The McGill Pain Questionnaire as a Multidimensional Measure in People With Cancer

An Integrative Review

Srisuda Ngamkham, PhD, RN, Catherine Vincent, PhD, RN, Lorna Finnegan, PhD, APN, CNP, Janean E. Holden, PhD, RN, FAAN, Zaijie Jim Wang, PhD, and Diana J. Wilkie, PhD, RN, FAAN

Disclosures

Pain Manag Nurs. 2012;13(1):27-51. 

In This Article

Abstract and Introduction

Abstract

First published in 1975, the McGill Pain Questionnaire (MPQ) is an often-cited pain measure, but there have been no systematic reviews of the MPQ in cancer populations. Our objective was to evaluate the MPQ as a multidimensional measure of pain in people with cancer. A systematic search of research that used the MPQ in adults with cancer and published in English from 1975 to 2009 was conducted. Twenty-one articles retrieved through computerized searches and nine studies from manual searches met the criteria. Review of the 30 studies demonstrated that pain intensity (n = 29 studies) and pain quality (n = 27 studies) were measured more frequently than pain location, pattern, and behavior parameters. Measuring cancer pain using the MPQ provided insights about disease sites, magnitude of pain, and effectiveness of treatment and intervention. Additionally, the MPQ data informed speculations about pain mechanisms, emotional status, overall sensory pain experience, changes in pain over time, and alleviating and aggravating behaviors/factors. Findings supported the MPQ as an effective multidimensional measure with good stability, content, construct, and criterion validity and showed sensitivity to treatment or known-group effects. The MPQ is a valid, reliable, and sensitive multidimensional measure of cancer pain. Cancer pain is a subjective complex experience consisting of multiple dimensions, and measuring cancer pain with the MPQ may help clinicians to more fully understand whether those dimensions of cancer pain influence each other. As a result, clinicians can provide better and effective cancer pain management.

Introduction

The evaluation of cancer pain remains a troubling issue because of the subjective experience of pain and the complexity of the disease (McGuire, 1995, Wilkie and Monreal, 1999). Many investigators have used the multidimensional conceptualization of cancer pain as a framework for assessing and studying cancer pain as a subjective perception (Turk, Monarch, & Williams, 2002). The McGill Pain Questionnaire (MPQ) is a comprehensive multidimensional measure (Ahles et al., 1983, McGuire, 1995, Melzack and Wall, 1965, Wilkie and Monreal, 1999) that quantifies neurophysiologic as well as psychologic domains of pain. The MPQ thus allows a comprehensive approach to measure cancer pain. Although the MPQ has been used in many cancer studies, few reviews have been found to date on its use in exclusively cancer populations. Therefore, the purpose of the present integrative review was to critically analyze the knowledge about the multiple dimensions of pain when measured by the MPQ in cancer populations.

Based on the Gate Control Theoretical framework, Melzack and Torgerson (1971) developed the MPQ to measure the pain experience from multiple dimensions: sensory (pain location, intensity, quality, and pattern), affective (fear, depression, and anxiety related to pain); cognitive (overall pain appraisal), and behavioral (aggravating and alleviating actions) ( Ahles et al., 1983, Melzack, 1975, Melzack and Torgerson, 1971). Widely used in multiple studies, the MPQ has demonstrated good reliability and validity (Melzack, 1975) and has discriminated among different pain diagnoses. Because participants take ~25–30 minutes to complete the MPQ long version, it is commonly used in clinical research more than in practice (Flaherty, 1996).

The MPQ includes five main measures ( McGuire, 1984, Melzack, 1975, Wilkie et al., 1990):

  1. Pain location (sensory dimension). On a drawing of the human body with both anterior and posterior sides, participants indicate the areas of their bodies that have pain. The number of pain sites is summed as in indicator of the sensory pain dimension.

  2. Pain intensity (sensory dimension). Participants rate the intensity of their current, least, and worst pain and their worst headache, stomachache, and toothache by responding to six separate questions on the strength of their pain. From a list of six words, the patient selects the one best word describing the intensity of pain: 0 = none; 1 = mild; 2 = discomforting; 3 = distressing; 4 = horrible; and 5 = excruciating.

  3. Pain quality (sensory, affective, and cognitive dimensions). Participants respond to the question, "What does your pain feel like?" by selecting from 78 descriptors in 20 subclasses. The descriptors are used qualitatively or they are combined quantitatively in several measures. The quantitative data are summed to form the pain rating index (PRI) which includes PRI-Total (PRI-T, score 0–78), PRI-Sensory (PRI-S, score 0–42), PRI-Affective (PRI-A, score 0–14), PRI-Evaluative (PRI-E, score 0–5), and PRI-Miscellaneous (PRI-M, score 0–17) (Katz & Melzack, 1999). In addition, the qualitative data include 78 descriptors of pain quality that describe pain characteristics in three dimensions of pain: 1) sensory qualities (word groups 1–10, 17–19) described in terms of temporal, spatial, pressure, thermal, and other properties; 2) affective qualities (word groups 11–15, 20) described in terms of tension, fear, and autonomic properties; and 3) cognitive qualities or evaluative words (word groups 16, 20) that describe the overall appraisal of the pain (Katz & Melzack, 1999). Finally, the number of words chosen (NWC, range 0–20) is the sum score of the total number of descriptors that the participant chooses.

  4. Pain pattern (sensory dimension). Participants respond to the question, "How does your pain change with time?" by selecting from nine words (continuous, steady, constant, rhythmic, periodic, intermittent, brief, momentary, and transient). These nine words are categorized into three main pain patterns: continuous, intermittent, and transient.

  5. Alleviating and aggravating factors (behavioral dimension). Participants respond to two open-ended questions, "What kinds of things decrease your pain?" and "What kinds of things increase your pain?" Responses are qualitative and commonly are organized in themes with frequency distributions reported.

Since 1975, only two literature reviews of the MPQ were found, but one review focused on the normative scores obtained with the MPQ when used in a variety of pain populations (Wilkie, Savedra, Holzemer, Tesler, and Paul, 1990) and the other review focused on cross-cultural adaptation of the MPQ (Menezes Costa Lda, Maher, McAuley, & Costa, 2009). No published review of the empirical studies in which the English version of the MPQ was used to measure pain in cancer populations was found. From studies in which the MPQ was used to measure pain in people with cancer, the specific objective of the present study was to critically analyze: 1) the knowledge generated about the multiple dimensions of pain; and 2) the psychometric properties of the MPQ.

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