10
From the *Multidisciplinary Pain Center, Hospital das Clinicas; Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, Brazil; School of Nursing, University of Guarulhos (UnG), Guarulhos, Sao Paulo, Brazil; § Department of Neurology, School of Medicine, University of S~ ao Paulo, S~ ao Paulo, Brazil. Address correspondence to Karine Azevedo S~ ao Le~ ao Ferreira, PhD, RN, BSN, R. Anibal Borbola, 105, Parque dos Pr ıncipes.Sao Paulo, SP, Brazil. Zip Code: 05396-265. E-mail: [email protected] Received March 9, 2011; Revised April 13, 2011; Accepted April 21, 2011. 1524-9042/$36.00 Ó 2013 by the American Society for Pain Management Nursing http://dx.doi.org/10.1016/ j.pmn.2011.04.006 Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ) --- Karine Azevedo S ~ ao Le ~ ao Ferreira, PhD, RN, BSN, *,,Daniel Ciampi de Andrade, PhD, MD, *,,§ and Manoel Jacobsen Teixeira, PhD, MD *,§ - ABSTRACT : The aim of this study was to develop and validate a short form of the Brazilian version of McGill Pain Questionnaire (SF-MPQ). Three hun- dred two patients with chronic pain filled out the validated Brazilian long form of the McGill Pain Questionnaire (LF-MPQ). Words chosen by $25% of the patients were selected to comprise the SF-MPQ. The Brazilian SF-MPQ consisted of 15 descriptors (8 sensory, 5 affective, and 2 evaluative) rated on a binary mode (present or absent). Four pain scores were derived by counting the words chosen by the patients for sensory, affective, evaluative, and total descriptors. The SF-MPQ showed poor internal consistency (KR-20 ¼ 0.52) but possibly ac- ceptable because it showed discriminant validity to discriminate patients presenting different levels and mechanisms of pain, and it was strongly correlated with the LF-MPQ. The low KR-20 coefficient could result from the small number of items. The Brazilian version of the SF-MPQ proved to be a useful instrument to evaluate the different qualities of pain. It is a reliable option to the long-form MPQ. Ó 2013 by the American Society for Pain Management Nursing Chronic pain has three main aspects: the sensory-discriminative, affective- emotional, and cognitive-evaluative. These aspects are present in chronic pain pa- tients in different proportions and may have a negative impact on quality of life. Also, these aspects may respond differently to treatment (Passard, Attal, Benadhira, Brasseur, Saba, Sichere, Perrot, Januel, & Bouhassira, 2007; Picarelli, Teixeira, de Andrade, Myczkowski, Luvisotto, Yeng, Fonoff, Pridmore, & Marcolin, 2010). The assessment of pain is probably one the most challenging areas of health measurement, because pain is an abstract, subjective, and multidimensional experience. Different tools have become available to assess pain in general, such as the Brief Pain Inventory (Ferreira, Teixeira, Mendonza, & Cleeland, 2010), and specific pain syndromes, such as neuropathic pain (Santos, Brito, de Andrade, Kaziyama, Ferreira, Souza, Teixeira, Bouhassira, & Baptista, Pain Management Nursing, Vol 14, No 4 (December), 2013: pp 210-219 Original Article

Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ)

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Page 1: Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ)

Original Article

From the *Multidisciplinary Pain

Center, Hospital das Clinicas;†Instituto do Cancer do Estado de

Sao Paulo, Sao Paulo, Brazil; ‡School

of Nursing, University of Guarulhos

(UnG), Guarulhos, Sao Paulo,

Brazil;§Department of Neurology,

School of Medicine, University of S~ao

Paulo, S~ao Paulo, Brazil.

Address correspondence to Karine

Azevedo S~ao Le~ao Ferreira, PhD, RN,

BSN, R. Anibal Borbola, 105, Parque

dos Pr�ıncipes. Sao Paulo, SP, Brazil.

Zip Code: 05396-265. E-mail:

[email protected]

Received March 9, 2011;

Revised April 13, 2011;

Accepted April 21, 2011.

1524-9042/$36.00

� 2013 by the American Society for

Pain Management Nursing

http://dx.doi.org/10.1016/

j.pmn.2011.04.006

Development andValidation of a BrazilianVersion of theShort-Form McGill PainQuestionnaire (SF-MPQ)

--- Karine Azevedo S~ao Le~ao Ferreira, PhD, RN, BSN,*,†,‡

Daniel Ciampi de Andrade, PhD, MD,*,†,§

and Manoel Jacobsen Teixeira, PhD, MD*,§

- ABSTRACT:The aim of this study was to develop and validate a short form of the

Brazilian version of McGill Pain Questionnaire (SF-MPQ). Three hun-

dred two patients with chronic pain filled out the validated Brazilian

long form of the McGill Pain Questionnaire (LF-MPQ). Words chosen

by $25% of the patients were selected to comprise the SF-MPQ. The

Brazilian SF-MPQ consisted of 15 descriptors (8 sensory, 5 affective,

and 2 evaluative) rated on a binary mode (present or absent). Four

pain scoreswere derived by counting thewords chosen by the patients

for sensory, affective, evaluative, and total descriptors. The SF-MPQ

showed poor internal consistency (KR-20 ¼ 0.52) but possibly ac-

ceptable because it showed discriminant validity to discriminate

patients presenting different levels and mechanisms of pain, and it

was strongly correlated with the LF-MPQ. The low KR-20 coefficient

could result from the small number of items. The Brazilian version of

the SF-MPQ proved to be a useful instrument to evaluate the different

qualities of pain. It is a reliable option to the long-form MPQ.

