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The Brief Pain Inventory Copyright and Terms of Use
User Guide
The Brief Pain Inventory (BPI) copyright is held by
Dr. Charles S. Cleeland (1991). The copyright
applies to the BPI and all its derivatives in any
language.
The BPI may not be used or reproducedwithout
permission from Charles S. Cleeland, PhD, or his
designee. Fees for use may apply.
The BPImay not be modified or translated into
another language without the express written
consent of the copyright holder. Failure to
comply may resul
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Table of Contents Chapter 1................................................................. 1 Development of the Brief Pain Inventory..............1 Background........................................................1 Developing a Measurement Model and Items2 Test Construction Standards.........................3 Measurement Conceptualization: Multiple Dimensions of Pain........................................ 3 Early Version: The Wisconsin Brief Pain Questionnaire................................
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A first step in this effort was to document the extent of poor pain management. The National Cancer Institute (NCI) and the Cancer Chapter 1 Unit of the World Health Organization (WHO) wanted Development of the Brief Pain measurement instruments that would better capture the severity and impact of cancer pain and measure improvement in pain Inventory after changes in analgesic practice or implementation of new pain treatments. These instruments also needed to function well in largescale nationa
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would be easily translated for nonEnglishspeaking patients; and daily function). We constructed four items to capture the variability (e) would capture not only pain severity, but also the perception of pain over time: pain at its “worst,” “least,” “average,” and of how pain interfered with daily life. “now” (current pain). On the basis of patient interviews from additional field testing, we chose seven items that measured how Test Construction Standards much pain interfered with various daily
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Most of the patients were able to complete the BPQ by Early Version: The Wisconsin Brief Pain Questionnaire themselves with little or no instruction; others were interviewed to The first version of our pain measure was the Wisconsin Brief Pain complete the questionnaire. A subset 25 patients completed both Questionnaire (BPQ; Daut & Cleeland, 1982; Daut, Cleeland, & an interviewadministered and selfadministered version of the Flanery, 1983). In the initial phase of scale development, 667 surve
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in clinical and research applications. The short form is typically We are exploring the utility of scoring the activity and affective what is referred to when the BPI is cited in research, and it is the dimensions described above (WAW and REM, see diagram [link]) version we describe below. Most psychometric evaluations of the as arithmetic means of these sets of items. BPI have been performed on the short form. How to Score the BPI: Other Items Scoring the Brief Pain Inventory as an Outcome Meas
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from 80 centers were enrolled in the study (Cleeland et al., 1994). TestRetest Reliability Factor analysis verified the two separate factors, pain severity and Values from any measure should not differ significantly between interference, found in the previous study. Internal stability assessments. The underlying concept of a measure should not (Cronbach alpha) was also examined in this study. Alphas showed change between assessments. This psychometric concept applies good internal consistency,
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TestRetest Reliability and AlternateForms Reliability: the Hindi Cleeland CS. Pain assessment in cancer. In: Osoba D, editor. Effect Translation of Cancer on Quality of Life. Boca Raton: CRC Press, Inc.; pp. 293305, 1991. Finally, one study combined an examination of both testretest reliability and alternateforms reliability (Saxena et al., 1999). In this Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart study, 100 patients with cancer who spoke both English and Hindi JA, Pan
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clinical trials: IMMPACT recommendations.J Pain 9(2): 105121, JP, Royal MA, Simon L, Stauffer JW, Stein W, Tollett J, Witter J. 2/2008. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations.Pain 106: 337345, 2003. Food and Drug Administration. Guidelines for Industry (draft). PatientReported Outcome Measures: Use in Medical Product Turk DC, Dworkin RH, Burke LB, Gershon R, Rothman M, Scott J, Development to Support Labeling Claims. 2006. Rockville MD, Allen RR, Atkin
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Chapter 2 Cancer Bone Pain BPI References: Use of the BPI in 1. Ahles TA, Herndon JE, Small EJ, Vogelzang NJ, Kornblith AB, Ratain MJ, Stadler W, Palchak D, Marshall ME, Wilding G, Various Studies Petrylak D, Holland JC. Quality of life impact of three different doses of suramin in patients with metastatic hormone refractory prostate carcinoma: results of Intergroup The Brief Pain Inventory has been used in more O159/Cancer and Leukemia Group B 9480. Cancer 101(10): than 400 studies worldwide.
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induced pain flare after palliative radiotherapy for bone 16. Hartsell WF, Scott CB, Bruner DW, Scarantino CW, Ivker RA, metastasesa pilot study. Support Care Cancer 15(6): 643647, Roach M, III, Suh JH, Demas WF, Movsas B, Petersen IA, Konski 6/2007. AA, Cleeland CS, Janjan NA, DeSilvio M. Randomized trial of short versus longcourse radiotherapy for palliation of painful 8. Cleeland CS. The measurement of pain from metastatic bone bone metastases. J Natl Cancer Inst 97(11): 798804, 6/2005.
