Quality of Life Concepts

Secondary Health Conditions

Multidimensional Pain Inventory - SCI Version (MPI-SCI)

Description: A spinal cord injury version of the MPI [1] that assesses the severity and impact of chronic pain, emotional and physical adaptation to persistent pain, and social support.

Format: 60 items [2]; 50 items [3] It consists of 3 sections: (1) Pain Impact, (2) Responses by Significant Others, and (3) Activities. The sections are separated into 12 sub-scales.

Eight of the 12 sub-scales measure cognitive, affective, social, and behavioural responses: Pain Severity (PS); Life Interference (LI); Life Control (LC); Affective Distress (AD); Support (S); Negative Responses (NR); Solicitous Responses (SR); and Distracting Responses (DR). The remaining sub-scales assess the degree of participation in various types of daily activities, and are often combined into a single General Activity (GA) scale.

Scoring: Each item is scored on a 7-point scale. Scale scores are computed by summing over all items and then the mean is composed based on the number of scale items. It is not possible to obtain a total score.

Administration and Burden: Interviewer-administered; Self-administered; Proxy-administered. Approximately 15-20 minutes.

Psychometrics for SCI: The internal consistency of the MPI-SCI sub-scales ranged from fair (.60) for affective distress to substantial (.94) for pain interference with activities. With the exception of the support and life control sub-scales, all others showed adequate test-retest reliability [3].

Languages: English.

QoL Concept: The MPI-SCI measures impact of pain on activities of daily living, which corresponds to Boxes C (achievements; activities of daily living) and E (subjective evaluations and reactions) of Dijker’s Model.

Permissions/Where to Obtain: Copyrighted; Please contact Dr. Eva Widerström-Noga at the Miami Project to Cure Paralysis to get details on how to obtain the MPI-SCI.


  1. Turk DC, Meichenbaum D, Genest M. Pain and Behavioral Medicine: A Cognitive-Behavioral Perspective.  New York: Guilford; 1983.

  2. Widerstrom-Noga EG, Duncan R, Felipe-Cuervo E, Turk DC. Assessment of the impact of pain and impairments associated with spinal cord injuries. Arch Phys Med Rehabil 2002;83:395-404.

  3. Widerström-Noga EG, Cruz-Almeida Y, Martinez-Arizala A, Turk DC. Internal consistency, stability, and validity of the spinal cord injury version of the multidimensional pain inventory. Arch Phys Med Rehabil 2006;87:516-23.




Pain SCI Studies: Twelve cross-sectional surveys.

  1. Widerstrom-Noga EG, Cruz-Almeida Y, Martinez-Arizala A, Turk DC. Internal consistency, stability, and validity of the spinal cord injury version of the Multidimensional Pain Inventory. Arch Phys Med Rehabil 2006; 87:516-23.

  2. Widerstrom-Noga EG, Turk DC. Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics. Spinal Cord 2003;41: 600-9.

  3. 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.

  4. Conant LL. Psychological variables associated with pain perceptions among individuals with chronic spinal cord injury pain. J Clin Psychol Med Settings 1998;5:71-90.

  5. Summers JD, Rapoff MA, Varghese G, Porter K, Palmer RE. Psychosocial factors in chronic spinal cord injury pain. Pain 1991;47:183-9.

  6. Widerstrom-Noga EG, Duncan R, Turk DC. Psychosocial profiles of people with pain associated with spinal cord injury. Identification and comparison with other chronic pain syndromes. Clin J Pain 2004;20:261-71.

  7. Widerstrom-Noga EG, Felix ER, Cruz-Almeida Y, Turk DC. Psychosocial subgroups in persons with spinal cord injuries and chronic pain. Arch Phys Med Rehabil 2007;88:1628-35.

  8. Widerstrom-Noga EG, Cruz-Almeida Y, Felix ER, Adcock JP. Relationship between pain characteristics and pain adaptation type in persons with SCI. J Rehabil Res Dev 2009;46:43-56.

  9. Widerstrom-Noga EG, Duncan R, Felipe-Cuervo E, Turk DC. Assessment of the impact of pain and impairments associated with spinal cord injuries. Arch Phys Med Rehabil 2002;83:395-404.

  10. Nicholson Perry K, Nicholas MK, Middleton J, Siddall P. Psychological characteristics of people with spinal cord injury-related persisting pan referred to a tertiary pain management center. J Rehabil Res Dev 2009;46: 57-68.

  11. Giardino ND, Jensen MP, Turner JA, Ehde DM, Cardenas DD. Social environment moderates the association between catastrophizing and pain among persons with a spinal cord injury. Pain 2003;106:19-25.

  12. 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.

Sensitivity to Impact: Widestrom-Noga and colleagues (2006) used the Multidimensional Pain Inventory - SCI Version (MPI-SCI) to define and compare patterns of adaptation to chronic pain after spinal cord injury (SCI; N = 190). Cluster analysis of the MPI-SCI scores revealed three sub-groups, independent of sex, pain duration, and functional status: dysfunctional, interpersonally supported, and adaptive copers. The three groups differed significantly in levels of depressed mood, pain-induced disability, and satisfaction with life. Scores on the Brief Pain Inventory (BPI) provided external validation for these sub-groups.

