|Year : 2015 | Volume
| Issue : 2 | Page : 61-63
Brief pain inventory scale: An emerging assessment modality for orofacial pain
Ruchika Khanna1, Anand Kumar2, Ruchit Khanna3
1 Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India
2 Department of Oral and Maxillofacial Surgery, Career Post Graduate Institute, Lucknow, Uttar Pradesh, India
3 Department of Pharmacology, MMISR, Mullana, Ambala, Haryana, India
|Date of Web Publication||15-Apr-2015|
Dr. Ruchika Khanna
Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Pain is an emotional experience almost experienced by almost every one of us. Since the pain can neither be seen nor measured, it poses a challenge to the patient as well as the clinician in understanding its complicated nature and the best way of managing it. There is no simple method of pain evaluation due to its subjective nature. However, comprehensive approaches for its evaluation exists, of which most common pain scale used are visual analog scale, Mc-Gills questionnaire, brief pain inventory (BPI) to name a few. We have tried to highlight the various advantages of the BPI scale over the other pain scales and to emphasize an improved instrument, which can be used as a promising modality for the assessment of orofacial pain.
Keywords: Brief pain inventory, experience, pain scale
|How to cite this article:|
Khanna R, Kumar A, Khanna R. Brief pain inventory scale: An emerging assessment modality for orofacial pain. Indian J Pain 2015;29:61-3
| Introduction|| |
The two mammoths of Ancient Greece, Plato and his student Aristotle, both considered pain to be an emotional experience rather than a sensory experience. The mortal fools who had angered the gods were punished by the Greek goddess of revenge, Poine which also gave us our word "pain". It is an undoubted fact that pain is universal.  Pain is defined by the International Association for the study of pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." To further improve its treatment, its measurement is imperative. No simple method, of measuring pain, is available due to its subjective nature. Poorly controlled pain has a ruinous effect in case of cancer patients along with their family members. It not only devalues the quality of life but, also affects appetite and activity of the patient. Apart from deteriorating the mood and quality of life it also causes adverse effects on appetite and activity of the patient.  A whole lot of instruments are available these days to assess pain. More comprehensive approaches to evaluate pain exists, out of which most common pain scales are visual analogue scale (VAS) and Mc-Gill pain scales, brief pain inventory (BPI) pain scale.
| Visual Analog Scale|| |
Visual analog scale is the most often used measure of pain intensity in clinical trials and is used for measurement of subjective characteristics that cannot be directly measured. It usually consists of a line, which is 100 mm long, with two descriptors representing extremes of pain intensity (e.g. no pain and extreme pain) at each end. Patients rate their pain intensity by making a mark on the line representing their intensity and VAS is scored by measuring the distance from "no pain" end of the line.  The patient usually rate on the line, the point that they feel represents their perception of their current state. This scale is of the most value when looking at change within individuals, and is of less value for comparing across a group of individuals at one time point.
These pain scales have certain advantages as well as certain disadvantages. The advantages of VAS are that it is simple, cost-effective, sensitive, quick can be filled out easily, does not demand high degree of literacy and sophistication, minimally intrusive that are effective and easy to administer and score, in most cases. However, verbal, numerical, and VASs cannot be used in all patients. The disadvantages of the pain scale are that it is ineffective in patients who have cognitive or motor problems, in patients who are unresponsive (e.g., due to injury), and in young children and elderly patients, it lacks theoretical foundation, measurement error, alteration in length of scale, measurement scores by the examiner.
| Mc-Gills Pain Questionnaire|| |
It was developed at McGill University by Melzack in 1975  for assessing the sensory, affective and evaluative dimensions of pain. It is most widely used instrument today for measuring the quality and intensity of pain.  It is a self-report questionnaire that allows the patients to describe the pain that they are experiencing. It has been translated to 17 different languages.  Sensory dimension of pain depicts what pain feels physically (burning, throbbing), affective dimension of pain depicts what pain feels emotionally (frightening, worrying) and evaluative dimension of pain depicts subjective overall intensity of pain. Scores are usually calculated by adding the intensity values for each of the categories. Hence, Mc-Gills questionnaire is regarded as a methodological approach for evaluation of pain. It has also been regarded as one of the widely used tests for evaluation of pain and is applied for the diagnosis of cancer pain as well. 
