Quality of Life Concepts

Secondary Health Conditions

Brief Pain Inventory (BPI)

Description: A measure of pain interference [1].

Format: 9 items in total: 7 items measuring interference with general activity, sleep, mood, relationships, walking (modified to mobility for spinal cord injury [SCI]), normal work, and enjoyment of life, 1 item asking a yes/no question about the experience of pain on that day, and 1 item where the respondent indicates the area in which the pain occurs.

Scoring: Scores are assigned on a scale from 0 (does not interfere) to 10 (completely interferes).

Administration and Burden: Interviewer-administered; Self-administered. Approximately 5 minutes.

Psychometrics for SCI: The BPI has excellent internal consistency and has been found to be valid for use in the SCI population [2].

Languages: The BPI has been translated into over 40 languages.

QoL Concept: The BPI measures Health Related Quality of Life (QoL) by assessing the impact of pain on activities, which corresponds to Boxes C (achievements) and E (subjective evaluations and reactions) of Dijker’s Model.

Permissions/Where to Obtain: Copyrighted; The BPI can be acquired by obtaining permission from Dr. Charles S. Cleeland at the University of Texas M.D. Anderson Cancer Centre via email at: symptomresearch@mdanderson.org


  1. Cleeland CS, Ryan KM. Pain assessment: Global use of the Brief Pain Inventory. Ann Acad Med Singapore 1994;23:129-38.

  2. 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 SCI Studies: Six cross-sectional surveys, one cross-sectional and longitudinal survey, two pre-post intervention studies, one randomized, double-blind, placebo-controlled trial.

  1. 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

  2. Jensen MP, Hoffman AJ, Cardenas DD. Chronic pain in individuals with spinal cord injury: a survey and longitudinal study. Spinal Cord 2005;43:704-12.

  3. 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.

  4. 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.

  5. Wardell DW, Rintala DH, Duan Z, Tan G. A pilot study of healing touch and progressive relaxation for chronic neuropathic pain in persons with spinal cord injury. J Holist Nurs 2006;24:231-40.

  6. Cardenas DD, Warms CA, Turner JA, Marshall H, Brooke MM, Loeser JD. Efficacy of amitriptyline for relief of pain in spinal cord injury: results of a randomized controlled trial. Pain 2002;96:365-73.  

  7. Kang BS, Shin HI, Bang MS. Effect of repetitive transcranial magnetic stimulation over the hand motor cortical area on central pain after spinal cord injury. Arch Phys Med Rehabil 2009;90:1766-71.

  8. Martin Ginis KA, Latimer AE. The effects of single bouts of body-weight supported treadmill training on the feeling states of people with spinal cord injury. Spinal Cord 2007;45:112-5.

  9. Stroud MW, Turner JA, Jensen MP, Cardenas DD. Partner responses to pain behaviors are associated with depression and activity interference among persons with chronic pain and spinal cord injury. J Pain 2006;7:91-9.

  10. Molton IR, Stoelb BL, Jensen MP, Ehde DM, Raichle KA, Cardenas DD. Psychosocial factors and adjustment to chronic pain in spinal cord injury: replication and cross-validation. J Rehabil Res Dev 2009;46:31-42.  

Sensitivity to Impact: Raichle and colleagues (2007) used a battery of tests, including a modified version of the Brief Pain Inventory (BPI), to study associations between specific pain-related beliefs, coping, and social support, and both mental health and pain interference in persons with spinal cord injury (SCI; N = 157). Pain intensity explained 41% of the variance in BPI pain interference scores.

Jensen and colleagues (2005) compared the severity of pain after SCI to national norms, and examined the association between pain measures and the prevalence and intensity of pain over time in patients with SCI (N = 147). Their battery included the Short-Form 36 (SF-36), the Community Integration Questionnaire (CIQ), and a modified version of the BPI. Results showed an association between presence of pain and trends toward poorer psychological functioning and social integration. Pain intensity and pain interference, as measured through the BPI, showed a strong and significant association with each of the 10 domains of pain interference. As the severity of pain increased, so did its negative impact on even very basic activities such as sleep, mobility, and self-care.  

Hanley and colleagues (2006) used the Chronic Pain Grade Scale (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.

Wardell and colleagues (2006) used the BPI to assess the role of Healing Touch (HT) in modulating chronic neuropathic pain in males with SCI (N = 12). Participants were assigned either to an HT group or a guided progressive relaxation group. There was a significant difference in the composite of interference scale of the BPI, with the HT group reporting less interference. Life satisfaction increased in the HT group, but not in the control group.

A study by Cardenas and colleagues (2002) determined whether amitriptyline was efficacious in relieving chronic pain, as measured by the BPI, and improving pain-related physical and psychosocial function in persons with SCI (N = 84). Patients were assigned to either amitriptyline treatment or an active placebo. Regression analyses showed that pre-treatment scores explained a large and significant portion of variance of the post-treatment scores, and treatment group did not make a significant contribution.

Kang and colleagues (2009) evaluated the analgesic effect of repetitive transcranial magnetic stimulation applied on the hand motor cortical area in persons with SCI (N = 11) and chronic neuropathic pain using the BPI. Patients were assigned to either a treatment or sham-treatment group. Scores on the BPI did not change in either group.

Martin Ginis and Latimer (2007) used the BPI to assess whether exercise-related changes in feeling states are related to exercise-related changes in pain and in-task pain in persons with SCI (N = 14). Results showed that participants who showed the greatest decrease in pain were also those who experienced the greatest improvement in scores on measures of mood and feelings. In contrast, pain experienced during exercise was unrelated to changes in feeling states.

Stroud and colleagues (2006) investigated the extent to which psychosocial factors (partner responses to pain behaviours, social support) are associated with pain-related activity interference and depressive symptom severity among persons with SCI and chronic pain (N = 61). Regression analyses showed that pain intensity accounted for 25% of the variance in pain-related activity interference. SCI-subjects reported negative partner responses and social support accounted for an additional 16% of the variance in pain-related activity interference.

Molton and colleagues (2009) used the BPI and the SF-36 to replicate and extend previous work demonstrating associations among specific pain-related beliefs, coping, mental health and pain outcomes in persons with SCI (N = 130). Beliefs about pain and pain-related coping strategies significantly predicted pain outcomes and accounted for 21 to 25% of the variance.

Suggestions for Use: The BPI is a valid and reliable measure of pain interference in persons with SCI.  It is suggested that the item focused on walking ability should be changed to ‘mobility' (i.e., your ability to get around) in order to be more appropriate for persons with SCI. The BPI has been recommended for use by the National Institute on Disability and Rehabilitation Research in Spinal Cord Injury Measures (NIDDR SCI) [1], and has also been endorsed by the Spinal Cord Outcomes Partnership Endeavor (SCOPE) [2], which is a broad-based international consortium of scientists and clinical researchers representing academic institutions, industry, government agencies, not-for-profit organizations and foundations.

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.

  2. Alexander MS, et al. Outcome measures in spinal cord injury: Recent assessments and recommendations for future directions. Spinal Cord 2009:1-10
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