Development, refinement, and validation of a standardized estimation of pain irritability - introducing the Pain...

Rehabilitation is often adjusted based on subsequent symptoms, thereby risking persistent aggravations. Pain irritability assessment 'prior-to-examination-and-treatment' offers a solution to this, but current methods lack standardization. The aim is to develop, refine, and test standardized questions to evaluate pain irritability in patients with shoulder pain.

Multi-method study. Qualitative: Development of prototype questions within pain irritability aspects followed by validation and refinement through participant interviews and analysis. Quantitative: 14-day cohort study. Participants completed questions on severity and pain persistence at baseline and provided daily reports of actual pain aggravations through text messages (follow-up). Predictive validity was examined with Kendall's Tau-b (T_b) comparing answers at baseline and follow-up.

Twelve prototype questions were developed. Validation and refinement through semi-structured telephone interviews (n = 9) resulted in a six‑question version covering pain severity and persistence. Prospective cohort (n = 41) demonstrated a significant large positive correlation between baseline estimates and actual persistence of gradual aggravations (T_b = 0.559, 95% CI: 0.372-0.702), and moderate positive correlation for sudden aggravations (T_b = 0.456, 95% CI: 0.246-0.624).

This study provides six standardized questions and response categories that uncover severity and persistence of pain aggravations, comprehensible to patients and aligning with the theoretical intention. Pain persistence questions possessed satisfactory predictive validity. Further psychometric validation is warranted.