A review and critique of assessment instruments for patients with persistent pain

Background: Early identification of individuals at risk of developing persistent pain is important to decrease unnecessary treatment costs and disability. However there is scant comprehensive information readily available to assist clinicians to choose appropriate assessment instruments with sound psychometric and clinical properties.

Objective: A national insurer commissioned the development of a compendium of assessment instruments to identify adults with, or at-risk of developing, persistent pain. This paper reports on the instrument identification and review process.

Methods: A comprehensive systematic literature review was undertaken of assessment instruments for persistent pain of noncancer origin, and their developmental literature. Only assessment instruments which were developed for patients with pain, or tested on them, were included. A purpose-built ‘Ready Reckoner’ scored psychometric properties and clinical utility.

Results: One hundred sixteen potentially useful instruments were identified, measuring severity, psychological, functional and/or quality of life constructs of persistent pain. Forty-five instruments were short-listed, with convincing psychometric properties and clinical utility. There were no standard tests for psychometric properties, and considerable overlap of instrument purpose, item construct, wording, and scoring.

Conclusion: No one assessment instrument captured all the constructs of persistent pain. While the compendium focuses clinicians’ choices, multiple instruments are required for comprehensive assessment of adults with persistent pain.

Keywords: persistent pain, assessment, psychometric properties, evidence-base, clinical utility