Clinical and Research Tools for Pain Assessment

  • Myrella Paschali
  • Asimina Lazaridou
  • Robert R. EdwardsEmail author


Pain is an internal, subjective experience that cannot be measured using physiologic markers or bioassays. The assessment of pain, therefore, relies largely on the use of self-report. Furthermore, individual differences in pain sensitivity and pain report have long remained a perplexing and challenging clinical problem. For instance, pain assessment can vary substantially across individuals based on patient demographic (e.g., culture, gender), psychosocial, and other features. Therefore, self-report measures follow a multidimensional approach aimed at characterizing multiple aspects of the pain experience such as chronicity, severity, quality, locations, affective impact, and associated factors. In special populations, limited cognitive or language skills may influence pain measures, as may the positive or negative consequences of an individual’s behaviors associate with pain.


Pain assessment Self-report measures Screening tools Pain rating scales Behavioral observation Pain intensity Pain affect Quantitative sensory testing Disability assessment Pain assessment challenges 


  1. 1.
    National Institutes of Health. Pain management. Research portfolio online reporting tools 2015.
  2. 2.
    Dworkin RH, Bruehl S, Fillingim RB, Loeser JD, Terman GW, Turk DC. Multidimensional diagnostic criteria for chronic pain: introduction to the ACTTION-American Pain Society Pain Taxonomy (AAPT). J Pain. 2016;17(9 Suppl):T1–9. Scholar
  3. 3.
    Turk DC, Melzack R, editors. Handbook of pain assessment. 3rd ed. New York: Guilford Press; 2011.Google Scholar
  4. 4.
    Kent ML, Tighe PJ, Belfer I, Brennan TJ, Bruehl S, Terman G, et al. The ACTTION–APS–AAPM Pain Taxonomy (AAAPT) multidimensional approach to classifying acute pain conditions. J Pain. 2017;18(5):479–89. Scholar
  5. 5.
    Melzack R, Casey KL. Sensory, motivational, and central control determinants of pain: a new conceptual model. In: Kenshalo D, editor. The skin senses. Springfield: Charles C Thomas; 1968. p. 423–43.Google Scholar
  6. 6.
    Jette AM. The functional status index: reliability and validity of a self-report functional disability measure. J Rheumatol. 1987;14(Suppl 15):15–21.Google Scholar
  7. 7.
    Wideman TH, Edwards RR, Walton DM, Martel MO, Hudon A, Seminowicz DA. The multi-modal assessment model of pain: a novel framework for further integrating the subjective pain experience within research and practice. Clin J Pain. 2018;1. Scholar
  8. 8.
    Seymour RA. The use of pain scales in assessing the efficacy of analgesics in post-operative dental pain. Eur J Clin Pharmacol. 1982;23(5):441–4. Scholar
  9. 9.
    Price DD, Bush FM, Long S, Harkins SW. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain. 1994;56(2):217–26. Scholar
  10. 10.
    Jensen MP, Karoly P, O’Riordan EF, Bland F, Burns RS. The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain. 1989;5(2):153–9.PubMedGoogle Scholar
  11. 11.
    Bieri D, Reeve RA, Champion GD, Addicoat L, Ziegler JB. The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: development, initial validation, and preliminary investigation for ratio scale properties. Pain. 1990;41(2):139–50.PubMedGoogle Scholar
  12. 12.
    Stuppy DJ. The Faces Pain Scale: reliability and validity with mature adults. Appl Nurs Res. 1998;11(2):84–9.PubMedGoogle Scholar
  13. 13.
    Gracely RH, McGrath F, Dubner R. Ratio scales of sensory and affective verbal pain descriptors. Pain. 1978;5(1):5–18.PubMedGoogle Scholar
  14. 14.
    Price DD, Von der Gruen A, Miller J, Rafii A, Price C. A psychophysical analysis of morphine analgesia. Pain. 1985;22(3):261–9.PubMedGoogle Scholar
  15. 15.
    Duncan GH, Bushnell MC, Lavigne GJ. Comparison of verbal and visual analogue scales for measuring the intensity and unpleasantness of experimental pain. Pain. 1989;37(3):295–303.PubMedGoogle Scholar
  16. 16.
    Gaston-Johansson F. Measurement of pain: the psychometric properties of the Pain-O-Meter, a simple, inexpensive pain assessment tool that could change health care practices. J Pain Sympt Manag. 1996;12(3):172–81. Scholar
  17. 17.
