Current Pain and Headache Reports

, Volume 13, Issue 1, pp 39–43 | Cite as

Pain outcomes: A brief review of instruments and techniques

  • Jarred YoungerEmail author
  • Rebecca McCue
  • Sean Mackey


Pain is a difficult outcome to measure due to its multifaceted and subjective nature. The need for selecting proper outcome measures is high because of the increasing demand for scientifically valid demonstrations of treatment efficacy. This article discusses some basic topics in the measurement of pain outcomes and addresses issues such as statistical versus clinical significance, daily home data collection, appropriate length of outcome measurement packets, and the possibility of objective pain measurements. This article also reviews some of the more commonly used tools for measuring pain and pain-related disability. By selecting the proper tools and employing them correctly, we can obtain highly reliable and valid measures of pain outcomes in research and clinical care.


Chronic Pain Pain Intensity Numerical Rating Scale Skin Conductance Minimal Important Clinical Difference 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Turk DC, Melzack R: Handbook of Pain Assessment. New York: Guilford Press; 2001.Google Scholar
  2. 2.
    Todd KH: Clinical versus statistical significance in the assessment of pain relief. Ann Emerg Med 1996, 27:439–441.PubMedCrossRefGoogle Scholar
  3. 3.
    Farrar JT, Young JP, LaMoreaux L, et al.: Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001, 94:149–158.PubMedCrossRefGoogle Scholar
  4. 4.
    Farrar JT, Berlin JA, Strom BL: Clinically important changes in acute pain outcome measures: a validation study. J Pain Symptom Manage 2003, 25:406–411.PubMedCrossRefGoogle Scholar
  5. 5.
    Kvien TK, Heiberg T, Hagen KB: Minimal clinically important improvement/difference (MCII/MCID) and patient acceptable symptom state (PASS): what do these concepts mean? Ann Rheum Dis 2007, 66(Suppl 3):iii40–iii41.PubMedCrossRefGoogle Scholar
  6. 6.
    Dworkin RH, Turk DC, Wyrwich KW, et al.: Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain 2008, 9:105–121.PubMedCrossRefGoogle Scholar
  7. 7.
    Louis TA, Lavori PW, Bailar JC, et al.: Crossover and self-controlled designs in clinical research. N Engl J Med 1984, 5:24–31.CrossRefGoogle Scholar
  8. 8.
    Vickers AJ: How many repeated measures in repeated measures designs? Statistical issues for comparative trials. BMC Med Res Methodol 2003, 3:22.PubMedCrossRefGoogle Scholar
  9. 9.
    Experiential Sampling Program. Available at Accessed August 2008.
  10. 10.
    Wright DB: Making friends with your data: improving how statistics are conducted and reported. Br J Educ Psychol 2003, 73:123–136.PubMedCrossRefGoogle Scholar
  11. 11.
    Dworkin RH, Turk DC, Farrar JT, et al.: Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005, 113:9–19.PubMedCrossRefGoogle Scholar
  12. 12.
    Melzack R: The short-form McGill Pain Questionnaire. Pain 1987, 30:191–197.PubMedCrossRefGoogle Scholar
  13. 13.
    Cleeland CS, Ryan KM: Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 1994, 19:129–138.Google Scholar
  14. 14.
    Kerns RD, Turk DC, Rudy TE: The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985, 23:345–356.PubMedCrossRefGoogle Scholar
  15. 15.
    Rogers WH, Wittink H, Wagner A, et al.: Assessing individual outcomes during outpatient multidisciplinary chronic pain treatment by means of an augmented SF-36. Pain Med 2000, 1:44–54.PubMedCrossRefGoogle Scholar
  16. 16.
    Li D, Puntillo K, Miaskowski C: A review of objective pain measures for use with critical care adult patients unable to self-report. J Pain 2008, 9:2–10.PubMedCrossRefGoogle Scholar
  17. 17.
    Hummel P, van Dijk M: Pain assessment: current status and challenges. Semin Fetal Neonatal Med 2006, 11:237–245.PubMedCrossRefGoogle Scholar
  18. 18.
    Chizh BA, Hobson AR: Using objective markers and imaging in the development of novel treatments of chronic pain. Expert Rev Neurother 2007, 7:443–447.PubMedCrossRefGoogle Scholar
  19. 19.
