COSMIN database

Measuring pain and efficacy of pain treatment in inflammatory arthritis: a systematic literature review

Englbrecht, M., Tarner, I. H., van der Heijde, D. M., Manger, B., Bombardier, C., and Muller-Ladner, U.
OBJECTIVE: To systematically review the available literature on measuring pain and the efficacy of pain treatment in inflammatory arthritis (IA), as an evidence base for generating clinical practice recommendations.

METHODS: A systematic literature search was performed in Medline, Embase, Cochrane Library, and the American College of Rheumatology/European League Against Rheumatism 2008/2009 meeting abstracts, searching for studies evaluating clinimetric properties of pain measurement tools in IA (convergent validity, internal consistency, retest reliability, responsiveness, feasibility, and standardization). Studies that presented information on these properties were reviewed and their data were integrated into the pool of results available for pain measures in IA.

RESULTS: In total, 51 articles were included in the review. Validated information on pain was available for tools covering different facets such as overall pain, anatomically specific pain, or a mixture of both. Data from these studies showed that single pain-related items such as the visual analog scale (VAS), numeric rating scale (NRS), or verbal rating scale (VRS) provide sufficient clinimetric information. Similar results were obtained for the pain subscales of the Arthritis Impact Measurement Scales (AIMS/AIMS2) and the bodily pain subscale of the Medical Outcome Study Short-Form Survey 36. Most clinimetric coefficients showed acceptable results with respect to validity, reliability, and sensitivity to change, while the degree of standardization and feasibility mostly filled at least 2 of 3 predefined criteria.

CONCLUSION: A variety of pain measures are available to cover different aspects of pain such as intensity, frequency, or location. Single-item tools such as VAS, NRS, or VRS can be recommended to measure overall pain in clinical practice. If more specific issues need to be addressed, more sophisticated tools should be taken into account.
J Rheumatol Suppl
0380-0903 (Print)
Publication year:
Symptom status:
Physical state
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
ADL pain scale - Activities of Daily Living pain scale
AIMS2 - Arthritis Impact Measurement Scales 2   
AIMS2-SF - Arthritis Impact Measurement Scales-Short Form
AIMS - Arthritis Impact Measurement Scales (versions; sAIMS; shortened AIMS)
BASDAI - Bath Ankylosing Spondylitis Disease Activity Index
DAREA - Disease Activity Index for Reactive Arthritis
FFI - Foot Function Index
IBD - Index bidimensionnel de la douleur
MHQ - Michigan Hand outcomes Questionnaire (versions: BriefMHQ)   
MPQ - McGill Pain Questionnaire (versions MPQ-SF)    
NHP - Nottingham Health Profile   
NRS - Numeric Rating Scale (versions: NRS-6; NRS-11; NRS-21)   
RADAI - Rheumatoid Arthritis Disease Activity Index
RAOS - Rheumatoid Arthritis Outcome Score
RAPS - Rheumatoid Arthritis Pain Scale
SF-36 - 36-item Short Form Health Survey [alias: RAND-36][alias: Medical Outcomes Study (MOS) SF-36]]    |  | also see:
SF-AIMS: Short-Form Arthritis Impact Measurement Scales
SF-MPQ - McGill Short Form Pain Questionnaire
VAS - Visual Analogue Scale (versions: vertical; horizontal)   
VRS - Verbal (Pain) Rating Scale (versions: VRS-5; VRS-16)