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metastases in cancer patients]. Nippon Igaku Hoshasen interference in patients with painful bone metastases: a Gakkai Zasshi 65(4): 399410, 10/2005. quality assurance study. Clin Oncol (R Coll Radiol ) 18(7): 539 544, 9/2006. 24. PistevouGompaki K, Kouloulias VE, Varveris C, Mystakidou K, Georgakopoulos G, Eleftheriadis N, Gompakis N, Kouvaris J. 32. Yamada K, Kohno N. [Efficacy of bisphosphonates for bone Radiotherapy plus either transdermal fentanyl or paracetamol pain control]. Nippon Rins
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9. Holtan A, Aass N, Nordoy T, Haugen DF, Kaasa S, Mohr W, Cancer Pain. International Association for the Study of Pain. Kongsgaard UE. Prevalence of pain in hospitalised cancer Pain 82(3): 263274, 9/1999. patients in Norway: a national survey. Palliat Med 21(1): 713, 5. Caraceni A, Martini C, Zecca E, Portenoy RK, Ashby MA, 1/2007. Hawson G, Jackson KA, Lickiss N, Muirden N, Pisasale M, 10. Kongsgaard UE, Holtan A, Aass N. Prevalence of cancer pain Moulin D, Schulz VN, Rico Pazo MA, Serrano J
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Cooperative Oncology Group. Ann Oncol 16(6): 972980, 19. Hsu TH, Lu MS, Tsou TS, Lin CC. The relationship of pain, 6/2005. uncertainty, and hope in Taiwanese lung cancer patients. J Pain Symptom Manage 26(3): 835842, 9/2003. 11. Du Pen SL, Du Pen AR, Polissar N, Hansberry J, Kraybill BM, Stillman M, Panke J, Everly R, Syrjala K. Implementing 20. Huang HY, Wilkie DJ, Chapman CR, Ting LL. Pain trajectory of guidelines for cancer pain management: results of a Taiwanese with nasopharyngeal carcino
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28. Liang SY, Yates P, Edwards H, Tsay SL. Factors influencing P, Poggi B, Fochessati F, Giannunzio D, Barbagallo ML, opioidtaking selfefficacy and analgesic adherence in Minnotti V, Betti M, Giordani S, Piazza E, Scapaticci R, Ferrario Taiwanese outpatients with cancer. Psychooncology, 3/2008. S. A validation study of the WHO analgesic ladder: a twostep vs threestep strategy. Support Care Cancer 13(11): 888894, 29. Lin CC. Comparison of the effects of perceived selfefficacy 11/2005. on co
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morphine pretreated and opioid naive patients with Weinberg A, Boardman KD, Williams HM, Zhang JH, Peduzzi transdermal fentanyl. Int J Cancer 107(3): 486492, 11/2003. PN, Beisel CE, Morrison VA, Guatelli JC, Brooks PA, Kauffman CA, Pachucki CT, Neuzil KM, Betts RF, Wright PF, Griffin MR, 46. Mystakidou K, Parpa E, Katsouda E, Galanos A, Vlahos L. Brunell P, Soto NE, Marques AR, Keay SK, Goodman RP, Influence of pain and quality of life on desire for hastened Cotton DJ, Gnann JW, Jr., Loutit J,
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population of men with prostate cancer. Br J Cancer 85(4): 69. Tsai PS, Chen PL, Lai YL, Lee MB, Lin CC. Effects of 497503, 8/2001. electromyography biofeedbackassisted relaxation on pain in patients with advanced cancer in a palliative care unit. 62. Sandblom G, Carlsson P, Sennfalt K, Varenhorst E. A Cancer Nurs 30(5): 347353, 9/2007. populationbased study of pain and quality of life during the year before death in men with prostate cancer. Br J Cancer 70. Twycross R, Harcourt J, Bergl S.
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8. Poleshuck EL, Giles DE, Tu X. Pain and depressive symptoms Depressive Disorders among financially disadvantaged women's health patients. J 1. Brannan SK, Mallinckrodt CH, Brown EB, Wohlreich MM, Watkin Womens Health (Larchmt ) 15(2): 182193, 3/2006. JG, Schatzberg AF. Duloxetine 60 mg oncedaily in the 9. Wasan AD, Butler SF, Budman SH, Benoit C, Fernandez K, treatment of painful physical symptoms in patients with major Jamison RN. Psychiatric History and Psychologic Adjustment depressive di
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7. Schiffmann R, Kopp JB, Austin HA, III, Sabnis S, Moore DF, safety of duloxetine for treatment of fibromyalgia in patients Weibel T, Balow JE, Brady RO. Enzyme replacement therapy in with or without major depressive disorder: Results from a 6 Fabry disease: a randomized controlled trial. JAMA 285(21): month, randomized, doubleblind, placebocontrolled, fixed 27432749, 6/2001. dose trial. Pain 136(3): 432444, 6/2008. 8. Rutledge DN, Jones CJ. Effects of topical essential oil on Fibromyalgi
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8. Newshan G, Lefkowitz M. Transdermal fentanyl for chronic 6. Poleshuck EL, Giles DE, Tu X. Pain and depressive symptoms pain in AIDS: a pilot study. J Pain Symptom Manage 21(1): 69 among financially disadvantaged women's health patients. J 77, 1/2001. Womens Health (Larchmt ) 15(2): 182193, 3/2006. 9. Simmonds MJ, Novy D, Sandoval R. The differential influence Neuromuscular Pain of pain and fatigue on physical performance and health status in ambulatory patients with human immunodeficiency 1
