Introduction
The Brief Pain Inventory (BPI), developed by Charles S. Cleeland and Kathleen M. Ryan in 1994, published in the Journal of Pain and Symptom Management and maintained by the Pain Research Group at MD Anderson Cancer Center. This robust questionnaire rapidly assesses both the severity of pain and its profound impact on daily functioning, making it an indispensable resource for clinicians and researchers alike. Furthermore, with over 6,000 citations on Google Scholar, the BPI’s widespread adoption underscores its reliability and clinical utility.
This article will delve into the multifaceted features, diverse applications, and significant clinical value of the BPI, providing experts with actionable insights to enhance pain management strategies and inform robust neurology research.
Key Features of the Brief Pain Inventory (BPI)
Purpose and Use
The BPI serves as a critical tool for rapidly assessing the severity of pain and its interference with various aspects of daily life. Clinicians routinely utilize it to guide treatment decisions, evaluate patient disability, and monitor the effectiveness of interventions over time. Consequently, researchers heavily rely on the BPI for robust clinical trials and insightful epidemiological studies across diverse domains of healthcare. Its primary focus on both pain intensity and pain interference helps tailor interventions, thus making it a cornerstone in palliative care, oncology, rheumatology, neurology, anesthesiology, and rehabilitation.
Target Population
The BPI has been validated for adults aged 18 and older, encompassing various age groups including:
- Young adults (18–24 years)
- Middle-aged adults (25–44 years)
- Older adults (45–64 years)
- Seniors (65+ years).
It specifically targets individuals with chronic pain, such as those suffering from cancer, arthritis, or neuropathy. Therefore, it is highly suitable for use in diverse clinical settings and research environments.
Structure
The BPI is a comprehensive questionnaire comprising 32 items. These items thoroughly cover various aspects of the patient’s pain experience, including:
- Pain Intensity: Four items assess the worst, least, average, and current pain experienced in the last 24 hours, all rated on a 0–10 numeric scale.
- Pain Interference: Seven items, also rated on a 0–10 scale, evaluate how pain interferes with general activity, mood, walking ability, normal work, relationships, sleep, and enjoyment of life.
- Pain Location: Patients indicate pain areas on a body diagram.
- Pain Relief: This section assesses the percentage of pain relief experienced from treatments.
- Expanded Details: Additionally, the BPI expands to include socioeconomic and demographic questions, a detailed pain history and characteristics, medication use, and qualitative pain descriptors (e.g., burning, tingling).
Scoring Method
The BPI employs a 0–10 numeric rating scale (NRS) for both pain intensity and pain interference, where 0 signifies “no pain” or “does not interfere” and 10 represents “worst imaginable pain” or “completely interferes.”
- Pain Intensity Score: This is calculated by averaging the scores of the four intensity items (worst, least, average, current pain), yielding a score ranging from 0–10.
- Pain Interference Score: Similarly, this is derived by averaging the scores of the seven interference items, also resulting in a score from 0–10.
- Pain Relief: This is assessed on a 0%–100% scale, where 0% indicates “no relief” and 100% indicates “complete relief.” Significantly, higher scores consistently indicate greater pain severity or interference.
The BPI also defines pain severity categories as:
- Mild (1–4)
- Moderate (5–6)
- Severe (7–10) based on the worst pain score.
These clear scoring guidelines facilitate clinical decision-making and research analysis.
Administration Format
Administering the BPI is relatively straightforward, as it can be administered via:
- Paper-based forms
- Digital (Online)
- Interview (in-person)
- Phone/Video Call
It typically takes 10-15 minutes to complete the questionnaire. It is worth mentioning that no special training is required as it is often self-administered.
Applications of the Brief Pain Inventory (BPI)
The BPI plays several vital roles in both clinical practice and research settings.
- Screening: Clinicians use the BPI to efficiently identify patients with significant pain and related disability, thus signaling the need for intervention.
- Monitoring: Researchers meticulously track changes in pain intensity and interference over time, particularly during treatment trials, to objectively assess intervention efficacy.
- Treatment Planning: Healthcare professionals can effectively tailor therapies based on BPI scores, allowing for personalized approaches and prioritizing severe cases.
- Research: Investigators widely employ the BPI in clinical trials to evaluate various pain interventions, thereby advancing evidence-based practices in pain management.
Other versions and Related Questionnaires
The BPI has several valuable versions and related tools that complement its utility:
- BPI-SF (Short Form): This shorter version contains 9-11 questions, providing a quicker assessment while retaining core insights.
- Modified Versions: Some versions include modified items for disability, replacing terms like “walking” with “mobility.”
