AB Soft The Brief Pain Inventory ii - Manual (Page 3)

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Chapter 1
Development of the Brief Pain
Inventory
The Brief Pain Inventory (BPI) has become one of
the most widely used measurement tools for
assessing clinical pain. The BPI allows patients to
rate the severity of their pain and the degree to
which their pain interferes with common
dimensions of feeling and function. Initially
developed to assess pain related to cancer, the
BPI has been shown to be an appropriate
measure for pain caused by a wide range of
clinical conditions. The BPI has been used in
hundreds of studies. In some ways, the BPI is a
“legacy” instrument— a self-report measure that
has, over time, become a standard for the
assessment of pain and its impact.
Background
In the late 1970s, it became increasingly evident
that patients with cancer, especially the later
stages of the disease, experienced
incapacitating pain that was often poorly
controlled. A constellation of events— the
publishing of opinion pieces by prominent
persons with cancer pain, the increasing
advocacy of pain professionals and
organizations for better cancer pain
management, a growing awareness of the
problem by national and international policy
groups, and the simple recognition that pain
often could be controlled— created the climate
for a sustained effort to improve pain
management for those with cancer.
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A first step in this effort was to document the extent of poor pain
management. The National Cancer Institute (NCI) and the Cancer
Unit of the World Health Organization (WHO) wanted
measurement instruments that would better capture the severity
and impact of cancer pain and measure improvement in pain
after changes in analgesic practice or implementation of new
pain treatments. These instruments also needed to function well in
large-scale national and international studies of the epidemiology
of cancer pain.
With grant support from both the NCI and the WHO, the Pain
Research Group at the University of Wisconsin Medical School-
Madison, under the direction of Charles S. Cleeland, PhD,
undertook a program to test and develop self-report measures of
cancer pain and to apply them to studies of pain and its
treatment in the United States and internationally. The Pain
Research Group, now the Department of Symptom Research at
The University of Texas M. D. Anderson Cancer Center, was also the
WHO Collaborating Center for Symptom Research in Cancer.
Developing a Measurement Model and Items
Several existing pain measures (such as the McGill Pain
Questionnaire; Melzack, 1975) were field-tested in interviews with
cancer patients who had pain (N=50). Almost all of these
measures had been designed to assess pain in patients with
nonmalignant disease. The patients reported that the measures
were too complex and too long, making them excessively
burdensome for patients with high levels of pain. Patients also
noted that the existing instruments included items not relevant to
cancer patients and sometimes required responses that patients
felt were ambiguous (Cleeland, 1984). Patients were also asked
what questions they felt were the most important for
communicating their experience of pain. The results of this study
made clear that a new measurement instrument was needed.
The Pain Research Group planned a program to develop such an
instrument. The aims were to have a scale that: (a) would take
only a short time to complete; (b) would be easy for patients to
understand; (c) could be self-administered for literate patients, or
be completed by interview for illiterate or low-literacy patients; (d)