Early Version: The Wisconsin Brief Pain Questionnaire
The first version of our pain measure was the Wisconsin Brief Pain Questionnaire (BPQ; Daut & Cleeland, 1982; Daut, Cleeland, & Flanery, 1983). In the initial phase of scale development, 667 patients with cancer and 32 patients with rheumatoid arthritis were administered a three-page questionnaire and interviewed about the basic parameters of their pain (Daut et al., 1982). Patients who had experienced pain in the last month were asked to rate their pain intensity at its “worst,”“average,”and “now”and to rate the extent to which pain had interfered with activity and enjoyment of life. Patients were also asked to mark their pain location(s) on front/back body diagrams and to describe their perception of the cause of pain, the types of pain treatment they were receiving, and the amount of relief provided by their treatment. Patients were also asked to describe the quality of their pain by choosing words among a list of verbal descriptors derived from the McGill Pain Questionnaire (Melzack, 1975).
The design of the four-page BPQ was based on this initial questionnaire. In the BPQ, a 0–10 numerical rating scale was used to measure three pain severity items: “worst”in the past month, “average,” and “now,”where 0=no pain and 10=pain as bad as you can imagine. The interference items were measured using a five-option verbal descriptor scale, with ratings of 0=not at all, 1=a little bit, 2=moderately, 3=quite a bit, and 4=extremely. The recall period for both severity and interference scales was “in the last week.”The BPQ also retained the body diagram from the initial questionnaire, along with word descriptors of pain quality and questions about types and effectiveness of pain treatment, the patient’s perception of the cause of pain, and certain demographic information.
A second study (Daut et al., 1983) investigated the psychometric properties of the BPQ. This set of analyses was based on BPQ data obtained from more than 1200 patients with cancer at The University of Wisconsin Cancer Center. To determine test-retest characteristics of the BPQ, subsamples of patients completed the BPQ on two or more occasions. For comparison with other disease sites, a sample of patients with pain from rheumatoid arthritis was also surveyed.
Most of the patients were able to complete the BPQ by themselves with little or no instruction; others were interviewed to complete the questionnaire. A subset 25 patients completed both an interview-administered and self-administered version of the survey in counterbalanced order. We found little difference in ratings due to mode of administration. As expected, test-retest reliability varied by item. Short (days) test-retest reliability was 0.93 for “worst pain,”but only 0.59 for “pain now.”Preliminary exploration found that patient-reported pain severity and interference were directly associated with the use of opioid analgesics and the severity of disease.
The Brief Pain Inventory
The next iteration of our pain measure was the long form of the Brief Pain Inventory (BPI; Cleeland, 1989; Cleeland, 1990; Cleeland, 1991; Cleeland & Ryan, 1994). In this new instrument, we added the item “least pain”to the severity items and dropped the categorical rating scale for the interference items, in response to patient preference. The interference items were now presented with 0–10 scales, with 0=no interference and 10=interferes completely. The initial version of the BPI used a recall period of one week for both pain severity and pain interference ratings, included questions about medication use, and asked the patient to check potential pain quality descriptors that may describe their pain. The BPI long form also asked questions about the percentage and duration of pain relief and nonmedical methods used to relieve pain.
This version of the BPI proved to be too lengthy for repeated use in clinical monitoring or as a repeated measure in research. As a result, we developed a shorter version of the BPI. This version of the BPI retained the front and back body diagrams, the four pain severity items and seven pain interference items rated on 0–10 scales, and the question about percentage of pain relief by analgesics. The most important difference between the longer and shorter versions of the BPI is that the latter uses a 24-hour recall period.
Whereas the BPI long form is still used as a baseline measure in clinical trials, the shorter version has become the standard for use