� 2013 by the American Society for Pain Management Nursing

Chronic pain has three main aspects: the sensory-discriminative, affective-

emotional, and cognitive-evaluative. These aspects are present in chronic pain pa-tients in different proportions and may have a negative impact on quality of life.

Also, these aspects may respond differently to treatment (Passard, Attal,

Benadhira, Brasseur, Saba, Sichere, Perrot, Januel, & Bouhassira, 2007; Picarelli,

Teixeira, de Andrade, Myczkowski, Luvisotto, Yeng, Fonoff, Pridmore, &

Marcolin, 2010). The assessment of pain is probably one the most challenging

areas of health measurement, because pain is an abstract, subjective, and

multidimensional experience. Different tools have become available to assess

pain in general, such as the Brief Pain Inventory (Ferreira, Teixeira, Mendonza, &Cleeland, 2010), and specific pain syndromes, such as neuropathic pain (Santos,

Brito, de Andrade, Kaziyama, Ferreira, Souza, Teixeira, Bouhassira, & Baptista,

Pain Management Nursing, Vol 14, No 4 (December), 2013: pp 210-219

Page 2: Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ)

211Brazilian SF-MPQ

2010). However, despite the large number of pain ques-

tionnaires and scales available today, few tools are able to

characterize its different aspects.

The McGill Pain Questionnaire (MPQ) developed

by Melzack (1975) assesses three major dimensions of

pain; sensory-discriminative, motivational-affective, and

cognitive-evaluative. The first version of the MPQ with78 descriptors was published (Melzack, 1975). The

MPQ was translated into the Brazilian-Portuguese lan-

guage in 1996 (Pimenta & Teixeira, 1996).

TheMPQ takes�10minutes to be filled out, which

could be too long for some studies and for many clinical

conditions (Melzack, 1975). Therefore, in 1987, a short

form of the MPQwas proposed (Melzack, 1987). It con-

sisted of 15 descriptors (11 sensory and 4 affective), oneitem for assessing the present pain intensity (PPI), and

the visual analog scale (VAS). The short form was trans-

lated into different languages around the world

(Burckhardt & Bjelle, 1994; Dudgeon, Raubertas, &

Rosenthal, 1993; Georgoudis, Watson, & Oldham,

2000; Kitisomprayoonkul, Klaphajone, & Kovindha,

2006; Masedo & Esteve, 2000) and became a useful

instrument to assess and describe pain in differentgroups of patients: elderly people (McDonald &

Weiskopf, 2001), patients with osteoarthritis (Grafton,

Foster, & Wright, 2005), and other pain syndromes

(Grace & MacBride-Stewart, 2007). In Brazil, the short-

form has not been validated.

The aim of the present study was to develop and

validate a short-form of the Brazilian version of the

MPQ.

METHODS

SampleA cross-sectional study at the Multidisciplinary Pain

Center, Hospital das Clinicas, School of Medicine, Uni-

versity of S~ao Paulo, in S~ao Paulo, Brazil, was done after

receiving approval by the institution’s Ethics

Committee.

Eligible patients were required to be 1) an outpa-tient at the institution; 2) diagnosed by a pain specialist

as having chronic pain; 3) $18 years old; 4) a native

Portuguese speaker; and 5) able to complete the ques-

tionnaire. If an eligible patient agreed to participate,

a written informed consent was obtained. Data were

obtained from patients by an interview performed by

a health care provider specialized in pain (physician,

nurse, or dentist).A convenience sample of 302 outpatients with

chronic pain conditions were enrolled. A power calcu-

lation before the study was not done. The sample

included patients with each of the following pain

conditions: cancer-related (n ¼ 30), low-back

pain (n ¼ 30), fibromyalgia (n ¼ 30), postherpetic

pain (n ¼ 20), phantom limb pain (n ¼ 10), complex

regional pain syndrome (CRPS) (n ¼ 6), myofascial

pain (n ¼ 28), visceral/abdominal pain (n ¼ 30),

myelopathic syndromes (n ¼ 30), trigeminal neuralgia

(n ¼ 30), burning mouth syndrome (n ¼ 28), and

work-related pain syndromes (n ¼ 30). They were di-vided into three groups according to the major pain

mechanism: musculoskeletal pain (low-back pain, fi-

bromyalgia, myofascial pain syndrome), neuropathic

pain (postherpetic, phantom limb pain, trigeminal neu-

ralgia, burning mouth syndrome, complex regional

pain syndrome, myelopathic pain), and other pain syn-

dromes (cancer-related and visceral/abdominal pain).

Although some studies strongly suggest that CRPS isnot a typical neuropathic pain syndrome (Janig &

Baron, 2006) and that fibromyalgia has also an impor-

tant neuropathic component, in the present study, fi-

bromyalgia was included in the musculoskeletal pain

syndrome group and CRPS in the neuropathic pain

group, because patients with fibromyalgia would prob-

ably describe their pain with words similar to patients

with musculoskeletal pain and patients with CRPSwould describe their pain similarly to patients in the

neuropathic pain group.

Development of the Brazilian Version of theShort-Form MPQThe development and validation of the short form of

the Brazilian version of the MPQ (BV-SF-MPQ) oc-

curred in two phases: 1) questionnaire development

(item generation); and 2) evaluation of psychometric

properties.Phase 1: Questionnaire Development—Item Gen-eration. The strategy used to develop the BV-SF-MPQ

was similar to that used during the development of the

original version of the SF-MPQ (Melzack, 1987). A few

representative numbers of words from the sensory, af-

fective, evaluative, and miscellaneous categories of the

long form of the McGill Pain Questionnaire (LF-MPQ)

were selected and a numeric rating scale was used toprovide the overall pain intensity. Patients completed

the Brazilian version of the LF-MPQ (BV-LF-MPQ)

(Pimenta & Teixeira, 1996). The descriptors chosen

by $25% of patients were selected to compose the

BV-SF-MPQ.

The criterion of 25% was adopted because the de-

scriptors electric-shock and sharp have appeared on the

representative word list of some earlier studies with pa-tients with neuropathic pain syndromes (M. Bennett,

2001; M. I. Bennett, Smith, Torrance, & Potter, 2005;

Bouhassira, Attal, Alchaar, Boureau, Brochet, Bruxelle,

Cunin, Fermanian, Ginies, Grun-Overdyking, Jafari-

Schluep, Lant�eri-Minet, Laurent, Mick, Serrie, Valade,

Page 3: Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ)

212 Ferreira et al.

& Vicaut, 2005). In the present study, these descriptors

were reported by 24.8% and 25.2%, respectively, of the

total sample. They did not reach the criterion of 33%

adopted by Melzack (1987). In addition, the words

sore or aching have been associated with nonneuro-

pathic pain syndromes in other studies (Hoffman

et al., 2005; Lin, Kupper, Gammaitoni, Galer, & Jensen,2011). In the present study, these descriptors were

reported by 25.8% and 19.2%, respectively, of the total

sample. In Brazilian Portuguese, these words are often

used interchangeably. The authors considered that

descriptors such as electric-shock, sharp, sore, and ach-

ing had to be included in the BV-SF-MPQ, because they

have the potential to be of use for discriminating neuro-

pathic from nonneuropathic pain. The resulting ques-tionnaire was pilot tested among patients with chronic

pain. They evaluated each word as present or absent.

The LF-MPQ includes 78 pain descriptors ar-

ranged in three major classes and 20 subclasses, mea-

suring the sensory-discriminative (items 1-10),

affective-motivational (items 11-15), and evaluative-

cognitive (item 16) aspects of pain (Melzack, 1975).

There is a class called miscellaneous (items 17-20),that includes items that could not be included in the

other three classes (dimensions of pain). Each word

from these classes has a rank value indicative of the rel-

ative intensity of the descriptor.

Different scores can be obtained from the MPQ.

The simplest score is the number of words chosen

(NWC), which has a range of 0-78, and the rank values

of each word are added to obtain a pain rating index(PRI) for each dimension as well as a total score. In

the present study, the LF-MPQ was scored according

to the NWC as well as rank values of the words se-

lected using the PRIs for the sensory (PRI-S), affective

(PRI-A), evaluative (PRI-E), and miscellaneous (PRI-M)

groups as well as for the total (PRI-T). In the present

study, the LF-MPQ demonstrated internal consistency

when measured by the Cronbach alpha coefficientfor all 20 subgroups of words (Cronbach alpha ¼0.87) and for sensory and affective dimensions (sen-

sory ¼ 0.73; affective ¼ 0.80). The reliability was

not good for the miscellaneous class (Cronbach

alpha ¼ 0.54).

Phase 2: Evaluation of the Psychometric Proper-ties. The validity and reliability of the BV-SF-MPQ

were measured according to the definitions and in-structions proposed by Nunnaly and Bernstein

(1994) and McDowell and Newell (1996).

Statistical AnalysisData were stored and analyzed with the use of SPSS

13.0. Descriptive statistics were generated for all vari-

ables. The internal consistency reliability of the SF-

MPQ was evaluated by Kuder-Richardson 20 (KR-20)

coefficient, because the BV-SF-MPQ questions had di-

chotomous items (presence or absence). This coeffi-

cient was computed for the total items.

Spearman correlation coefficients were calculated

to assess convergent validity between the BV-SF-MPQ,

LF-MPQ, and the numeric rating scale (11 points).Construct validitywas determined by known-group

validity and discriminant validity. Known-group validity

was evaluated by comparing subgroups of patients

known to differ in clinical variables with the use of

one-way analyses of variance or Kruskal-Wallis tests de-

pending on their adherence to normal distribution.

Post hoc contrastswere donewith the Bonferroni proce-

dure to control all family alpha levels at .05. We hypoth-esized that patientswith a higher intensity of painwould

choose a greater number of words in the SF-MPQ.

The patientswere classified into three levels of pain

intensity, according to the optimal cutoff points on a 0–

10-point numeric rating scale proposed by Serlin,

Mendoza, Nakamura, Edwards, and Cleeland, 1995:

mild (1-4), moderate (5-6), and severe pain (7-10).

A multiple discriminant analysis was performedon the sample to identify which SF-MPQ dimensions

contributed significantly to discriminate among differ-

ent intensity of pain and pain syndromes (neuropathic,

musculoskeletal, and other). For all tests, a p value of

<.05 was considered to be statistically significant.

RESULTS

Pain CharacteristicsThe majority of the patients reported severe pain

(76.1%). The mean intensity of pain was 7.66 (SD ¼2.17). Neuropathic pain was present in 41.1% and mus-

culoskeletal pain in 39.1% (Table 1).

Descriptors SelectionOut of the 78 descriptors of the BV-LF-MPQ, 18 were

chosen by >25% of the patients (Table 2). Twelve de-

scriptors were selected equally by 25% of the patientspresenting both types of pain syndromes. The other

six descriptors (flashing, sharp, spreading, exhausting,

blinding, and troublesome) were selected by $25% of

the patients of either neuropathic or musculoskeletal

pain syndromes (Table 2). These 18 descriptors repre-

sented the four classes of the LF-MPQ. They were

then kept for analysis and were included in the first ver-

sion of the BV-SF-MPQ, which comprised the followingwords: sensory (throbbing, jumping, flashing, sharp,

pricking, tugging, burning, and sore), affective (tiring,

exhausting, sickening, suffocating, blinding, and fright-

ful), evaluative (troublesome and unbearable), and mis-

cellaneous (spreading and nagging).

Page 4: Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ)

TABLE 1.

Characteristics of Pain

Characteristic n %

Intensity of painMild 22 7.17Moderate 51 16.73Severe 230 76.10

Pain syndromesMusculoskeletal 118 39.07Neuropathic 124 41.06Other 60 19.87

Mean SD

Present pain intensity 7.66 2.17LF-MPQ

PRI-MPQ 28.21 14.42PRI-Sensory 14.72 7.74PRI-Affective 2.98 1.62PRI-Evaluative 5.61 3.97NWC-MPQ (total score) 12.39 5.42NWC-Sensory 6.17 2.85NWC-Affective 3.13 1.78NWC-Evaluative 0.92 0.27

SF-MPQNWC-MPQ (total score) 5.82 2.53NWC-Sensory 2.91 1.60NWC-Affective 2.30 1.20NWC-Evaluative 0.60 0.49

PRI ¼ pain rating index (sum of given values of all words chosen); NWC ¼number of words chosen.

213Brazilian SF-MPQ

Similar to the procedure used in the development

of the English short form of the LF-MPQ, some words

were grouped: tiring-exhausting, sharp-pricking, and

frightful-blinding. The remaining 15 items were group-

ed in three pain dimensions: sensory, evaluative, and

affective (Table 3).

The final version of the SF-MPQ with 15 items was

used for the following analyses. In this version, four dif-ferent scores were calculated: the total score (sum of

the rankings of all words chosen); the affective score

(sum of the rankings of words chosen in the affective

dimension of pain experience); the sensory score

(sum of the rankings of words chosen in the sensory

dimension); and the evaluative score (sum of the rank-

ings of words chosen in the evaluative dimension).

These results are summarized in Table 1. The highestscore was obtained in the sensory dimension of pain

experience (mean 5.82).

Convergent ValidityAs expected, the sensory, affective, evaluative, and to-

tal scores of the short and long forms of the MPQ were

significantly correlated. Positive and moderate to

strong correlations were obtained among the sensory,

affective, and total scores of the short form and the sen-

sory, affective, and total scores of the long form

(Table 4). However, the evaluative dimension of both

short and long forms was weakly correlated with the

other dimensions and the total score.

The correlations among numeric rating scale andsensory, evaluative, affective and total scores of the

short and long forms were significant, though weak

(Table 4).

ReliabilityThe reliability of the BV-SF-MPQ was evaluated by the

internal consistency. To measure the internal consis-

tency, the KR-20 coefficient of the BV-SF-MPQ with

15 items was performed. The KR-20 coefficient forthe total score was 0.52. The low number of items in

the questionnaire may partially account for this modest

coefficient.

Construct ValidityThe construct validity was measured by the known-

group validity. It was examined by comparing the sen-

sory, affective, evaluative, and total scores of the shortform of the MPQ according to types of pain (pain syn-

dromes) and intensity of pain (mild, moderate, and se-

vere). Except for the evaluative dimension, the scores

of the SF-MPQ dimensions differed significantly among

subgroups. Patients with severe pain had greater total,

sensory, and affective scores than those with moderate

or mild pain. These results indicated that SF-MPQ was

able to distinguish patients according to their intensityof pain and pain syndrome (Table 5).

The construct validity was also examined by mul-

tiple discriminant analyses. Results indicated that sen-

sory, affective, and total scores were significantly able

to discriminate different intensities of pain (Wilk

lambda: sensory ¼ 0.91 [p ¼ .000]; affective ¼ 0.93

[p ¼ .000], and total score ¼ 0.89 [p ¼ .000]); and

pain syndromes (Wilk lambda: sensory ¼ 0.97 [p ¼.037]; affective ¼ 0.91 [p ¼ .000]; and total score ¼0.95 [p ¼ .001]).

DISCUSSION

Brazilian health care providers have indicated a need

for a short instrument that helps to identify sensory, af-

fective, and evaluative descriptors of pain experience.

The BV-SF-MPQ proved to be a reliable and simple toolto identify descriptors of pain and to measure pain in-

tensity in patients with neuropathic and musculoskele-

tal pain conditions.

The results of this study showed that sensory, af-

fective, and total scores of BV-SF-MPQ were capable of

Page 5: Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ)

TABLE 2.

Number and Percentage Use of Pain Descriptors by Pain Syndromes

Pain Descriptor

Total Sample Neuropathic Musculoskeletal Other

c2 p Valuen % n % n % n %

SensoryVibrac~ao (flickering) 7 2.3 1 0.8 5 4.2 1 1.7 3.28 .19Tremor (quivering) 7 2.3 1 0.8 5 4.2 1 1.7 3.28 .19Pulsante (pulsing) 22 7.3 7 5.6 12 10.2 3 5.0 2.41 .30Latejante (throbbing) 148 49.0 55 44.4 61 51.7 32 53.3 1.86 .40Como batida (beating) 6 2.0 — — 2 1.7 4 6.7 9.31 .01*Como pancada (pounding) 15 5.0 5 4.0 9 7.6 1 1.7 3.38 .18Pontada (jumping) 117 38.7 36 29.0 54 45.8 27 45.0 8.38 .01*Choque (electric-shock) 75 24.8 37 29.8 28 23.7 10 16.7 3.88 .14Tiro (shooting) 1 0.3 — — 1 0.8 — — 1.56 .46Agulhada (pricking) 102 33.8 36 29.0 45 38.1 21 35.0 2.29 .32Perfurante (boring) 18 6.0 4 3.2 6 5.1 8 13.3 7.63 .02*Facada (drilling) 22 7.3 10 8.1 9 7.6 3 5.0 0.60 .74Punhalada (stabbing) 10 3.3 3 2.4 3 2.5 4 6.7 2.64 .27Em lanca (lancinating) 5 1.7 2 1.6 1 0.8 2 3.3 1.51 .47Fina (sharp) 76 25.2 24 19.4 32 27.1 20 33.3 4.59 .10Cortante (cutting) 39 12.9 14 11.3 14 11.9 11 18.3 1.97 .37Estracalha (lacerating) 36 11.9 8 6.5 23 19.5 5 8.3 10.71 .005*Belisc~ao (pinching) 32 10.6 20 16.1 6 5.1 6 10.0 7.81 .02*Aperto (pressing) 37 12.3 8 6.5 24 20.3 5 8.3 11.92 .003*Mordida (gnawing) 7 2.3 4 3.2 1 0.8 2 3.3 1.85 .40C�olica (cramping) 39 12.9 2 1.6 17 14.4 20 33.3 36.56 .001*Esmagamento (crushing) 37 12.3 9 7.3 24 20.3 4 6.7 11.79 .003*Fisgada (tugging) 104 34.4 35 28.2 48 40.7 21 35.0 4.16 .12Pux~ao (pulling) 32 10.6 11 8.9 15 12.7 6 10.0 0.97 .62Em torc~ao (wrenching) 45 14.9 9 7.3 23 19.5 13 21.7 9.84 .01*Calor (hot) 48 15.9 17 13.7 24 20.3 7 11.7 2.98 .22Queimac~ao (burning) 138 45.7 62 50.0 51 43.2 25 41.7 1.61 .48Fervente (scalding) 11 3.6 4 3.2 6 5.1 1 1.7 1.42 .49Em brasa (searing) 20 6.6 9 7.3 7 5.9 4 6.7 0.17 .92Formigamento (tingling) 63 20.9 16 12.9 43 36.4 4 6.7 29.43 .001*Coceira (itchy) 31 10.3 16 12.9 9 7.6 6 10.0 1.83 .40Ardor (smarting) 68 22.5 34 27.4 21 17.8 13 21.7 3.24 .20Ferroada (stinging) 49 16.2 16 12.9 19 16.1 14 23.3 3.24 .20Mal localizada (dull) 24 7.9 5 4.0 12 10.2 7 11.7 4.53 .10Dolorida (sore) 78 25.8 28 22.6 34 28.8 16 26.7 1.25 .53Machucada (hurting) 10 3.3 4 3.2 2 1.7 4 6.7 3.08 .21Doida (aching) 58 19.2 16 12.9 25 21.2 17 28.3 6.69 .03*Pesada (heavy) 72 23.8 30 24.2 31 26.3 11 18.3 1.39 .50Sens�ıvel (tender) 70 23.2 30 24.2 28 23.7 12 20.0 0.43 .81Esticada (taut) 40 13.2 9 7.3 21 17.8 10 16.7 6.61 .04*Esfolante (rasping) 11 3.6 2 1.6 3 2.5 6 10.0 8.87 .01*Rachado (splitting) 31 10.3 11 8.9 14 11.9 6 10.0 0.59 .74

