Confirming the theoretical structure of the McGill Pain Questionnaire in acute clinical pain

Based upon a tripartite theoretical model of pain, the Pain Rating Index (PRI) of the McGill Pain Questionnaire (MPQ) continues to be one of the most frequently used instruments to measure clinical pain. Although a number of exploratory factor analytic studies have failed to consistently support the theoretical structure of the instrument, one previous confirmatory factor analytic study of chronic pain did statistically support the a priori model. Because it has been suggested that acute pain may not involve the same dimensions as chronic pain, this study provided a direct test of the theoretical structure of the MPQ through multi-sample confirmatory factor analysis (CFA) using data provided by women experiencing pain during labor (n = 185) and women experiencing acute postoperative pain (n = 192). Results of the LISREL CFA analysis indicated that the a priori, 3-factor, oblique model originally proposed by Melzack provided the most parsimonious representation of the data across the 2 samples of acute pain.     

The McGill Pain Questionnaire as a Multidimensional Measure in People with Cancer: An Integrative Review

First published in 1975, the McGill Pain Questionnaire (MPQ) is an often-cited pain measure, but there have been no systematic reviews of the MPQ in cancer populations. Our objective was to evaluate the MPQ as a multidimensional measure of pain in people with cancer. A systematic search of research that used the MPQ in adults with cancer and published in English from 1975 to 2009 was conducted. Twenty-one articles retrieved through computerized searches and nine studies from manual searches met the criteria. Review of the 30 studies demonstrated that pain intensity (n = 29 studies) and pain quality (n = 27 studies) were measured more frequently than pain location, pattern, and behavior parameters. Measuring cancer pain using the MPQ provided insights about disease sites, magnitude of pain, and effectiveness of treatment and intervention. Additionally, the MPQ data informed speculations about pain mechanisms, emotional status, overall sensory pain experience, changes in pain over time, and alleviating and aggravating behaviors/factors. Findings supported the MPQ as an effective multidimensional measure with good stability, content, construct, and criterion validity and showed sensitivity to treatment or known-group effects. The MPQ is a valid, reliable, and sensitive multidimensional measure of cancer pain. Cancer pain is a subjective complex experience consisting of multiple dimensions, and measuring cancer pain with the MPQ may help clinicians to more fully understand whether those dimensions of cancer pain influence each other. As a result, clinicians can provide better and effective cancer pain management.     

The experience of headache — An assessment of the qualities of tension headache pain

The subjective component of headache pain has been neglected in headache research. In this study of 65 chronic headache sufferers, assessment of the subjective component was amplified using the McGill Pain Questionnaire (MPQ) as well as headache diaries. The overall level of pain experienced was as high as that previously reported for cancer and phantom-limb patients. Assessment of sensory pain qualities (MPQ) revealed differences between tension and migraine headache types; tension headaches were felt to be “tight”, while migraines were experienced as “sharp”, “blinding”, “nauseating” and “sickening”. The results thus support a dichotomous rather than a continuum model of headache.The relationship between the subjective experience of headache and mood (Wakefield Depression Scale) and personality (EPQ) was examined. Pain intensity and affective reactions to pain were associated with general mood state; however, no subjective measures correlated with personality indices.It was argued that the MPQ provided valuable additional information to be used with headache diaries, particularly in the assessment of sensory qualities and affective reactions to pain.     

疼痛的测量和评估方法

测量疼痛的方法包括词语和数字的自我评定量表、行为观察量表和生理学方法。视觉模拟量表(VAS)和McGill疼痛问卷表(MPQ)可能是进行疼痛测量时最常用的自我评估手段。MPQ是用来评估疼痛过程中具有多方向性的,而且已被证实是一种可靠的、有效的、有一致性的测量手段;描述语的区分量表(DDS)运用了复杂的精神物理学技术,是用来分别测量疼痛的感觉和不愉快的情绪,已证实DDS具有比率量表性质,是有效的,可靠的疼痛测量方法,被广泛应用于临床。     

Transcutaneous electrical nerve stimulation for the relief of postoperative pain.

The pain-killing abilities of electricity were known as far back as the ancient Egyptians and Hippocrates, but it was not until 1965 when Melzack and Wall [10] proposed the “gate theory of pain” that clinical interest was re-awakened. This theory postulated that a “gate” for pain existed in the substantia gelatinosa of the posterior spinal horns and that modification of the perception of pain might be possible by blocking the “gate” with non-painful stimuli. They suggested that selective stimulation of large diameter myelinated cutaneous afferent nerve fibers could set a process in motion which would close the “gate” to information coming over smaller pain-carrying fibers.The first clinical application of this theory centered around the relief of chronic pain by surgical placement of dorsal column stimulators [1] and implantation of stimulating devices around large peripheral nerves to block pain sensations. Transcutaneous electrical nerve stimulation was first employed in an attempt to select patients for implantable devices and then as a therapeutic device to alleviate chronic pain [2,4,6,9,11].The next logical step was to apply this modality to patients in the immediate postoperative period to decrease incisional pain. Hymes et al. [8] noted a decrease in atelectasis, ileus, postoperative pain and days spent in intensive care in patients using transcutaneous electrical stimulation. Vanderank and McGrath [9] reported that 77% of their patients treated with stimulators experienced some relief of postoperative pain.     

