A systematic review of measures used to assess chronic musculoskeletal pain in clinical and randomized controlled clinical trials.
There are many types of pain assessments available to researchers conducting clinical trials, ranging from simple, single-item Visual Analog Scale (VAS) questions through extensive, multidimensional inventories. The primary question addressed in this survey of top-tier medical journals was: Which pain assessments are most commonly used in trials? Articles addressing chronic musculoskeletal pain in clinical trials were identified in 7 major medical journals for the year 2003. A total of 50 studies (1476 total original research articles reviewed) met selection criteria, and from these we identified 28 types of pain assessments. Selected studies were classified according to the dimensions of pain assessed, the type of scale and descriptors/anchors used, and the reporting period specified. The most frequently used assessments were the single-item VAS and the Numeric Rating Scale; multidimensional inventories were used infrequently. There was considerable variability in the instructions patients received about the period to consider when evaluating their pain, and many studies provided only cursory information about their assessments in the methods. Overall, it appears that clinical trials use simple measures of pain and that there is no widely accepted standard for clinical pain assessment that would facilitate comparison of outcomes across trials.


CONCLUSIONS
This review highlights the heterogeneity of pain outcome measures used and the abundance of single-item measures in clinical trials. Although there are many pain outcome measures available to clinical researchers, more consistency in the field should be encouraged so that results between studies can be compared.
Litcher-Kelly
Leighann
L
Applied Behavioral Medicine Research Institute, Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, New York 11794-8790, USA. Leighann.Litcher@sunysb.edu
Martino
Sharon A
SA
Broderick
Joan E
JE
Stone
Arthur A
AA
D006801:Humans; D009140:Musculoskeletal Diseases / Q000150:complications*; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000209:etiology*; D059408:Pain Management; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic / Q000379:methods*
Arthritis Rheum. 2006 Jun 15;55(3):480-92
16739188
Pain. 2003 Jun;103(3):277-83
12791434
Arthritis Rheum. 2003 Jun 15;49(3):314-20
12794785
Arthritis Rheum. 2003 Jun 15;49(3):321-7
12794786
Rheumatology (Oxford). 2003 Jul;42(7):865-9
12730546
Spine (Phila Pa 1976). 2003 Jul 1;28(13):1355-62
12838090
Pain. 2003 Jul;104(1-2):65-73
12855315
Spine (Phila Pa 1976). 2003 Jul 15;28(14):1490-502; discussion 1502-3
12865832
Arthritis Rheum. 2003 Aug 15;49(4):541-5
12910561
Arthritis Rheum. 2003 Aug 15;49(4):556-66
12910564
Pain. 2003 Aug;104(3):453-69
12927618
Pain. 2003 Aug;104(3):529-37
12927625
Pain. 2003 Aug;104(3):627-37
12927635
Pain. 2003 Aug;104(3):665-72
12927639
Spine (Phila Pa 1976). 2003 May 1;28(9):851-8; discussion 859
12941996
Spine (Phila Pa 1976). 2003 Sep 1;28(17):1913-21
12973134
Spine (Phila Pa 1976). 2003 Sep 1;28(17):1922-7
12973135
JAMA. 2003 Sep 17;290(11):1474-8
13129987
Pain. 2003 Sep;105(1-2):71-8
14499422
Pain. 2003 Sep;105(1-2):89-96
14499424
Rheumatology (Oxford). 2003 Oct;42(10):1207-15
12810937
Spine (Phila Pa 1976). 2003 Oct 1;28(19):2185-91
14520029
Arthritis Rheum. 2003 Oct 15;49(5):665-72
14558052
Spine (Phila Pa 1976). 2003 Oct 15;28(20):2309-15; discussion 2316
14560075
Pain. 2003 Nov;106(1-2):59-64
14581111
Pain. 2003 Nov;106(1-2):119-25
14581118
JAMA. 2003 Nov 12;290(18):2428-9
14612479
N Engl J Med. 2003 Nov 13;349(20):1907-15
14614165
J Pain. 2003 Aug;4(6):307-15
14622687
Rheumatology (Oxford). 2003 Dec;42(12):1477-85
12867587
Rheumatology (Oxford). 2003 Dec;42(12):1508-17
12890859
Rheumatology (Oxford). 2003 Dec;42(12):1523-8
13130145
Spine (Phila Pa 1976). 2003 Dec 1;28(23):2561-9
14652472
Pain. 2003 Dec;106(3):401-9
14659523
Pain. 2003 Dec;106(3):419-26
14659525
Arthritis Rheum. 2003 Dec 15;49(6):766-77
14673962
Arthritis Rheum. 2003 Dec 15;49(6):789-97
14673965
Pain. 1975 Sep;1(3):277-99
1235985
Pain. 1983 Oct;17(2):197-210
6646795
Pain. 1985 Dec;23(4):345-56
4088697
Pain. 1987 May;29(2):175-85
3614956
Pain. 1988 Mar;32(3):265-70
3362564
J Rheumatol. 1988 Dec;15(12):1833-40
3068365
Pain. 1990 Feb;40(2):153-60
2137905
Surg Clin North Am. 1999 Apr;79(2):231-52
10352653
Curr Med Res Opin. 1999;15(2):113-9
10494494
Curr Med Res Opin. 1999;15(2):121-7
10494495
Am Psychol. 2004 Nov;59(8):795-805
15554853
BMJ. 2002 May 18;324(7347):1193-4
12016186
Rheumatology (Oxford). 2003 Jan;42(1):141-8
12509627
Arthritis Rheum. 2003 Feb 15;49(1):29-35
12579591
Arthritis Rheum. 2003 Feb 15;49(1):36-50
12579592
Pain. 2003 Feb;101(3):267-74
12583869
Pain. 2003 Feb;101(3):275-82
12583870
Pain. 2003 Feb;101(3):291-8
12583872
Rheumatology (Oxford). 2003 Feb;42(2):235-9
12595616
Rheumatology (Oxford). 2003 Mar;42(3):422-6
12626791
Rheumatology (Oxford). 2003 Mar;42(3):435-41
12626793
Rheumatology (Oxford). 2003 Apr;42(4):541-8
12649401
Pain. 2003 May;103(1-2):119-30
12749966
JAMA. 2003 May 21;289(19):2509-16
12759322
Rheumatology (Oxford). 2003 Jun;42(6):743-9
12730532
JAMA. 2003 Jun 4;289(21):2810-8
12783911
Pain. 2005 Jan;113(1-2):9-19
15621359
Am J Phys Med Rehabil. 2005 Mar;84(3 Suppl):S29-41
15722781