Validity of an observation method for assessing pain behavior in individuals with multiple sclerosis

Karon F. Cook*, Toni S. Roddey, Alyssa M. Bamer, Dagmar Amtmann, Francis J. Keefe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Context. Pain is a common and complex experience for individuals who live with multiple sclerosis (MS) and it interferes with physical, psychological, and social function. A valid and reliable tool for quantifying observed pain behaviors in MS is critical to understand how pain behaviors contribute to pain-related disability in this clinical population. Objectives. To evaluate the reliability and validity of a pain behavioral observation protocol in individuals who have MS. Methods. Community-dwelling volunteers with MS (N = 30), back pain (N = 5), or arthritis (N = 8) were recruited based on clinician referrals, advertisements, fliers, web postings, and participation in previous research. Participants completed the measures of pain severity, pain interference, and self-reported pain behaviors and were videotaped doing typical activities (e.g., walking and sitting). Two coders independently recorded frequencies of pain behaviors by category (e.g., guarding and bracing) and interrater reliability statistics were calculated. Naýve observers reviewed videotapes of individuals with MS and rated their pain. The Spearman's correlations were calculated between pain behavior frequencies and self-reported pain and pain ratings by naýve observers. Results. Interrater reliability estimates indicated the reliability of pain codes in the MS sample. Kappa coefficients ranged from moderate (sighing = 0.40) to substantial agreements (guarding = 0.83). These values were comparable with those obtained in the combined back pain and arthritis sample. Concurrent validity was supported by correlations with self-reported pain (0.46e0.53) and with self-reports of pain behaviors (0.58). Construct validity was supported by a finding of 0.87 correlation between total pain behaviors observed by coders and mean pain ratings by naýve observers. Conclusion. Results support the use of the pain behavior observation protocol for assessing pain behaviors of individuals with MS. Valid assessments of pain behaviors of individuals with MS could lead to creative interventions in the management of chronic pain in this population. J Pain Symptom Manage 2013;46:413e421.

Original languageEnglish (US)
Pages (from-to)413-421
Number of pages9
JournalJournal of Pain and Symptom Management
Issue number3
StatePublished - 2013


  • Multiple Sclerosis
  • Observation Protocol
  • Pain Behaviors
  • Validity

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • General Nursing


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