Reliability and validity of individual and composite recall pain measures in patients with cancer

Pain Med. 2012 Oct;13(10):1284-91. doi: 10.1111/j.1526-4637.2012.01470.x. Epub 2012 Aug 23.


Objectives: To evaluate and compare the validity and reliability of individual and composite recall pain intensity measures.

Design: Secondary analyses using data from a published 14-day open-label crossover clinical trial comparing two active treatments.

Setting: Multiple settings.

Participants: Fifty-two adults with a history of chronic cancer pain.

Measures: Recall ratings of least, worst, and average pain during the past 2 days; composite score representing recalled characteristic pain in the past 2 days; and daily diary ratings of pain intensity from which "actual" least, worst, and average pain scores were derived.

Results: Recall ratings of least and average pain, and a composite score representing recalled characteristic pain were accurate (differed no more than three points from "actual" scores on a 0-100 scale). Although the recall rating of worst pain significantly (P < 0.05) overestimated actual worst pain, the differences were minor (i.e., seven to eight points on a 0-100 scale). All of the recall measures demonstrated validity via their strong associations with the measures of actual pain intensity. The recall measures also demonstrated excellent test-retest stability, although the diary-derived measures tended to be more stable than the recall measures did. The composite measure of recalled characteristic pain demonstrated a high level of internal consistency (Cronbach's α = 0.90).

Conclusions: Individual recall ratings and a composite score representing recalled characteristic pain intensity are reliable and valid measures of actual pain in patients with cancer. The findings support their use as outcome measures in clinical trials.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / therapeutic use
  • Cross-Over Studies
  • Female
  • Humans
  • Male
  • Medical Records
  • Mental Recall*
  • Middle Aged
  • Neoplasms / complications
  • Neoplasms / psychology*
  • Outcome Assessment, Health Care / methods*
  • Pain / drug therapy
  • Pain / etiology
  • Pain / psychology*
  • Pain Measurement
  • Reproducibility of Results


  • Analgesics, Opioid