Assessing pain characteristics in persons with hand osteoarthritis using the McGill pain questionnaire

Abstract

Purpose: Pain in osteoarthritis (OA) causes significant limitations for physical, psychological and social functioning. Increased understanding of the complexity of the pain experience is important for improved patient care. We aimed to assess the pain characteristics of hand OA using the McGill Pain Questionnaire, a multidimensional self-reporting questionnaire that assesses the quality and intensity of the pain. Secondly, the external validity of McGill was examined. Methods: Three-hundred persons with hand OA from the Nor-Hand study completed questionnaires about pain, including a modified McGill questionnaire. The participants are presented with a list of 106 pain descriptors in 18 sections. The questionnaire consists of three subscales: sensory (12 sections, 0-71.3 scale), affective (5 sections, 0-32.9 scale) and evaluative (one section, 0-8.6 scale), and an additional pain intensity score (no pain - severe pain). The total scale is rated from 0-112.8 with higher scores reflecting worse pain. The McGill subscales and total scale were normalized to 0-100 scales. In addition, the participants completed the Numeric Rating Scale (NRS, 0-10 scale) about hand pain, the Australian/Canadian (AUSCAN) hand pain subscale (0-20 scale) and questionnaires about psychological factors, including Hospital Depression and Anxiety Scale (HADS, 0-42 scale), Pain Catastrophizing Scale (PCS, 0-52 scale), and the pain subscale of the Arthritis Self Efficacy Scale (ASES, 10-100 scale). For all scales except ASES, high scores indicate poor health. We identified the pain adjectives in the McGill questionnaire with most frequent responses. To determine the external validity, the McGill questionnaire was correlated to other questionnaires (AUSCAN, NRS, HADS, PCS and ASES) using Spearman correlation coefficients. Results: The participants (89% women) with median (IQR) age of 61 (57-66) years demonstrated a wide range in pain characteristics and intensity, with a median (IQR) of 34.5 (0-62.3), 14.9 (0-39.2) and 44.2 (34.9-48.8) for the sensory, affective and evaluate subscales, respectively. The median for the total pain sum score was 29.7 (7.0-53.2). A floor effect was detected for the sensory (23.7% with score 0) and affective (40.3% with score 0) subscales. The reported adjectives with highest frequency were “sore” (n=208, 69.3%), “inhibiting” (n=124, 41.3%) and “annoying” (n=97, 32.3%). The participants frequently reported neuropathic-like characteristics such as sticking/stabbing/pricking (n=137, 45,7%), speeding/radiant (n=110, 36,6%), smarting/burning (n=89, 29.6%) and creeping (n=43, 14.3%). The McGill total scale showed moderate correlations with AUSCAN and NRS pain (Table). Similar strength of correlations was found for the sensory, affective and evaluative subscales, and stronger for the McGill intensity score (0.63-0.64). The correlation with HADS was similar for the McGill questionnaire, AUSCAN and NRS pain, whereas the correlations with PCS and ASES were weaker for McGill than for the other pain questionnaires. Conclusions: The McGill Pain questionnaire may be a useful tool in research settings for a broad evaluation of pain characteristics in hand OA. Moderate correlations with other pain questionnaires suggest that the McGill questionnaire measures other constructs. For the first time, we have shown that neuropathic-like pain characteristics are frequently reported by persons with hand OA.Tabled 1Correlations between McGill questionnaire and questionnaires assessing pain and psychological healthMcGill totalAUSCANNRS painHADSPCSASESMcGill total1.0AUSCAN0.411.0NRS pain0.450.731.0HADS0.310.240.291.0PCS0.260.400.410.471.0ASES-0.20-0.35-0.40-0.30-0.421.0 Open table in a new tab