The advantages of Mc-Gills questionnaire are:
- Well validated,
- Describes qualities of pain,
- Sensitive to change,
- Its uniqueness of its translations to various languages,
- Suitable for pharmacological trials.
The disadvantages are:
- Extensive understanding of language like "smarting," "struging",
- Difficult and time consuming,
- Demands sophisticated literacy,
- Less convenient.
| Brief Pain Inventory Scale|| |
Brief pain inventory scale was first developed by Cleeland in the year 1984. It is a short, self-administered questionnaire which is designed in order to assess the severity and impact of pain, mainly of cancer origin. Greatest use of this scale apart from cancer has been in AIDS patients.  The other areas, where its use is reported, were in assessment of muscle tenderness, pain medication use in temporomandibular joint patients, shoulder dysfunction patients, osteoporosis, herpes zoster, cereberal palsy. It too has been translated to various languages like Vietnamese, Chinese, Italian, German, Taiwanese, Greek, Norwegian, French, Hindi, Japanese, and Spanish etc. for use throughout the world to analyze pain. It is composed of 11 items on a 1-point scale (0-10). Four items are concerning pain intensity, rest seven items deal with pain interference with general life activities (Chen and Lee 2010) added seven more items to it focusing on the interference of pain with orofacial activities and hence the entire 18-item instrument was called the BPI-facial.  BPI asks the patient for graphic representation regarding the location of pain by providing the patient with a front as well as a back view of a human figure for shading the area of pain.  This can provide a lot of information regarding the possible mechanism of pain like possibility of involvement of a particular nerve through its distribution or a tumor impingement on that nerve. Harris et al.  studied BPI on 199 patients referred to the Rapid Response Radiotherapy Program for palliative radiotherapy of symptomatic bone metastases for evaluation of patient's response to radiotherapy. An overall response rate was observed in 66, 58, and 54% of patients for worst, average, and current pain, respectively. Hence, can also be used to assess pain in bone metastasis.
The advantages of this pain scale are:
- Easy to assess,
- Utilized for an overall assessment,
- Validated in many languages,
- Provides graphic representation of location of pain,
- Provides information on duration of pain relief.
The disadvantage is that it is time consuming.
The comparison of Visual analogue scale, McGill pain questionnaire and Brief Pain Inventory are [Table 1]:
| Conclusion|| |
Hence, BPI is multidimensional, assesses pain in several aspects like location, intensity, interference, impact on the patient's daily life. The BPI assesses the major clinical characteristics of pain and its impact on daily functions. It can be used as a qualitative as well as a quantitative measure in various research works and has been adopted in various countries as an important assessment tool. Its elements involve the items that are usually used in medical consultations for diagnosis and follow-up, thus being preferred by physicians and patients both. Thus, we can say that BPI pain scale is more complete.
| References|| |
Mystakidou K, Parpa E, Tsilika E, Kalaidopoulou O, Georgaki S, Galanos A, et al.
Greek McGill Pain Questionnaire: Validation and utility in cancer patients. J Pain Symptom Manage 2002;24:379-87.
Cleeland CS, Ryan KM. Pain assessment: Global use of the Brief Pain Inventory. Ann Acad Med Singapore 1994;23:129-38.
Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: A reanalysis of two clinical trials of postoperative pain. J Pain 2003;4:407-14.
Melzack R. The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1975;1:277-99.
Menezes Costa Lda C, Maher CG, McAuley JH, Hancock MJ, de Melo Oliveira W, Azevedo DC, et al
. The Brazilian-Portuguese versions of the McGill Pain Questionnaire were reproducible, valid, and responsive in patients with musculoskeletal pain. J Clin Epidemiol 2011;64:903-12.
Menezes Costa Lda C, Maher CG, McAuley JH, Costa LO. Systematic review of cross-cultural adaptations of McGill Pain Questionnaire reveals a paucity of clinimetric testing. J Clin Epidemiol 2009;62:934-43.
Keller S, Bann CM, Dodd SL, Schein J, Mendoza TR, Cleeland CS. Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004;20:309-18.
Chen HI, Lee JY. The measurement of pain in patients with trigeminal neuralgia. Clin Neurosurg 2010;57:129-33.
Harris K, Li K, Flynn C, Chow E. Worst, average or current pain in the Brief Pain Inventory: Which should be used to calculate the response to palliative radiotherapy in patients with bone metastases? Clin Oncol (R Coll Radiol) 2007;19:523-7.