    Galer BS, Jensen MP. Development and preliminary validation of a pain measure specific to neuropathic pain: the Neuropathic Pain Scale. Neurology. 1997;48(2):332–8.PubMedGoogle Scholar
  18. 18.
    Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22(10):1911–20. Scholar
  19. 19.
    Nikaido T, Sumitani M, Sekiguchi M, Konno S. The Spine painDETECT questionnaire: development and validation of a screening tool for neuropathic pain caused by spinal disorders. PLoS One. 2018;13(3):e0193987. Scholar
  20. 20.
    Margolis RB, Tait RC, Krause SJ. A rating system for use with patient pain drawings. Pain. 1986;24(1):57–65. Scholar
  21. 21.
    Toomey TC, Gover VF, Jones BN. Spatial distribution of pain: a descriptive characteristic of chronic pain. Pain. 1983;17(3):289–300. Scholar
  22. 22.
    Melzack R. The McGill pain questionnaire: major properties and scoring methods. Pain. 1975;1(3):277–99.PubMedGoogle Scholar
  23. 23.
    Melzack R. The short-form McGill pain questionnaire. Pain. 1987;30(2):191–7. Scholar
  24. 24.
    Fordyce WE. Behavioral methods for chronic pain and illness. St. Louis: Mosby; 1976.Google Scholar
  25. 25.
    Craig KD. The facial expression of pain better than a thousand words? APS J. 1992;1(3):153–62. Scholar
  26. 26.
    Poole GD, Craig KD. Judgments of genuine, suppressed, and faked facial expressions of pain. J Pers Soc Psychol. 1992;63(5):797–805.PubMedGoogle Scholar
  27. 27.
    Prkachin KM. Assessing pain by facial expression: facial expression as nexus. Pain Res Manag. 2009;14(1):53–8.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Ekman P, Friesen WV. Measuring-facial-movement. Environ Psychol Nonverbal Behav. 1976;1(1). Retrieved from Scholar
  29. 29.
    Prkachin M. The consistency of facial expressions of pain: a comparison across modalities. Pain. 1992a;51:297–306.PubMedGoogle Scholar
  30. 30.
    Arendt-Nielsen L. Pain sensitisation in osteoarthritis. Clin Exp Rheumatol. 2017;35(Suppl 107(5)):68–74.PubMedGoogle Scholar
  31. 31.
    Forstenpointner J, Otto J, Baron R. Individualized neuropathic pain therapy based on phenotyping: are we there yet? Pain. 2018;159(3):569–75. Scholar
  32. 32.
    Mao J. Opioid-induced hyperalgesia. New York: Informa Healthcare USA; 2010.Google Scholar
  33. 33.
    Compton P, Charuvastra VC, Ling W. Pain intolerance in opioid-maintained former opiate addicts: effect of long-acting maintenance agent. Drug Alcohol Depend. 2001;63(2):139–46.PubMedGoogle Scholar
  34. 34.
    Doverty M, White JM, Somogyi AA, Bochner F, Ali R, Ling W. Hyperalgesic responses in methadone maintenance patients. Pain. 2001;90(1–2):91–6.PubMedGoogle Scholar
  35. 35.
    Coghill RC, Eisenach J. Individual differences in pain sensitivity: implications for treatment decisions. Anesthesiology. 2003;98(6):1312–4.PubMedGoogle Scholar
  36. 36.
    Barad MJ, Ueno T, Younger J, Chatterjee N, Mackey S. Complex regional pain syndrome is associated with structural abnormalities in pain-related regions of the human brain. J Pain. 2014;15(2):197–203. Scholar
  37. 37.
    Borsook D, Becerra L, Fava M. Use of functional imaging across clinical phases in CNS drug development. Transl Psychiatry. 2013;3(7):e282. Scholar
  38. 38.
    Smith SM, Dworkin RH, Turk DC, Baron R, Polydefkis M, Witter J, et al. The potential role of sensory testing, skin biopsy, and functional brain imaging as biomarkers in chronic pain clinical trials: IMMPACT considerations. J Pain. 2017;18(7):757–77. Scholar
  39. 39.
    Chapin H, Bagarinao E, Mackey S. Real-time fMRI applied to pain management. Neurosci Lett. 2012;520(2):174–81. Scholar
  40. 40.
    Davis KD. Legal and ethical issues of using brain imaging to diagnose pain. Pain Rep. 2016;1(4). Scholar
  41. 41.
