Skip to main content
NCBI home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 2002 Apr;52(477):269–274.

Assessing change in chronic pain severity: the chronic pain grade compared with retrospective perceptions.

Alison M Elliott 1, Blair H Smith 1, Philip C Hannaford 1, W Cairns Smith 1, W Alastair Chambers 1
PMCID: PMC1314266  PMID: 11942442

Abstract

BACKGROUND: There is no standard method of measuring change in chronic pain severity. Clinical trials commonly use serial assessment scales, completed at two points in time, to estimate change in pain severity, while clinicians usually ask patients to make a retrospective assessment of change. How the two methods compare is not known. AIM: To assess different methods of measuring change in chronic pain severity, by comparing changes in scores on a serial measure of chronic pain severity using the Chronic Pain Grade (CPG) questionnaire and responders' retrospective perception of change in pain severity. DESIGN OF STUDY: Postal self-completion questionnaires. SETTING: The Grampian region of Scotland. METHOD: Postal questionnaires were sent in March and September 1998 to a random sample of 535 adults with chronic pain, drawn from responders to a postal survey of the region conducted in 1996. RESULTS: Corrected response rates of 87.5% and 90.7% were obtained. Over a six-month period poor levels of agreement were found, with responders' retrospective perceptions mirroring recorded changes in 41.8% of individuals (kappa = 0.081). A low partial correlation coefficient between the two measures (-0.209) was also found. Over a two-year period there were again poor levels of agreement, with responders' retrospective perceptions mirronng recorded changes in 35.2% of individuals (kappa = 0.071). A low partial correlation coefficient (-0.401) was again found. CONCLUSION: There was poor agreement and low correlation between two commonly used methods for assessing change in pain severity over time. This finding has important implications for both service practitioners and researchers.

Full Text

The Full Text of this article is available as a PDF (198.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aseltine R. H., Jr, Carlson K. J., Fowler F. J., Jr, Barry M. J. Comparing prospective and retrospective measures of treatment outcomes. Med Care. 1995 Apr;33(4 Suppl):AS67–AS76. [PubMed] [Google Scholar]
  2. Bayley K. B., London M. R., Grunkemeier G. L., Lansky D. J. Measuring the success of treatment in patient terms. Med Care. 1995 Apr;33(4 Suppl):AS226–AS235. [PubMed] [Google Scholar]
  3. Becker M. H. Patient adherence to prescribed therapies. Med Care. 1985 May;23(5):539–555. doi: 10.1097/00005650-198505000-00014. [DOI] [PubMed] [Google Scholar]
  4. Cleary P. D., McNeil B. J. Patient satisfaction as an indicator of quality care. Inquiry. 1988 Spring;25(1):25–36. [PubMed] [Google Scholar]
  5. Davis A. E. Primary care management of chronic musculoskeletal pain. Nurse Pract. 1996 Aug;21(8):72, 75, 79-82, passim. [PubMed] [Google Scholar]
  6. Diamond A. The future development of chronic pain relief. Anaesthesia. 1991 Feb;46(2):83–84. doi: 10.1111/j.1365-2044.1991.tb09343.x. [DOI] [PubMed] [Google Scholar]
  7. Elliott A. M., Smith B. H., Penny K. I., Smith W. C., Chambers W. A. The epidemiology of chronic pain in the community. Lancet. 1999 Oct 9;354(9186):1248–1252. doi: 10.1016/s0140-6736(99)03057-3. [DOI] [PubMed] [Google Scholar]
  8. Elliott A. M., Smith B. H., Smith W. C., Chambers W. A. Changes in chronic pain severity over time: the Chronic Pain Grade as a valid measure. Pain. 2000 Dec 1;88(3):303–308. doi: 10.1016/S0304-3959(00)00337-7. [DOI] [PubMed] [Google Scholar]
  9. Fischer D., Stewart A. L., Bloch D. A., Lorig K., Laurent D., Holman H. Capturing the patient's view of change as a clinical outcome measure. JAMA. 1999 Sep 22;282(12):1157–1162. doi: 10.1001/jama.282.12.1157. [DOI] [PubMed] [Google Scholar]
  10. Gallagher R. M. Primary care and pain medicine. A community solution to the public health problem of chronic pain. Med Clin North Am. 1999 May;83(3):555-83, v. doi: 10.1016/s0025-7125(05)70124-3. [DOI] [PubMed] [Google Scholar]
  11. Herrmann D. Reporting current, past, and changed health status. What we know about distortion. Med Care. 1995 Apr;33(4 Suppl):AS89–AS94. [PubMed] [Google Scholar]
  12. Katon W., Sullivan M. D. Depression and chronic medical illness. J Clin Psychiatry. 1990 Jun;51 (Suppl):3–14. [PubMed] [Google Scholar]
  13. Mancuso C. A., Charlson M. E. Does recollection error threaten the validity of cross-sectional studies of effectiveness? Med Care. 1995 Apr;33(4 Suppl):AS77–AS88. [PubMed] [Google Scholar]
  14. Roter D. L., Hall J. A. Studies of doctor-patient interaction. Annu Rev Public Health. 1989;10:163–180. doi: 10.1146/annurev.pu.10.050189.001115. [DOI] [PubMed] [Google Scholar]
  15. Smith B. H., Penny K. I., Purves A. M., Munro C., Wilson B., Grimshaw J., Chambers W. A., Smith W. C. The Chronic Pain Grade questionnaire: validation and reliability in postal research. Pain. 1997 Jun;71(2):141–147. doi: 10.1016/s0304-3959(97)03347-2. [DOI] [PubMed] [Google Scholar]
  16. Starfield B., Wray C., Hess K., Gross R., Birk P. S., D'Lugoff B. C. The influence of patient-practitioner agreement on outcome of care. Am J Public Health. 1981 Feb;71(2):127–131. doi: 10.2105/ajph.71.2.127. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Sullivan M. D., Turner J. A., Romano J. Chronic pain in primary care. Identification and management of psychosocial factors. J Fam Pract. 1991 Feb;32(2):193–199. [PubMed] [Google Scholar]
  18. Von Korff M., Ormel J., Keefe F. J., Dworkin S. F. Grading the severity of chronic pain. Pain. 1992 Aug;50(2):133–149. doi: 10.1016/0304-3959(92)90154-4. [DOI] [PubMed] [Google Scholar]
  19. Ware J. E., Jr Monitoring and evaluating health services. Med Care. 1985 May;23(5):705–709. [PubMed] [Google Scholar]
  20. Whitney C. W., Von Korff M. Regression to the mean in treated versus untreated chronic pain. Pain. 1992 Sep;50(3):281–285. doi: 10.1016/0304-3959(92)90032-7. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES