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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:
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
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,
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).
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
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.
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,
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.
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
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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