4.1.3 Brief Pain Inventory
The Brief Pain Inventory (BPI) was developed in 1983 to assess pain in
individuals with cancer115. Unlike the unidimensional
VAS and NRS tools, not only does it capture pain severity (derived from
the average of four NRS pain intensity questions)116,
but also calculates an accompanying pain interference score, derived
from seven items which evaluate how pain affects ability to participate
in activities of daily living. Together, these scores produce an overall
rating between zero and 70, reflecting the intensity, chronicity, and
functional impact of pain115.
With a completion time of approximately five minutes, and
multidimensional approach to pain assessment117, the
BPI is particularly valuable when assessing individuals with
co-occurring OUD and chronic pain114. Notably, it has
been endorsed by the Initiative on Methods, Measurement, and Pain
Assessment in Clinical Trials (IMMPACT) for use in chronic pain trials
due to its “reliable, validated assessment of pain’s impact on physical
functioning”118.
With respect to its applicability to persons with co-occurring OUD and
chronic pain, the BPI was used by Hall and colleagues to assess the
relationship between pain interference and central sensitization (an
abnormal state of responsiveness of the nociceptive
system)119 in 141 patients with
OUD120. Nearly 90% of participants reported chronic
widespread pain, often meeting diagnostic criteria for fibromyalgia, and
those with higher levels of central sensitization (assessed by the
American College of Rheumatology Fibromyalgia Survey), were more likely
to report BPI pain interference as a reason for delaying OUD treatment,
continuing and escalating opioid use, and returning to non-medical
opioid use. In short, the BPI assesses multiple dimensions of pain,
providing a more comprehensive characterization than unidimensional
intensity scales like the VAS or NRS as is appropriate for chronic, as
opposed to acute, pain.