EvaluativeChata (annoying) 35 11.6 14 11.3 10 8.5 11 18.3 3.79 .15Que incomoda (troublesome) 92 30.5 45 36.3 34 28.8 13 21.7 4.33 .11Desgastante (miserable) 33 10.9 8 6.5 20 16.9 5 8.3 7.36 .02*Forte (intense) 29 9.6 10 8.1 13 11.0 6 10.0 0.62 .73Insuport�avel (unbearable) 89 29.5 33 26.6 33 28.0 23 38.3 2.88 .24

AffectiveCansativa (tiring) 145 48.0 47 37.9 61 51.7 37 61.7 10.20 .01*Exaustiva (exhausting) 81 26.8 23 18.5 45 38.1 13 21.7 12.83 .002*Enjoada (sickening) 122 40.4 43 34.7 52 44.1 27 45.0 2.87 .24Sufocante (suffocating) 92 30.5 32 25.8 43 36.4 17 28.3 3.39 .18Amedrontadora (fearful) 50 16.6 12 9.7 20 16.9 18 30.0 12.11 .002*

(Continued )

214 Ferreira et al.

Page 6: Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ)

TABLE 2.

Continued

Pain Descriptor

Total Sample Neuropathic Musculoskeletal Other

c2 p Valuen % n % n % n %

Apavorante (frighful) 109 36.1 37 29.8 49 41.5 23 38.3 3.74 .15Aterrorizante (terrifying) 59 19.5 20 16.1 30 25.4 9 15.0 4.30 .12Castigante (punishing) 40 13.2 10 8.1 24 20.3 6 10.0 8.61 .01*Atormenta (gruelling) 46 15.2 18 14.5 20 16.9 8 13.3 0.49 .78Cruel (cruel) 23 7.6 8 6.5 8 6.8 7 11.7 1.75 .42Maldita (vicious) 30 9.9 8 6.5 15 12.7 7 11.7 2.90 .23Mortal (killing) 20 6.6 6 4.8 9 7.6 5 8.3 1.11 .57Miser�avel (wretched) 39 12.9 10 8.1 20 16.9 9 15.0 4.53 .10Enlouquecedora (blinding) 88 29.1 29 23.4 40 33.9 19 31.7 3.48 .18

MiscellaneousEspalha (spreading) 84 27.8 27 21.8 41 34.7 16 26.7 5.12 .08Irradia (radiating) 56 18.5 14 11.3 31 26.3 11 18.3 8.98 .01*Penetra (penetrating) 31 10.3 15 12.1 9 7.6 7 11.7 1.47 .48Atravessa (piercing) 17 5.6 6 4.8 10 8.5 1 1.7 3.72 .16Aperta (tight) 51 16.9 6 4.8 30 25.4 15 25.0 21.76 .001*Adormece (numb) 52 17.2 27 21.8 22 18.6 3 5.0 8.26 .02*Repuxa (drawing) 67 22.2 21 16.9 32 27.1 14 23.3 3.69 .16Espreme (squeezing) 10 3.3 3 2.4 5 4.2 2 3.3 0.62 .73Rasga (tearing) 16 5.3 5 4.0 8 6.8 2 3.3 0.92 .63Fria (cool) 38 12.6 13 10.5 19 16.1 6 10.0 2.19 .33Gelada (cold) 16 5.3 6 4.8 6 5.1 4 6.7 0.29 .87Congelante (freezing) 5 1.7 — — 3 2.5 2 3.3 3.69 .16Aborrecida (nagging) 90 29.8 35 28.2 39 33.1 16 26.7 1.02 .60da nausea (nauseating) 25 8.3 4 3.2 11 9.3 10 16.7 9.89 .01*Agonizante (agonizing) 19 6.3 5 4.0 9 7.6 5 8.3 1.85 .39Pavorosa (dreadful) 20 6.6 4 3.2 9 7.6 7 11.7 4.97 .08Torturante (torturing) 60 19.9 25 20.2 27 22.9 8 13.3 2.30 .32

*Significant difference at the level of p < .05.

215Brazilian SF-MPQ

discriminating groups of patients with different inten-

sities of pain (mild, moderate, and severe) and differ-

ent pain syndromes. The BV-SF-MPQ showed

convergent validity, because it was highly correlated

with the PRI and NWC of the BV-LF-MPQ. Although

it did not show good internal consistency when

measured by KR-20 coefficient, the BV-SF-MPQ

showed results similar to those obtained with theLF-MPQ.

Taking these results into account it can be ques-

tioned whether the BV-SF-MPQ evaluates the three di-

mensions of pain (sensory, affective, and evaluative)

with equal sensitivity. These data suggest that the sen-

sory and affective dimensions could be well discrimi-

nated, but weak evidence was found for the

evaluative dimension of pain. It is interesting to noticethat similar results were found in the short form of the

Spanish LF-MPQ (Masedo & Esteve, 2000). It remains to

be evaluated whether these differences are due to the

low number of descriptors in the short form for this as-

pect of chronic pain, or to an intrinsic limitation of the

questionnaire itself to evaluate such complex

phenomenon.

The criterion adopted to select descriptors to the

BV-SF-MPQ was not the same one adopted by Melzack

in the development of the original version of the SF-

MPQ (Melzack, 1987). If the Melzack’s criterion was

used (select the descriptors chosen by $33% of

patients), only eight descriptors would have been se-lected (throbbing, jumping, pricking, tugging, burning,

tiring, sickening, and frightful). Melzack did not explain

the reason he established 33% as a cutoff point for se-

lecting the descriptors. In the Swedish translation, fo-

cused on rheumatoid arthritis patients, only eight of

the 15 descriptors met the criterion of 33%

(Burckhardt & Bjelle, 1994). Also in the validation of

the Thai version (Kitisomprayoonkul, Klaphajone, &Kovindha, 2006), three pain descriptors (stabbing,

gnawing, and splitting) did not meet the 33% cutoff. In-

terestingly, a study showed that older people used

a number of additional words not usually found in the

SF-MPQ to describe their pain (Bergh, Gunnarsson,

Page 7: Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ)

TABLE 3.

The Short-Form McGill Pain Questionnaire (Brazilian Version)*

Dimension Presence Absence Localization of pain

Sensory1. Latejante (throbbing) ( ) ( )2. pontada (jumping) ( ) ( )3. choque (flashing) ( ) ( )4. fina-agulhada (sharp-pricking) ( ) ( )5. fisgada (tugging) ( ) ( )6. queimac~ao (burning) ( ) ( )7. espalha (spreading) ( ) ( )8. dolorida/doida (sore/aching) ( ) ( )

Affective9. cansativa-exaustiva (tiring-

exhausting)( ) ( )

10. enjoada (sickening) ( ) ( )11. sufocante (suffocating) ( ) ( )12. apavorante-enlouquecedora

(frightful-blinding)( ) ( )

13. aborrecida (nagging) ( ) ( )

Evaluative14. que incomoda (troublesome) ( ) ( )15. insuport�avel (unbearable) ( ) ( )

*The actual scale used by the subjects was that the VAS line was 10 cm in length.

216 Ferreira et al.

Allwood, Oden, Sjostrom, & Steen, 2005), indicating

that special populationsmight require a specific versionof the SF-MPQ.

BV-SF-MPQ had only six words in common with

Melzack’s original SF-MPQ: throbbing, sickening,

TABLE 4.

Correlation Coefficients Between Brazilian Version ofNumeric Pain Rating Scale, r (p Value)

Variable

Brazilian Version o

Total score Sensory E

LF-MPQ (PRI)*Total score 0.66 (.000) 0.50 (.000)PRI- Sensory 0.60 (.000) 0.51 (.000)PRI- Affective 0.61 (.000) 0.41 (.000)PRI- Evaluative 0.31 (.000) 0.20 (.001)

LF-MPQ (NWC)Total score 0.75 (.000) 0.61 (.000)NWC- Sensory 0.73 (.000) 0.67 (.000)NWC- Affective 0.65 (.000) 0.43 (.000)NWC- Evaluative 0.32 (.000) 0.21 (.000)

SF-MPQ (NWC)Total score 1.00 0.90 (.000)NWC- Sensory — 1.00NWC- Affective — 0.50 (.000)NWC- Evaluative — 0.10 (.078) 1

PRI ¼ pain rating index (sum of given values of all words chosen); NWC ¼ numbe

sharp, burning, and tiring-exhausting. This could re-

flect cultural differences between Brazilian and Cana-dian individuals unrelated to overall pain intensity,

because ethnicity was identified as a moderating vari-

able for five items of the SF-MPQ (gnawing, aching,

the SF-MPQ Scores, LF-MPQ Scores, and

f SF-MPQ

Numeric Rating Scalevaluative Affective

0.20 (.000) 0.63 (.000) 0.46 (.000)0.13 (.029) 0.53 (.000) 0.37 (.000)0.18 (.001) 0.70 (.000) 0.43 (.000)0.39 (.000) 0.30 (.000) 0.38 (.000)

0.16 (.004) 0.69 (.000) 0.42 (.000)0.13 (.019) 0.58 (.000) 0.37 (.000)0.19 (.001) 0.72 (.000) 0.38 (.000)0.36 (.000) 0.29 (.000) 0.20 (.001)

0.31 (.000) 0.78 (.000) 0.31 (.000)0.10 (.078) 0.47 (.000) 0.21 (.000)0.12 (.033) 1.00 0.28 (.001).00 0.12 (.033) 0.19 (.002)

r of words chosen.

