Introduction
Chronic and acute pain significantly affects patients’ quality of life, disrupting daily activities, mood, and overall well-being. Therefore, clinicians and researchers need reliable tools to assess pain’s severity and impact. To address this need, Charles S. Cleeland, PhD, developed the Brief Pain Inventory-Short Form (BPI-SF) at MD Anderson Cancer Center, with its short form validated in 1994. With over 6,300 Google Scholar citations, the BPI-SF has become a cornerstone in pain assessment, particularly for cancer and non-cancer pain.
For example, its concise 15-item format makes it ideal for busy clinical settings. This article explores the BPI-SF’s key features, clinical applications, and limitations, providing actionable insights for researchers and clinicians aiming to enhance pain management strategies.
Key Features of Brief Pain Inventory
Purpose and Use of the Brief Pain Inventory
The BPI-SF aims to evaluate pain severity and its interference with daily functions, such as mood, work, and sleep. Consequently, clinicians use it to guide treatment decisions, while researchers employ it in clinical trials and epidemiological studies. For instance, its focus on pain’s functional impact helps tailor interventions, making it a vital tool in pain management.
Target Population
Researchers validate the BPI-SF for adults aged 18 and older, including:
- Young Adults (18–24 years)
- Middle-Aged Adults (25–44 years)
- Older Adults (45–64 years)
- Seniors (65+ years)
It targets individuals with chronic or acute pain, such as cancer-related or non-cancer pain. Thus, it suits oncology, neurology, and primary care settings. However, limited data exist for pediatric populations.
Structure
Charles S. Cleeland designed the BPI-SF with 15 items under the domain of Pain Assessment. The questionnaire comprises a combination of scored and unscored items designed to assess pain severity and its impact on daily functions.
- Total Number of Questions/Items:
- Scored Items: 11:
- Pain Severity (Items 3–6): 4 items assessing pain at its worst pain in the last 24 hours, least pain in the last 24 hours, average, and right now.
- Pain Interference (Items 9A–9G): 7 items evaluating how pain interferes with general activity, mood, walking ability, normal work, relations with others, sleep, and enjoyment of life
- Unscored Items: 4
- Item 1: Inquires about the presence of pain other than everyday kinds of pain during the last week.
- Item 2: Pain location diagram where patients shade areas of pain and mark the area that hurts the most.
- Item 7: Asks about treatments or medications the patient is receiving for pain.
- Item 8: Requests the percentage of relief provided by pain treatments or medications.
Therefore, the BPI-SF includes a total of 15 items, with 11 scored components using a 0–10 Numeric Rating Scale, and 4 unscored components, including open-ended components such as (items 2, 7, 8).
Scoring Method of Brief Pain Inventory
The BPI-SF employs a 0–10 numeric rating scale for its 11 scored items. For example, pain severity items (3–6) measure intensity from “no pain” (0) to “pain as bad as you can imagine” (10). Similarly, pain interference items (9A–9G) assess disruption from “does not interfere” (0) to “completely interferes” (10). Clinicians calculate two main scores:
- Pain Severity Score: Add scores from items 3–6 and divide by 4 (e.g., scores of 8, 2, 5, 6 yield (8+2+5+6)/4 = 5.25).
- Pain Interference Score: Add scores from items 9A–9G and divide by 7 (e.g., scores of 6, 7, 5, 8, 6, 7, 7 yield (6+7+5+8+6+7+7)/7 = 6.57).
- Additional Scores (Unscored Items):
While not used in the total scores, these provide qualitative insights:
- Item 2: Pain location diagram informs clinicians about the affected areas.
- Item 8: Asks for percentage relief from treatments (0%–100%), indicating treatment effectiveness.
- Item 7: Lists current pain treatments or medications.
Although no universal cut-off scores exist, clinicians often interpret scores as:
- 0–3: Mild pain/interference
- 4–6: Moderate pain/interference
- 7–10: Severe pain/interference
Ultimately, interpretation should always be contextualized within the specific clinical setting and professional judgment.
Administration Format and Time
The BPI-SF offers flexibility in its administration, available in different formats such as:
- Paper-based.
- Digital (online).
- Interview (in-person).
This adaptability allows for its seamless integration into various clinical workflows. Furthermore, the questionnaire is remarkably efficient, typically taking only 5-10 minutes to complete, making it practical for routine use. Since it is self-administered, special training for its administration or interpretation is generally not required.
Applications of Brief Pain Inventory
The BPI-SF serves multiple roles in clinical and research settings:
- Screening: Clinicians identify patients with significant pain-related disability, signaling the need for intervention.
- Diagnosis: Professionals assess pain severity to inform diagnostic decisions.
- Monitoring: Researchers track changes in pain impact over time, particularly during treatment trials.
- Treatment Planning: Clinicians tailor therapies based on BPI-SF scores, prioritizing severe cases.
- Research: Investigators use the BPI-SF in clinical trials to evaluate pain interventions, advancing evidence-based pain management.