    McGrath PJ, Walco GA, Turk DC, Dworkin RH, Brown MT, Zeltzer L. Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations. J Pain. 2008;9(9):771–83. Scholar
  42. 42.
    von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain. 2007;127(1–2):140–50. Scholar
  43. 43.
    Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993;12(6):59–66.PubMedGoogle Scholar
  44. 44.
    Gibson SJ, Lussier D. Prevalence and relevance of pain in older persons. Pain Med. 2012;13(Suppl 2):S23–6. Scholar
  45. 45.
    Bruckenthal P. Clinics in geriatric medicine, 2008. In: Assessment of pain in the elderly adult-ClinicalKey. Retrieved November 24, 2018, from!/content/playContent/1-s2.0-S0749069007001061?returnurl=null&referrer=null.
  46. 46.
    Cleeland CS, Ryan KM. Pain assessment: global use of the brief pain inventory. Ann Acad Med Singap. 1994;23(2):129–38.PubMedGoogle Scholar
  47. 47.
    Tait RC, Chibnall JT, Krause S. The pain disability index: psychometric properties. Pain. 1990;40(2):171–82. Scholar
  48. 48.
    Gloth FM, Scheve AA, Stober CV, Chow S, Prosser J. The Functional Pain Scale: reliability, validity, and responsiveness in an elderly population. J Am Med Dir Assoc. 2001;2(3):110–4.PubMedGoogle Scholar
  49. 49.
    Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain. 1985;23(4):345–56. Scholar
  50. 50.
    Ferrell BA, Ferrell BR, Rivera L. Pain in cognitively impaired nursing home patients. J Pain Symptom Manag. 1995;10(8):591–8.Google Scholar
  51. 51.
    Hadjistavropoulos T, Herr K, Turk DC, Fine PG, Dworkin R, Williams J, et al. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain. 2007;23(1 Suppl):S1–43. Scholar
  52. 52.
    LaChapelle DL, Hadjistavropoulos T, Craig KD. Pain measurement in persons with intellectual disabilities. Clin J Pain. 1999;15(1):13–23.PubMedGoogle Scholar
  53. 53.
    Malara A, De Biase GA, Bettarini F, Ceravolo F, Di Cello S, Rispoli V, et al. Pain assessment in elderly with behavioral and psychological symptoms of dementia. J Alzheimers Dis. 2016;50(4):1217–25. Scholar
  54. 54.
    Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc. 2003;4(1):9–15. Scholar
  55. 55.
    Kunz M, Scharmann S, Hemmeter U, Schepelmann K, Lautenbacher S. The facial expression of pain in patients with dementia. Pain. 2007;133(1–3):221–8. Scholar
  56. 56.
    Chan S, Hadjistavropoulos T, Williams J, Lints-Martindale A. Evidence-based development and initial validation of the pain assessment checklist for seniors with limited ability to communicate-II (PACSLAC-II). Clin J Pain. 2014;30(9):816–24. Scholar
  57. 57.
    Stubbs B, Thompson T, Acaster S, Vancampfort D, Gaughran F, Correll CU. Decreased pain sensitivity among people with schizophrenia: a meta-analysis of experimental pain induction studies. Pain. 2015;156(11):2121–31. Scholar
  58. 58.
    Potvin S, Marchand S. Hypoalgesia in schizophrenia is independent of antipsychotic drugs: a systematic quantitative review of experimental studies. Pain. 2008;138(1):70–8. Scholar
  59. 59.
    Singh MK, Giles LL, Nasrallah HA. Pain insensitivity in schizophrenia: trait or state marker? J Psychiatr Pract. 2006;12(2):90–102.PubMedGoogle Scholar
  60. 60.
    Pasero C, McCaffery M. Pain assessment and pharmacologic management. 1st ed. Philadelphia: Elsevier; 2011; ISBN 9780323056960.Google Scholar
  61. 61.
    Watson GD, Chandarana PC, Merskey H. Relationships between pain and schizophrenia. Br J Psychiatry. 1981;138:33–6.PubMedGoogle Scholar
  62. 62.
    Norman SB, Stein MB, Dimsdale JE, Hoyt DB. Pain in the aftermath of trauma is a risk factor for post-traumatic stress disorder. Psychol Med. 2008;38(4):533–42. Scholar
  63. 63.
    Asmundson GJ, Coons MJ, Taylor S, Katz J. PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatr. 2002;47(10):930–7. Scholar
  64. 64.
    Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 2009;10(5):447–85. Scholar
  65. 65.