Page 8: Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ)

TABLE 5.

Comparison of the Mean Number of Words Chosen in the Brazilian Version of the Short-Form McGillPain Questionnaire (SF-MPQ) According to Pain Syndromes and Intensity of Pain

SF-MPQ

Pain Syndrome

Test

p Value,Post HocContrasts

Total Sample Neuropathic (N) Musculoskeletal (M) Other (O)

Mean SD Mean SD Mean SD Mean SD

Total score 5.82 2.53 5.17 2.77 6.41 2.31 6.00 2.11 7.767† .001*, N < Mp ¼ .000, N < Op ¼ .002

Sensorydimension

2.91 1.60 2.65 1.52 3.17 1.65 2.97 1.64 6.16‡ .037*, N < Mp ¼ .033, N < Op ¼ .002

Affectivedimension

2.30 1.20 1.90 1.41 2.67 1.00 2.43 0.77 20.01‡ .001*, N < Mp ¼ .000, N < Op ¼ .001

Evaluativedimension

0.60 0.49 0.63 0.49 0.57 0.50 0.60 0.49 0.94‡ .62

Level of Pain Intensity

Mild Moderate Severe

Mean SD Mean SD Mean SD

Total score — — 3.22 2.18 5.05 2.64 6.22 2.40 15.04† .01*, mild < moderatep ¼ .024, mild<severe p ¼ .000;moderate < severep ¼ .015

Sensorydimension

— — 1.50 1.20 2.55 1.66 3.18 1.54 7.86‡ .02*, mild < severep ¼ .000; moderate< severe p ¼ .05

Affectivedimension

— — 1.33 1.41 1.98 1.35 2.44 1.10 14.51‡ .009*, mild < severep ¼ .000

Evaluativedimension

— — 0.39 0.50 0.52 0.51 0.60 0.49 3.55‡ .16

*Significant difference at the level of p < .05.†Analysis of variance test.‡Kruskall-Wallis test.

217Brazilian SF-MPQ

tiring-exhausting, sickening, and throbbing) when

comparing Hispanic and non-Hispanic caucasian pa-

tients with pain (Zinke, Lam, Fogg, Harden, & Lofland,2008). In addition, this could also be a consequence

of the different number of individuals (302 in the pres-

ent study and 70 in the original version) and type of pain

syndromes (12 different pain syndromes in this study

and mainly postsurgical pain, labor pain, and musculo-

skeletal pain [low back and neck-and-shoulder pain]

in the SF-MPQ) (Melzack, 1987).

The LF-MPQ total score (NWC) had higher corre-lation with the SF-MPQ total score than with the

LF-MPQ PRI. Similar results were found in patients

with pain related to metastatic cancer (Dudgeon,

Raubertas, & Rosenthal, 1993).

In the present study, the most selected descriptors

were kept under their original dimension. Thus, the

BV-SF-MPQ had three dimensions (sensory, affective,and evaluative). In the original SF, there were two di-

mensions (sensory and affective). In the Swedish ver-

sion, a confirmatory factor analysis confirmed the

three-factor solution (dimensions) in their question-

naire (Burckhardt & Bjelle, 1994), but such confirma-

tory results of the three-dimensional structure was

not universal. A study conducted with patients with

chronic back pain, using the same methods, confirmedthe two original dimensions (sensory and affective)

(Wright, Asmundson, & McCreary, 2001).

Internal consistency for overall score of the SF-

MPQ was 0.52. It could be the result of the number of

Page 9: Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ)

218 Ferreira et al.

items included and the low correlation between the

evaluative dimension and the other dimensions of

pain (ranging from 0.10 to 0.12) (McDowell &

Newell, 1996). The poor internal consistency reliability

does not necessarily mean that this scale is poorly con-

structed, because the KR-20 and Cronbach alpha coeffi-

cients are not only dependent on the magnitude of thecorrelations among items, but also on the number of

items in the instrument. A scale can be made look

more ‘‘homogeneous’’ simply by adding items (Streiner

& Norman, 2003). Therefore, in addition to psychomet-

ric properties, clinical relevance is also important for

developing an instrument (Fayers & Machin, 2000).

The present study has some limitations in that the

SF-MPQ’s test-retest reliability and responsivenesswere not evaluated. However, it was observed that

the SF-MPQ was able to differentiate between patients

with severe, mild, and moderate pain and those with

neuropathic and musculoskeletal pain syndromes.

This could imply that if the SF-MPQwere used to assess

the effectiveness of some therapy to treat pain, the SF-

MPQ would be able to identify changes in pain charac-

teristics and intensity.

Intercorrelation between scales supports the clus-tering of descriptors in the affective, evaluative, and

sensory dimensions of chronic pain. Thus, it could

be concluded that the BV-SF-MPQ evaluated pain in

a brief fashion as a multidimensional tool.

Acknowledgments

The authors gratefully thank the members of the Multidisci-

plinary Pain Center of the Hospital das Clinicas, University

of S~ao Paulo, Brazil, for their collaboration and support.

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