    Storm H: Skin conductance and the stress response from heel stick in preterm infants. Arch Dis Child Fetal Neonatal Ed 2000, 83:F143–F147.PubMedCrossRefGoogle Scholar
  20. 20.
    Tousignant-Laflamme Y, Rainville P, Marchand S: Establishing a link between heart rate and pain in healthy subjects: a gender effect. J Pain 2005, 6:341–347.PubMedCrossRefGoogle Scholar
  21. 21.
    Bossart P, Fosnocht D, Swanson E: Changes in heart rate do not correlate with changes in pain intensity in emergency department patients. J Emerg Med 2007, 32:19–22.PubMedCrossRefGoogle Scholar
  22. 22.
    Hellerud BC, Storm H: Skin conductance and behaviour during sensory stimulation of preterm and term infants. Early Hum Develop 2002, 70:35–46.CrossRefGoogle Scholar
  23. 23.
    Harrison D, Boyce S, Loughnan P, et al.: Skin conductance as a measure of pain and stress in hospitalised infants. Early Hum Develop 2006, 82:603–608.CrossRefGoogle Scholar
  24. 24.
    Ledowski T, Bromilow J, Peach MJ, et al.: Monitoring of skin conductance to assess postoperative pain intensity. Br J Anaesth 2006, 97:862–865.PubMedCrossRefGoogle Scholar
  25. 25.
    Schasfoort FC, Formanoy MAG, Bussmann JBJ, et al.: Objective and continuous measurement of peripheral motor indicators of pain in hospitalized infants: a feasibility study. Pain 2008, 137:323–331.PubMedCrossRefGoogle Scholar
  26. 26.
    Okuse K: Pain signaling pathways: from cytokines to ion channels. Int J Biochem 2007, 39:490–496.CrossRefGoogle Scholar
  27. 27.
    Coghill RC, Sang CN, Maisog JA, et al.: Pain intensity processing within the human brain: a bilateral, distributed mechanism. J Neurophysiol 1999, 82:1934–1943.PubMedGoogle Scholar
  28. 28.
    Harding VR, Williams AC, Richardson PH, et al.: The development of a battery of measures for assessing physical functioning of chronic pain patients. Pain 1994, 58:367–375.PubMedCrossRefGoogle Scholar
  29. 29.
    Smeets RJ, Hijdra HJ, Kester AD, et al.: The usability of six physical performance tasks in a rehabilitation population with chronic low back pain. Clin Rehabil 2006, 20:989–998.PubMedCrossRefGoogle Scholar
  30. 30.
    Stratford PW, Kennedy DM, Woodhouse LJ: Performance measures provide assessments of pain and function in people with advanced osteoarthritis of the hip or knee. Phys Ther 2006, 86:1489–1496.PubMedCrossRefGoogle Scholar
  31. 31.
    Goodson A, McGregor AH, Douglas J, et al.: Direct, quantitative clinical assessment of hand function: usefulness and reproducibility. Man Ther 2007, 12:144–152.PubMedCrossRefGoogle Scholar
  32. 32.
    Simmonds MJ, Olson SL, Jones S, et al.: Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain. Spine 1998, 23:2412–2421.PubMedCrossRefGoogle Scholar
  33. 33.
    Ballinger DA, Rintala DH, Hart KA: The relation of shoulder pain and range-of-motion problems to functional limitations, disability, and perceived health of men with spinal cord injury: a multifaceted longitudinal study. Arch Phys Med Rehabil 2000, 81:1575–1581.PubMedCrossRefGoogle Scholar
  34. 34.
    Salisbury SK, Choy NL, Nitz J: Shoulder pain, range of motion, and functional motor skills after acute tetraplegia. Arch Phys Med Rehabil 2003, 84:1480–1485.PubMedCrossRefGoogle Scholar
  35. 35.
    Weiner DK, Rudy TE, Morrow L, et al.: The relationship between pain, neuropsychological performance, and physical function in community-dwelling older adults with chronic low back pain. Pain Med 2006, 7:60–70.PubMedCrossRefGoogle Scholar
  36. 36.
    Novy DM, Simmonds MJ, Lee CE: Physical performance tasks: what are the underlying constructs? Arch Phys Med Rehabil 2002, 83:44–47.PubMedCrossRefGoogle Scholar
  37. 37.
    Moseley GL: Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain 2004, 8:39–45.PubMedCrossRefGoogle Scholar
  38. 38.
    Thomas JS, France CR: The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain. Eur Spine J 2008, 17:97–103.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2009

Authors and Affiliations

  1. 1.Department of Anesthesia, Division of Pain ManagementStanford University School of MedicinePalo AltoUSA

Personalised recommendations