    Pieretti S, Di Giannuario A, Di Giovannandrea R, Marzoli F, Piccaro G, Minosi P, et al. Gender differences in pain and its relief. Annali Dell’Istituto Superiore Di Sanita. 2016;52(2):184–9. Scholar
  66. 66.
    Fillingim RB, Maixner W. Gender differences in the responses to noxious stimuli. Pain Forum. 1995;4(4):209–21. Scholar
  67. 67.
    Riley JL, Robinson ME, Wise EA, Myers CD, Fillingim RB. Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain. 1998;74(2–3):181–7.PubMedGoogle Scholar
  68. 68.
    LeResche L, Mancl L, Sherman JJ, Gandara B, Dworkin SF. Changes in temporomandibular pain and other symptoms across the menstrual cycle. Pain. 2003;106(3):253–61.PubMedGoogle Scholar
  69. 69.
    Brynhildsen JO, Björs E, Skarsgård C, Hammar ML. Is hormone replacement therapy a risk factor for low back pain among postmenopausal women? Spine. 1998;23(7):809–13.PubMedGoogle Scholar
  70. 70.
    Zubieta J-K, Smith YR, Bueller JA, Xu Y, Kilbourn MR, Stohler CS, et al. μ-opioid receptor-mediated antinociceptive responses differ in men and women. J Neurosci. 2002;22(12):5100–7.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Peacock S, Patel S. Cultural influences on pain. Rev Pain. 2008;1(2):6–9. Scholar
  72. 72.
    Shavers VL, Bakos A, Sheppard VB. Race, ethnicity, and pain among the U.S. adult population. J Health Care Poor Underserved. 2010;21(1):177–220. Scholar
  73. 73.
    Giger JN, Davidhizar RE. Transcultural nursing: assessment and intervention. 5th ed. London: Mosby; 2008.Google Scholar
  74. 74.
    Redelmeier DA. Patients’ memories of painful medical treatments: real-time and retrospective evaluations of two minimally invasive procedures. Pain. 1996;66:3–8.PubMedGoogle Scholar
  75. 75.
    Gedney JJ, Logan H. Pain related recall predicts future pain report. Pain. 2006;121(1):69–76. Scholar
  76. 76.
    Eich E, Reeves JL, Jaeger B, Graff-Radford SB. Memory for pain: relation between past and present pain intensity. Pain. 1985;23(4):375–80.PubMedGoogle Scholar
  77. 77.
    de la Vega R, Roset R, Castarlenas E, Sánchez-Rodríguez E, Solé E, Miró J. Development and testing of painometer: a smartphone app to assess pain intensity. J Pain. 2014;15(10):1001–7. Scholar
  78. 78.
    Liew CV, Standridge K, Leon G, Cronan TA. A longitudinal analysis of pain experience and recall in fibromyalgia. Int J Rheum Dis. 2018. Scholar
  79. 79.
    World Health Organization. International classification of functioning, disability, and health: ICF. Geneva: World Health Organization; 2001.Google Scholar
  80. 80.
    Lin CW, McAuley JH, Macedo L, Barnett DC, Smeets RJ, Verbunt JA. Relationship between physical activity and disability in low back pain: a systematic review and meta-analysis. Pain. 2011;152(3):607–13. Scholar
  81. 81.
    Verbunt JA, Huijnen IP, Köke A. Assessment of physical activity in daily life in patients with musculoskeletal pain. Eur J Pain. 2009;13(3):231–42. Scholar
  82. 82.
    Stevens ML, Lin CC, Maher CG. The Roland Morris disability questionnaire. J Physiother. 2016;62(2):116. Scholar
  83. 83.
    Smeets R, Köke A, Lin C-W, Ferreira M, Demoulin C. Measures of function in low back pain/disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland-Morris Disability Questionnaire (RDQ). Arthritis Care Res. 2011;63(S11):S158–73. Scholar
  84. 84.
    Kopec JA, Esdaik JM, Abrahamowicz M, Abe L, Wood-Dauphinee S, Lumping DL, et al. The Quebec back pain disability scale: conceptualization and development. J Clin Epidemiol. 1996;49(2):151–61.PubMedGoogle Scholar
  85. 85.
    Sadaf D, Ahmad MZ. Factors associated with postoperative pain in endodontic therapy. Int J Biomed Sci. 2014;10(4):5.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Myrella Paschali
    • 1
  • Asimina Lazaridou
    • 1
  • Robert R. Edwards
    • 1
    Email author
  1. 1.Department of AnesthesiologyBrigham and Women’s HospitalChestnut HillUSA

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