Quality of Life Concepts

Secondary Health Conditions

Chronic Pain Grade Scale (CPGS)

Description: A measure of pain intensity and interference with normal daily activities.

Format: 7 items

Scoring: Scores for 6 of the items range from 0 (no pain) to 10 (pain as bad as it could be). The one remaining item requires filling in the number of days that pain has kept respondents from their typical activities.

Scores classify respondents into one of 4 levels of pain intensity and activity interference:

  1. Low disability and low pain intensity
  2. Low disability and high pain intensity
  3. High disability and moderate limitation of activities
  4. High disability and severe limitation of activities

Pain intensity is calculated by averaging ratings of current pain, worst pain in the last 3 months, and average pain in the last 3 months, then multiplying by 10.

Pain-related disability scores were calculated by averaging ratings of pain interference with daily, social, and work/housework activities in the past 3 months, then multiplying by 10.

Administration and Burden: Interviewer-administered; Self-administered.

Psychometrics: The CPGS scores of pain intensity and disability show excellent reliability with Cronbach’s α at 0.95 and 0.94, respectively [1].

Languages: English.

QoL Concept: The CPGS is a Health-Related QoL measure of pain impact on activities, which corresponds to Box C (achievements; activities of daily living) and E (subjective evaluations and reactions) of Dijker’s Model.

Permissions/Where to Obtain: Public Domain; The CPGS can be obtained in the article:

Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain 1992;50;133-49.


  1. Raichle KA, Osborne TL, Jensen MP, Cardenas DD. The reliability and validity of pain interference measures in persons with spinal cord injury. J Pain 2006;7:179-86.



Pain Dysfunction SCI Studies: Eight cross-sectional surveys.

  1. Barrett H, McClelland JM, Rutkowski SB, Siddall PJ. Pain characteristics in patients admitted to hospital with complications after spinal cord injury. Arch Phys Med Rehabil 2003;84:789-95.

  2. Turner JA, Cardenas DD, Warms CA, McClellan CB. Chronic pain associated with spinal cord injuries: a community survey. Arch Phys Med Rehabil 2001;82:501-8.

  3. Wollaars MM, Post MWM, van Asbeck FWA, Brand N. Spinal cord injury pain: the influence of psychologic factors and impact on quality of life. Clin J Pain 2007;23:383-91.

  4. Raichle KA, Hanley M, Jensen MP, Cardenas DD. Cognitions, coping, and social environment predict adjustment to pain in spinal cord injury. J Pain 2007;8:718-29.

  5. Hanley MA, Masedo A, Jensen MP, Cardenas D, Turner JA. Pain interference in persons with spinal cord injury: classification of mild, moderate, and severe pain. J Pain 2006;7:129-33.

  6. Raichle KA, Osborne TL, Jensen MP, Cardenas D. The reliability and validity of pain interference measures in persons with spinal cord injury. J Pain 2006; 7:179-86.

  7. Turner JA, Jensen MP, Warms CA, Cardenas DD. Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury. Pain 2002;98:127-34.

  8. Pang MYC, Eng JJ, Lin K-H, Tang P-F, Hung C, Wang Y-H. Association of depression and pain interference with disease-management self-efficacy in community-dwelling individuals with spinal cord injury. J Rehabil Med 2009;41:1068-73.

Sensitivity to Impact: Barrett and colleagues (2003) used the Chronic Pain Grade Scale (CPGS) to determine characteristics of pain, the relation between pain and mood, the effect of pain on activities, and the perceived difficulty in coping with pain in patients hospitalized for treatment of conditions associated with spinal cord injury (SCI; N = 88). Most patients received a disability grade of low disability with a low to high intensity of pain, whereas the rest received a disability grade of high disability.

Turner and colleagues (2001) used the CPGS to investigate chronic pain prevalence, associated factors, sites, characteristic, and interference with daily functioning, treatments received, and treatment helpfulness in persons with SCI (N = 384). Respondents reported a moderate level of pain-related disability.

Wollaars and colleagues (2007) examined (1) chronic pain prevalence in a SCI population (N = 279), (2) the influence of psychological factors on SCI pain and (3) the impact of SCI pain on quality of life (QoL). In general, more pain was associated with higher pain-related disability. Pain intensity did not show an independent relationship with health, well-being, and depression in the regression analyses. Respondents with chronic SCI-related pain received higher scores on pain-related disability and depression, and lower scores on general health and well-being. Less helplessness and catastrophizing, greater acceptance of SCI and lower levels of anger made the largest unique contributions to the prediction of greater well-being.

Raichle and colleagues (2007) used a battery of tests, including the CPGS, the Brief Pain Inventory (BPI), the Multidimensional Scale of Perceived Social Support (MSPSS), and the mental health sub-scale of the Short-Form 36 (SF-36) to study the associations between specific pain-related beliefs, coping, and social support and both mental health and pain interference in persons with SCI (N = 157). They found that the interference sub-scale of the CPGS was significantly correlated with the SF-36.

Hanley and colleagues (2006) used the CPGS and the BPI to examine pain intensity classification in two samples of persons with SCI and chronic pain. The first sample (n = 307) was asked to rate pain generally, whereas the second (n = 174) was asked to rate their worst pain problem. In both samples, the optimal mild/moderate boundary was lower than that reported for individuals with other pain problems, suggesting that pain may interfere with activity at lower levels in persons with SCI.

Raichle and colleagues (2006) compared the psychometric properties of the CPGS and three versions of the BPI in persons with SCI (N = 127). All scales showed excellent internal consistency and appeared to be reliable and valid measures of pain-related interference in persons with SCI.

Turner and colleagues (2002) used the mental health scale of the SF-36, the Coping Strategies Questionnaire (CSQ), and the CPGS to examine associations of catastrophizing and specific pain coping strategies with pain intensity, psychological distress, and pain-related disability in persons with SCI and chronic pain. Results showed that pain coping and catastrophizing measures explained an additional 29% of the variance in pain intensity after adjusting for the demographic and SCI variables. The coping and catastrophizing scales accounted for an additional 30% of the variance in psychological distress and 11% of the variance in pain-related disability, after controlling for pain intensity and demographic and SCI variables.

Pang and colleagues (2009) evaluated associations between depression and pain interference with disease management self-efficacy in persons with SCI (N = 49). Their main outcome measure was the Self-Efficacy for Managing Chronic Disease, the International Support Evaluation List (ISEL), and the CPGS. Results showed that higher self-efficacy was correlated with longer time since injury, better social support, lower pain interference, and less severe depressive symptoms. In regression analyses, only lower pain interference and less severe depressive symptoms were significantly associated with higher disease-management self-efficacy.

Suggestions for Use: Although the CPGS has acceptable psychometric properties for use in the SCI population and the evidence suggests it is sensitive to the impact of SCI-related pain, the National Institute on Disability and Rehabilitation Research in Spinal Cord Injury Measures (NIDDR SCI) noted that the CPGS has limited applicability to SCI since there is a lack of differentiation between interference due to SCI per se, and interference due to chronic pain [1].

Additional References:

  1. Bryce TN, Norrbrink Budh C, Cardenas DD, Dijkers M, Felix E, Finnerup NB, Kennedy P, Lundeberg T, Richards JS, Rintala DH, Siddall P, Widerstrom-Noga E. Pain after spinal cord injury: An evidence-based review for clinical practice and research. Report of the National Institute on Disability and Rehabilitation Research Spinal Cord Injury Measures. J Spinal Cord Med 2007;30:421-40.

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