Cluster headache pain vs. other vascular headache pain: differences revealed with two approaches to the McGill Pain Questionnaire

We compared cluster headache pain and other vascular (migraine and mixed) headache pain on pain intensity ratings and the McGill Pain Questionnaire (MPQ). Cluster headache sufferers reported not only more intense pain and more affective distress, but also different pain qualities than did migraine and mixed headache sufferers. The pain qualities that best distinguished cluster headaches from other vascular headaches were the presence of punctate pressure and thermal sensations and the absence of dull pain. Although cluster headache sufferers and other vascular headache sufferers endorsed different sensory pain qualities, MPQ subscales proved no better than pain intensity ratings at distinguishing these two groups. This finding may have occurred because MPQ subscale scores include an intensity component and do not provide information about specific pain qualities such as that provided by MPQ sensory items. These findings provide evidence that cluster headaches are characterized by distinct pain qualities and are not simply a more intense version of the same vascular headache pain experienced by migraine and mixed headache sufferers. They further suggest than when the MPQ is used to assess specific pain qualities, sensory items and not the sensory subscale are the preferred units for analysis.     

The specificity of quality-of-life measures among the seriously ill

The need to address the impacts of serious disease and the effectiveness of interventions has led to the development of numerous measures of the quality of life. The research reported here explores the possibility that widely used measures do not truly distinguish among separate dimensions of the quality of life in a seriously ill population, but reflect a generalized tendency among such individuals to respond negatively to interviewers' questions about their well-being. This research examines three widely used measures--the Sickness Impact Profile (SIP), the Profile of Mood States (POMS), and the McGill Pain Questionnaire (MPQ)--as applied to 536 individuals with recent cancer diagnoses. In a multitrait-multimethod matrix, correlation coefficients among measures believed to reflect the same phenomena are consistently higher than correlation coefficients among measures supposed to reflect different phenomena. In a factor analysis performed on all 536 subjects, the unrotated factor matrix indicates that no single factor explains a preponderance of the variance in individual measures. Orthogonal rotation indicates that subscales from the SIP, POMS, and MPQ generally load on factors defined by the scales of which they are part. These findings were replicated on subsamples of subjects with particularly severe disease. The study suggests that the SIP, POMS, and MPQ measure the specific dimensions their names imply, even among individuals with illnesses posing immediate threats to survival.     

脊髓损伤的中枢性疼痛诊断、评价和康复治疗

脊髓损伤的中枢性疼痛,是一种严重影响患者生存质量的顽固性疼痛。关于这种痛的发生,R.Melzack和G.Bedbrook提出的中枢兴奋性升高学说,近年来已为一系列实验所逐步证实。戴红等提出它可能主要经由非特异性投射系统上传,造成患者大脑觉醒水平提高所致,并存在一定的受体机制。根据14年的临床观察,归纳出其诊断标准和鉴别诊断标准,其评测应采用莫克吉尔疼痛答卷和视觉模拟评分法进行,治疗宜采用综合疗法。     

Psychosocial predictors of labor pain

The relationship between labor pain and concomitant psychological state, in terms of prenatal anxiety levels and post-partum mood, has been studied. A consecutive series of primiparae (n = 129) was assessed at intervals over the course of their pregnancy and after delivery. State anxiety was measured at recruitment (10-14 weeks of pregnancy), 10 weeks, 32 weeks and at labor. Labor pain was assessed on the McGill Pain Questionnaire (MPQ) and visual analog rating scales. Pain ratings on the MPQ were found to be high when compared to other clinical pain groups. Drug use in labor emerged as the strongest predictor of pain ratings on the MPQ total, sensory and affective scales, accounting for 11, 9 and 7% of the variance respectively. Anxiety scores at 32 weeks accounted for a further 5% of the variance and emerged as the best predictor of MPQ evaluative scores and visual analog ratings. A significant association was found between pain ratings and ratings of post-partum mood. Neither attendance at preparatory classes nor initial attitudes towards the neonate were related to pain scores.     

The German counterpart to McGill Pain Questionnaire

This study presents a German version of the McGill Pain Questionnaire (MPQ) developed by strict adherence to the methodology originally employed by Melzack and Torgerson. Three groups of subjects participated: The first group (n = 40) was used to construct a 5-point intensity scale. The second group (n = 42) was presented a preliminary translation of the MPQ and asked to assign an intensity rating out of the 5-point intensity scale to each of the 78 adjectives. In the last phase, adjectives whose mean ratings differed markedly from those in the original MPQ were resubmitted, along with 3-4 synonyms to a third group (n = 40) who was again asked to assign an intensity value to each word. Finally, the adjectives whose ratings corresponded closest, and thus resulted in congruent rank positions to those of the English originals, were selected. The present counterpart to the MPQ retains the original grouping of adjectives, the identical number of words per group as well as their rank positions within groups. Thus a comparison between German and English mean ratings, rank values and number of words chosen as well as statistical calculations derived therefrom is feasible.