Widerstrom-Noga and Turk (2003) used the MPI-SCI to evaluate the ability of pain characteristics and psycho-social factors to predict the use of pain treatments in persons with SCI (N = 120). There were no differences in perceived social support between persons with SCI who were on pharmacological treatment and those who were not. Persons with pain taking prescription medication obtained higher scores on the MPI-SCI than non-medicated respondents on the item asking how much pain had decreased their activity levels. In addition, activities away from home were significantly lower in persons using prescription medication, compared to those who were not.

Stroud and colleagues (2006) investigated the extent to which psycho-social 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-subject-reported negative partner responses and social support accounted for an additional 16% of the variance in pain-related activity interference.

Conant (1998) explored the relationships between various psychological variables and pain perceptions in persons with chronic SCI pain (N = 103) using the first two sections of the MPI, in addition to a non-standardized study-specific questionnaire and the Multidimensional Health Locus of Control- Internal Scale (MHLC-I). There was a positive correlation between trait anger and perception of pain. There was also a negative correlation between the measures of internal health locus of control and pain severity. Punishing responses from significant others to pain complaints were related to feelings of guilt and perceived pain, but the relationship was not mediated by guilt.

Summers and colleagues (1991) used the MPI, the Profile of Mood States (POMS), and Spinal Cord Injury Interference Scale (SCIIS) to determine the psycho-social factors associated with pain in patients with SCI (N = 54). There was a significant correlation between POMS/Anger-hostility and POMS/Vigor with MPI Pain Severity. The emotional variables (anger, vigor, depression, and anxiety) had a significant effect on both SCI interference and pain interference.

Widerstrom-Noga and colleagues (2004) used the MPI-SCI to identify psychosocial profiles of people with pain associated with SCI (N = 120) and compared the profiles with those in other chronic pain syndromes. Cluster analysis of MPI-SCI scores identified two sub-groups of SCI chronic pain: dysfunctional and adaptive copers. This did not match the three clusters obtained in other chronic pain syndromes, suggesting that different norms should be used when comparing different pain syndromes.

Widerstrom-Noga and colleagues (2007) used a battery of tests including the MPI-SCI, the Pain Disability Index (PDI), the International Support Evaluation List (ISEL), and the Satisfaction With Life Scale (SWLS) to define adaptational sub-groups in males with chronic pain and SCI (N = 89), and to compare these sub-groups in terms of their demographic factors, level of injury, functional independence, pain disability, depressed mood, social support, and life satisfaction. Cluster analysis identified three sub-groups: dysfunctional copers, interpersonally supported, and adaptive copers. Severe pain was found to decrease life satisfaction after SCI, however the effect was mediated by perceived social support.

Widerstrom-Noga and colleagues (2009) used the MPI-SCI to determine the association between pain characteristics and specific adaptational patterns to pain after SCI (N = 182). Results suggested that neuropathic pain is more likely in those who experience intense pain, and who are classified as having dysfunctional coping skills and who are inter-personally supported, compared to adaptive copers.

Widerstrom-Noga and colleagues (2002) determined the adequacy of the MPI-SCI to assess the impact after SCI and to determine whether the impact of pain can be separated from other consequences of SCI (N = 120). Results showed that the MPI-SCI appeared to be appropriate for use in the SCI population when modified to eliminate questions related to work and supplement the activity scale with items addressing lower activity levels due to pain.

Nicholson Perry and colleagues (2009) used the MPI-SCI, the Short-Form 12 (SF-12), and the Hospital Anxiety and Depression Scale (HADS) to examine the psychological characteristics of a cohort of individuals with SCI and persisting pain (N = 45). Persons with SCI-related chronic pain had less life interference as measured by the sub-scale of the MPI than the general pain population, but received lower scores on the SF-12 mental component sub-scale. Usual pain intensity was significantly, but weakly, associated only with the MPI Life Interference sub-scale. There were no differences on the SF-12 physical functioning sub-scale between the group with SCI and pain, and the general pain sample.

Giardino and colleagues (2003) examined how social factors would moderate the association between catastrophizing and sensory and affective pain in persons with SCI (N = 74). The significant interaction with catastrophizing and sensory pain was stronger in those who lived with a spouse or partner than those who lived with someone else. There also was a stronger association between catastrophizing and affective pain in those who reported greater solicitousness in their relationship.

Raichle and colleagues (2007) studied the associations between specific pain-related beliefs, coping, and social support and both mental health and pain interference in persons with SCI (N = 157). In the model predicting pain interference, including MPI solicitousness, pain intensity explained 41% of the variance in BPI pain interference scores. However, the psychosocial variables as a whole accounted for an additional 33% of the variance in pain interference scores after controlling for pain intensity.

Suggestions for Use: The MPI-SCI is a valid and reliable measure for examining the impact of pain in persons with SCI.  The MPI-SCI has also 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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