Detectable Change (MDC)

Musculoskeletal: (Strand, 2008; n=58; mean age = 40.6 (9.8) years)

Minimally Clinically Important Difference (MCID)

Musculoskeletal: (Strand, 2008; n=58; mean age = 40.6 (9.8) years)

Cut-Off Scores

 

Musculoskeletal: (Strand, 2008; n=58; mean age = 40.6 (9.8) years)

Normative Data

Musculoskeletal: (Strand, 2008; n=58; mean age = 40.6 (9.8) years)

Test/Retest Reliability

Musculoskeletal: (Strand, 2008; n=58; mean age = 40.6 (9.8) years)

Criterion Validity (Predictive/Concurrent)

Musculoskeletal: (Strand, 2008; n=58; mean age = 40.6 (9.8) years)

Construct Validity

Musculoskeletal: (Strand, 2008; n=58; mean age = 40.6 (9.8) years)

Floor/Ceiling Effects

Musculoskeletal Pain: (Menezes et al., 2011; n = 203; 38% = lower limb conditions, 29% = upper limb conditions, 23% = back pain, 8% = neck pain, and 3% = fibromyalgia; mean age = 42.5 (15.5) years; Brazilian-Portuguese Short Form of the MPQ used) 

No floor or ceiling effects observed for the SF-MPQ (calculated as > 15% highest or lowest possible score)

Responsiveness

Musculoskeletal: (Strand, 2008; n=58; mean age = 40.6 (9.8) years)

Bibliography

Burckhardt CS, Bjelle A. A Swedish version of the short-form McGill Pain Questionnaire. Scand J Rheumatol 1994;23:77–81.

Drudgeon, D., Raubertas, R. F., & Rosenthal, S. N. (1993). The Short-Form McGill Pain Questionnaire in Chronic Cancer Pain. Journal of Pain and Sympton Management, 8, 191-195.

Dworkin, R. H., Turk, D. C., et al. (2009). "Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2)." Pain 144(1-2): 35-42.

Gauthier, L.R., Young A., Dworkin, R.H., Rodin, G., Zimmermann, C., Warr, D., Librach, S.L., Moore, M., Shepherd, F.A., Riddell, R.P., Macpherson, A., Melzack, R., & Gagliese, L. (2014). Validation of the Short-Form McGill Pain Questionnaire-2 in Younger and Older People With Cancer Pain. The Journal of Pain, 15(7), 1-15. Retrieved fromwww.jpain.org

Georgoudis G, Oldham JA, Watson PJ. Reliability and sensitivity measures of the Greek version of the short form of the McGill Pain Questionnaire. Eur J Pain 2001;5:109–18.

Grafton KV, Foster NE, Wright CC. Test–retest reliability of the Short-Form McGill Pain Questionnaire – assessment of intraclass correlation coefficients and limits of agreement in patients with osteoarthritis. Clin J Pain 2005;21:73–82.

McDonald, Deborah D., and Constance S. Weiskopf. "E Adult Patients' Postoperative Pain Descriptions and Responses to the Short-Form McGill Pain Questionnaire." Clinical Nursing Research 10.442 (2001): N. pag. Web. 1 July 2014.

Melzack, Ronald. "The short-form McGill pain questionnaire." Pain 30.2 (1987): 191-197. Menezes Costa Lda, C., Maher, C. G., et al. (2011). "The Brazilian-Portuguese versions of the McGill Pain Questionnaire were reproducible, valid, and responsive in patients with musculoskeletal pain." J Clin Epidemiol 64(8): 903-912.

Strand, Liv Inger, et al. "The Short‐Form McGill Pain Questionnaire as an outcome measure: Test–retest reliability and responsiveness to change." European Journal of Pain 12.7 (2008): 917-925.

Wilkie, Diana J., et al. "Use of the McGill Pain Questionnaire to measure pain: a meta-analysis." Nursing Research 39.1 (1990): 36-41.

Yakut Y, Yakut E, Bayar K, Uygur F. Reliability and validity of the Turkish version short-form McGill pain questionnaire in patients with rheumatoid arthritis. Clin Rheumatol 2006;26:1083–7.

Truong PT, Abnousi F, Yong CM, Hayashi A, Runkel JA, Phillips T, Olivotto IA. (2005). Standardized Assessment of Breast Cancer Surgical Scars Integrating the Vancouver Scar Scale, Short-Form McGill Pain Questionnaire, and Patients’ Perspectives. Plastic and Reconstructive Surgery, 116(5), 1291-1299.

Wright, K. D., Asmundson, G. J., & McCreary, D. R. (2001). Factorial validity of the short‐form McGill pain questionnaire (SF‐MPQ). European Journal of Pain, 5(3), 279-284.

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