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PROMIS Pain Behavior Short Form
Publicly Available from the PROMIS website:
This instrument is available on the PROMIS website through the Assessment Center, which houses all PROMIS instruments for each domain. Assessment Center is a free online research management tool enabling researchers to create study-specific websites for capturing participant data securely. PROMIS instruments are a central feature of the instrument library within Assessment Center. Any PROMIS measure can be included in an online study or downloaded for administration on paper.
Exploratory: Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS)
Short Description of Instrument
Construct measured: external manifestations of pain
Generic vs. disease specific: Generic.
Means of administration: Short forms or computerized adaptive testing (CAT).
Intended respondent: Patient.
# of items: 39 (total), (short form).
# of subscales and names of sub-scales: N/A.
# of items per sub-scale: N/A.
Comments/Special Instructions
Background: The PROMIS adult Pain Behavior item bank measures self-reported external manifestations of pain: behaviors that typically indicate to others that an individual is experiencing pain. These actions or reactions can be verbal or nonverbal, and involuntary or deliberate. They include observable displays (sighing, crying), pain severity behaviors (resting, guarding, facial expressions, and asking for help), and verbal reports of pain. The Pain Behavior short form is universal rather than disease-specific. It assesses pain behavior over the past seven days. Pain Behavior instruments are available for adults (ages 18+).
All PROMIS instruments including the Pain Behavior short form item banks are scored using item-level calibrations. The most accurate way to score the instrument is to utilize scoring tools within Assessment Center or Application Programming Interface (API) that look at responses to each item for each participant. Data collected in either of these platforms will automatically score in this way. A higher PROMIS T-score represents more of the concept being measured. For negatively-worded concepts like pain behavior, a T-score of 60 is one SD worse than average. By comparison, a pain behavior T-score of 40 is one SD better than average.
Strengths/ Weaknesses: Easily accessible with Multiple data collection tools: Paper NIH Toolbox iPad App Assessment Center API (includes RedCap) Assessment Center PROMIS iPad App.
This tool does not differentiate between behavior changes (e.g., resting/guarding) caused by pain and other ME/CFS symptoms, especially post-exertional malaise (PEM). Because of this, it is recommended that other instruments to measure pain and PEM be used in conjunction with the PROMIS Pain Behavior Short Forms.
Psychometric Properties:
Administration: There are two administration options for assessing pain interference: short forms and computerized adaptive testing (CAT). With the short form, participants are instructed to answer all items (i.e., questions or statements) presented. With CAT, participant responses guide the computer's choice of subsequent items from the full item bank (39 items in total). Although items differ across respondents taking CAT, scores are comparable across participants. Some administrators may prefer to ask the same question of all respondents or of the same respondent over time, to enable a more direct comparability across people or time. Whether one uses a short form or CAT, the score metric is Item Response Theory (IRT), a family of statistical models that link individual questions to a presumed underlying trait or concept of pain interference represented by all items in the item bank.
Amtmann D, et al. Development of a PROMIS item bank to measure pain interference. Pain. 2010;150(1):173-182.
Kim J, Chung H, Amtmann D, Revicki DA, Cook KF. Measurement invariance of the PROMIS pain interference item bank across community and clinical samples. Qual Life Res. 2013;22(3):501-507.


Document last updated June 2019
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