COSMIN database

How to measure pain in neurological conditions? A systematic review of psychometric properties and clinical utility of measurement tools

Tyson, S. F. and Brown, P.
OBJECTIVE: To systematically review the psychometric properties and clinical utility of measures of pain in neurological conditions.

DATA SOURCES: Electronic databases (AMED, CINAHL, MEDLINE, PEDro and Web of Knowledge) were searched from their inception to February 2013.

REVIEW METHODS: Studies investigating any measurement tool to assess pain in central nervous system conditions were systematically identified. Data about their psychometric properties and clinical utility were extracted and analysed independently. The strength of the psychometric properties and clinical utility were assessed.

RESULTS: A total of 13 articles met the selection criteria, which assessed 11 measurement tools; eight pain rating scales; one Neuropathic Pain Scale; and two measures of pain interference with every-day life. Most of the pain rating scales were specifically for hemiplegic shoulder pain. None had been sufficiently developed to recommend for use in clinical practice or research. Evaluation of reliability and the ability to detect change were particularly sparse. Reliability depended on the type of tools used. Patients with right hemisphere damage favoured verbal/written responses, while people with left hemisphere damage preferred and reported more effectively using visual/numeric responses. Validity between measures of pain intensity was moderate, while validity with mood or quality of life was weak to moderate.

CONCLUSION: None of the selected measures of pain have been fully developed or evaluated to demonstrate that they provide accurate, relevant reproducible information
Clinical Rehabilitation
Publication year:
Symptom status:
Physical state
Adults (18-65)
Children (0-18)
Seniors (65+)
Diseases of and symptoms related to the nervous system
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
6 - Clinical rating scales
7 - Observations
BPI - Brief Pain Inventory
FPS-R - Faces Pain Scale-Revised (versions: FPS; FPS-6; FPS-7)   
Graded Chronic Pain Disability Score
Likert Pain Scale
NPS - Neuropathic Pain Scale (versions: NPS-R)
NRS - Numeric Rating Scale (versions: NRS-6; NRS-11; NRS-21)   
Pain Assessment Instrument of CP - Pain Assessment Instrument for cerebral palsy
RAI - Ritchie articular index
VAS pain - Visual Analogue Scale pain (versions: VAS pain-parental)
VRS - Verbal (Pain) Rating Scale (versions: VRS-5; VRS-16)