Validating PRISM (Pictorial Representation of Illness and Self Measure) as a measure of suffering in chronic non-cancer pain patients during a mindfulness-based chronic pain management course

Abstract

The Pictorial Representation of Illness and Self Measure (PRISM) is a tool designed to measure the burden of suffering due to illness in a variety of patient populations. We validated PRISM as a measure of suffering in a group of 138 patients with chronic non-cancer pain recruited from hospital pain clinics, participating in a 10-week mindfulness-based chronic pain management course. PRISM scores were correlated with scores on the Short-Form 36, the Pain Catastrophizing Scale and the commonly-used zero to ten pain scale, at class 1 and at class 10. Correlations included content validity and test-retest reliability. A factor analysis was performed to identify relationships among the PRISM domains measured. PRISM was found to be reliable, and correlate with many of the subdomains of the other questionnaires. Overall, all five PRISM disks, representing pain, family, partner, work and recreation, showed stronger correlations reaching significance at class 10 compared to class 1. This difference could represent familiarization with the PRISM task, but might also suggest patients paid better attention to the task, being more mindful at class 10. Recent data shows that after participating in one ten week mindfulness-based pain management (MBCPM) course, patients reported improvements in mental and some physical health measures, as well as reductions in pain catastrophizing behaviours. This raises the possibility that the MBCPM course may have helped patients to better appreciate the role and impact of each of the PRISM components in their lives. This study demonstrates the reliability and validity of the PRISM task for measuring the burden of pain in a population of chronic pain sufferers. Clinicians in the field of chronic pain management should find this tool easy to apply and useful for monitoring the impact of psychosocial variables and pain on patients' suffering. The Pictorial Representation of Illness and Self Measure (PRISM) is a tool designed to measure the burden of suffering due to illness in a variety of patient populations. We validated PRISM as a measure of suffering in a group of 138 patients with chronic non-cancer pain recruited from hospital pain clinics, participating in a 10-week mindfulness-based chronic pain management course. PRISM scores were correlated with scores on the Short-Form 36, the Pain Catastrophizing Scale and the commonly-used zero to ten pain scale, at class 1 and at class 10. Correlations included content validity and test-retest reliability. A factor analysis was performed to identify relationships among the PRISM domains measured. PRISM was found to be reliable, and correlate with many of the subdomains of the other questionnaires. Overall, all five PRISM disks, representing pain, family, partner, work and recreation, showed stronger correlations reaching significance at class 10 compared to class 1. This difference could represent familiarization with the PRISM task, but might also suggest patients paid better attention to the task, being more mindful at class 10. Recent data shows that after participating in one ten week mindfulness-based pain management (MBCPM) course, patients reported improvements in mental and some physical health measures, as well as reductions in pain catastrophizing behaviours. This raises the possibility that the MBCPM course may have helped patients to better appreciate the role and impact of each of the PRISM components in their lives. This study demonstrates the reliability and validity of the PRISM task for measuring the burden of pain in a population of chronic pain sufferers. Clinicians in the field of chronic pain management should find this tool easy to apply and useful for monitoring the impact of psychosocial variables and pain on patients' suffering.