 Other related questionnaires include:
- SF-36 Bodily Pain Subscale
- PEG Scale (a 3-item BPI derivative)
- Roland-Morris Disability Questionnaire
- Visual Analog Scale (VAS)
- Numeric Rating Scale (NRS)
- McGill Pain Questionnaire (MPQ)
- Short-Form McGill (SF-MPQ)
- Pain Disability Index (PDI)
Languages and availability
To support its global application and enhance its value in diverse clinical and research contexts, the BPI has been meticulously translated into over 20 languages. These include, but are not limited to:
- Arabic
- English
- Spanish
- French
- Russian
- German
While there is no charge for non-funded academic research and clinical practice, funded academic research and commercial/pharmaceutical use may require permission and potential payment. Users are advised to contact Dr. Charles S. Cleeland for access or inquiries.
Reliability and Validity
The BPI is considered a highly reliable and valid instrument with strong Cronbach’s alpha ranging from 0.77 to 0.91, reflecting excellent internal consistency. Furthermore, it demonstrates strong test-retest reliability, with an Intraclass Correlation Coefficient (ICC) of 0.84–0.90.
Studies consistently confirm the BPI’s high reliability and validity, showcasing robust psychometric properties. This rigorous validation across diverse pain populations ensures its accuracy and makes it a trusted tool for monitoring treatment outcomes and advancing pain research.
- The original validation study link
- Validation for use in documenting the outcomes of patients with noncancer pain study link
- Validation of the Arabic version study link
- Validayion of the BPI in in Inflammatory Bowel Disease study link
Limitations and Considerations
Despite its strengths, the BPI has a few limitations:
- Self-report measure: Patients may unintentionally skew responses due to social desirability bias or personal interpretation of questions.
- Length: While comprehensive, the 32-item questionnaire might be perceived as lengthy by some patients, especially those in severe pain or with cognitive impairments.
- Social Desirability Bias: Responses can be influenced by patients’ desire to present themselves in a favorable light.
Additional Resources
- The Original Validation Study link
- You can access the questionnaire as a PDF through this link.
- For inquiries, contact Dr. Charles S. Cleeland, the author of the questionnaire: symptomresearch@mdanderson.org
or by mail at Charles S. Cleeland, PhD Professor and Chair, Department of Symptom Research The University of Texas M. D. Anderson Cancer Center 1515 Holcombe Boulevard, Unit 1450 Houston, Texas 77030 link - For additional BPI resources, consult the MD Anderson Cancer Center website: link
- User Guide: link
- Other studies about the BPI in patients with cancer link
Frequently Asked Questions (FAQ)
- Who can use the BPI?
Neurologists, researchers, and other healthcare providers apply the BPI for adults aged 18 and older, particularly those with chronic pain conditions such as cancer, arthritis, or neuropathy. - How long does it take to complete the BPI?
Patients typically complete the BPI in 10 to 15 minutes, making it feasible for use in diverse clinical and research settings. - How is the BPI administered?
Healthcare teams have the flexibility to administer the BPI via paper-based, digital (online), interview (in-person), or phone/video call formats. - Is there any cost to using the BPI?
For non-funded academic research and clinical practice, there is no charge for using the BPI. However, funded academic research and commercial/pharmaceutical use may require permission and potential payment.
A Word from ResRef about the Brief Pain Inventory (BPI)
The BPI is a gold-standard tool for multidimensional pain assessment, balancing brevity and depth. Its cross-cultural adaptability and strong psychometrics make it indispensable in both research and clinical settings.
References
- Cleeland, C. S., & Ryan, K. M. (1994). Pain assessment: global use of the Brief Pain Inventory. Annals of the Academy of Medicine, Singapore, 23(2), 129-138. link
- Keller, S., Bann, C. M., Dodd, S. L., Schein, J., Mendoza, T. R., & Cleeland, C. S. (2004). Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. The Clinical journal of pain, 20(5), 309-318. link
- Ballout, S., Noureddine, S., Huijer, H. A. S., & Kanazi, G. (2011). Psychometric evaluation of the arabic brief pain inventory in a sample of Lebanese cancer patients. Journal of pain and symptom management, 42(1), 147-154. link
- Jelsness-Jørgensen, L. P., Moum, B., Grimstad, T., Jahnsen, J., Opheim, R., Prytz Berset, I., … & Bernklev, T. (2016). Validity, reliability, and responsiveness of the brief pain inventory in inflammatory bowel disease. Canadian Journal of Gastroenterology and Hepatology, 2016(1). link
- Kumar, S. P. (2011). Utilization of brief pain inventory as an assessment tool for pain in patients with cancer: a focused review. Indian journal of palliative care, 17(2), 108. ‏link
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This will help reduce errors caused by misunderstanding