Standardization of chronic pain assessment: a multiperspective approach.

OBJECTIVE: this study reports the results of reliability and validity analyses on the Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). When pain becomes chronic it intertwines with the many dimensions of a patient's life, increasing the complexity of the patient's perception of the pain and, subsequently, the prescribed treatment. Both the patient's perspective and the physician's perspective are crucial in the assessment of these multiple dimensions, creating a fundamental need for a valid and reliable, multiperspective, multidimensional pain assessment tool. DESIGN: A randomized regional sample of outpatients complaining of chronic pain. Each MMPAP consisted of physical examinations by two physicians and the participant's subjective self-report. Primary criterion standards were the Multidimensional Pain Instrument and the McGill Pain Questionnaire. SETTING: Ambulatory referral centers, both public and private. PARTICIPANTS: A population-based random sample of 651 outpatients claiming chronic pain. Thirty-six patients who were originally recruited refused participation, and four patients did not complete the entire assessment. INTERVENTIONS: No interventions were continued or initiated by the research team. MAIN OUTCOME MEASURES: As this was a validation of the instruments used, no patient outcomes were influenced or assessed. The MMPAP is a recently developed pain assessment protocol, which uses both subjective information and objective medical evidence. RESULTS: The MMPAP proved to be a reliable and valid tool that may assist in the assessment of chronic pain when two physicians independently assess the patient and this information is combined with the patient's self-reported pain perceptions. Test-retest and interrater reliability analyses confirmed that the data collected with the MMPAP were repeatable. A combination of concurrent comparisons with previously validated instruments, construct corroboration with factor analysis, and internal consistency analyses ascertained the validity of the MMPAP. CONCLUSIONS: The introduction of this standardized protocol will assist in standardizing assessments of patients with chronic pain. The MMPAP has potential as a diagnostic tool, a measure of treatment effectiveness, and a tool to compare various pain treatment center outcomes.

Predicting subsequent employment status of SSA disability applicants with chronic pain.

OBJECTIVE: The study assessed the predictive ability of the standardized Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). An assessment tool that predicts return to work with chronic pain patients is needed, as increasing numbers of disability applications are adjudicated in the courts. DESIGN: National randomized validation sample of disability applicants. Each MMPAP consisted of physical examinations by two physiatrists and the participant's subjective assessment. Criterion standards were Multidimensional Pain Inventory and McGill Pain Questionnaire. There was phone follow-up 6 months postdecision. SETTING: Six clinical sites were ambulatory referral centers, both public and private. PARTICIPANTS: Population-based random national sample of 710 Social Security disability applicants claiming chronic pain related to their disability, stratified by national Social Security Administration (SSA) applicant demographics. Seventy-eight were lost to follow-up, and 688 initially refused. INTERVENTIONS: No interventions were continued or initiated by the research team between assessment and follow-up. MAIN OUTCOME MEASURES: Claimant employment status 6 months after disability decision was primary outcome, change in pain intensity, and change in employment situation. RESULTS: The MMPAP predicted with 90% accuracy employment status of SSA disability applicants with chronic pain 6 months postdecision when assessed at application by two physicians trained in Physical Medicine and Rehabilitation (physiatry). Accuracy of employment situation change was 93%, and pain intensity change was 65%. Self-report measures, physical examination results, psychological status, functional limitations, and physician's subjective appraisal predict future employment. CONCLUSIONS: The MMPAP accurately predicts future employment of disability applicants claiming chronic pain. The introduction of this standardized protocol will assist in standardizing disability determination for claimants with chronic pain.