Reliability and validity of chronic pain scales in adults with adverse childhood experiences
Deborah L. Helitzer, Cristina Murray-Krezan, David A. Graeber, Joanna G. Katzman, Daniel Duhigg, Robert L. Rhyne
Background: Chronic non-cancer pain (CNCP) affects millions of people and is a leading cause of disability. The progression of chronic pain is closely tied to anxiety and depression but less is known about the relationship between chronic pain and adverse childhood experiences (ACE). Two commonly used pain assessments, the short form-McGill pain questionnaire-2 (McGill) and the brief pain inventory short form (BPI), have been validated in populations with CNCP patients but have not been validated in populations of CNCP patients with ACE. In addition, we wanted to assess the test-retest reliability and internal consistency of the Brief Adverse Childhood Events Survey (BRACES), an original instrument developed by the authors, with CNCP patients. Methods: This study enrolled 123 patients with CNCP from an academic multidisciplinary pain clinic at the Clinical Trials Unit of our Clinical and Translational Science Center. ACE was not inclusion criteria. All patients had one of five CNCP pain diagnoses. We administered the three instruments twice, separated by 2 weeks. The analysis compared psychometric properties of the instruments in patients who had ACE and those who did not. Results: There was significant correlation of the scores between the two participant visits (r = 0.68, 0.85) and internal consistency was high (Cronbach-α = 0.68, 0.85). Around 70% of the study participants endorsed one or more categories of ACE, and 30% of study participants endorsed four to six ACE categories. Agreement between visits for reported ACE categories was high (κ = 0.72, 0.85). Demographic and pain characteristics were not different between patients reporting ACE and those who did not. Conclusions: The McGill, BPI, and BRACES instruments were reliable and internally consistent in both populations. They also appear to be useful in evaluating the relationship between the quality (McGill), severity and interference (BPI) of CNCP in individuals with a history of ACE. Future research studying the relationship between ACE and chronic pain syndromes in adults can confidently utilize these instruments to help understand the role that ACE may play in the course of chronic pain and potential treatments.