For example, a score of 7 on pain interference might prompt a clinician to adjust analgesic therapy, while researchers analyze trends in pain outcomes.
Languages and Availability
Translators adapt the BPI-SF into multiple languages to support global use, including:
- Arabic
- English
- Mandarin Chinese
- Spanish
- French
As well as Russian, Japanese and Hindi. Therefore, its multilingual accessibility enhances its applicability in diverse clinical and research contexts.
Reliability and Validity
The BPI-SF is highly reliable and valid, with Cronbach’s alpha ranging from 0.77 to 0.96 across studies, indicating strong internal consistency. For example:
- A 2011 study validated the Arabic BPI-SF in Lebanese cancer patients, confirming its psychometric properties (Psychometric Evaluation of the Arabic BPI-SF).
- A 2015 study in Spanish patients with non-cancer pain further supported its reliability and validity (Validation of the(BPI-SF) in Spanish Patients).
Additionally, its sensitivity to changes in pain severity makes it a trusted tool for monitoring treatment outcomes.
Cost and Licensing
MD Anderson Cancer Center, the proprietary holder, offers the BPI-SF for free in non-funded academic research and individual clinical practice. However, funded academic or commercial research requires payment and permission. These fees are applicable per project and are subject to change. Consequently, users should contact MD Anderson’s Department of Symptom Research (Contact Us | MD Anderson Cancer Center) for access details.
Limitations and Considerations
However, despite its strengths, the BPI-SF has a few limitations:
- Self-report measure: Patients may skew responses due to social desirability bias or personal interpretation.
Related Questionnaires
Several questionnaires complement the BPI-SF in pain assessment:
- BFI: Brief Fatigue Inventory.
- MPQ: McGill Pain Questionnaire.
- PDI: Pain Disability Index.
Although not identical, these tools provide additional perspectives for understanding pain’s impact in clinical and research contexts.
Other Versions
In addition to the BPI-SF, the Brief Pain Inventory-Long Form (BPI-LF) exists for more comprehensive assessments, often used as a baseline measure in clinical trials. However, the short form remains the standard for clinical and research applications due to its brevity and robust psychometric properties, that is why most psychometric evaluations of the BPI have been performed on the short form.
Additional Resources
For further exploration, consider these resources:
- Access link: Brief Pain Inventory (BPI) | MD Anderson Cancer Center.
- Access the questionnaire as a PDF: BPI-SF PDF.
- For permissions and inquiries, contact MD Anderson Cancer Center’s Department of Symptom Research.
Contact Us | MD Anderson Cancer Center - Additional resources are available at Brief Pain Inventory – Short Form – Physiopedia
Frequently Asked Questions (FAQ)
- Who can use the BPI-SF?
Clinicians, researchers, and healthcare providers employ the BPI-SF for adults aged 18 and older with chronic or acute pain. - How long does it take to complete the BPI-SF?
Patients typically complete the BPI-SF in 5–10 minutes, making it practical for clinical and research settings. - How is the BPI-SF administered?
Healthcare teams administer the BPI-SF via paper, digital, or interview formats, offering flexibility in usage. - Is there any cost to using the BPI-SF?
The BPI-SF is free for non-funded academic research and clinical practice, but funded or commercial use requires permission and payment.
A word from ResRef about Brief Pain Inventory
The Brief Pain Inventory–Short Form (BPI-SF) is a validated, reliable, and efficient tool for assessing pain severity and its interference with daily functions. Its brevity and ease of administration make it suitable for various clinical and research settings. The BPI-SF has been translated into multiple languages, enhancing its global applicability. While it is a self-report measure and may have limitations in certain populations, its widespread use and validation support its utility in pain assessment. Clinicians and researchers can employ the BPI-SF to monitor pain and evaluate treatment outcomes effectively. Overall, the BPI-SF is a valuable instrument in the management and study of pain.
References
Brief Pain Inventory – Short Form. (2023, July 23). Physiopedia, . Retrieved 14:15, May 30, 2025 from. Study link.
- Ballout S, Noureddine S, Huijer HA, Kanazi G. Psychometric evaluation of the arabic brief pain inventory in a sample of Lebanese cancer patients. J Pain Symptom Manage. 2011 Jul;42(1):147-54. doi: 10.1016/j.jpainsymman.2010.09.019. Epub 2011 Mar 12. PMID: 21398086. Study link.
- de Andrés Ares J, Cruces Prado LM, Canos Verdecho MA, Penide Villanueva L, Del Valle Hoyos M, Herdman M, Traseira Lugilde S, Velázquez Rivera I. Validation of the Short Form of the Brief Pain Inventory (BPI-SF) in Spanish Patients with Non-Cancer-Related Pain. Pain Pract. 2015 Sep;15(7):643-53. doi: 10.1111/papr.12219. Epub 2014 Apr 28. PMID: 24766769. Study link.
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