Quaghebeur J and Qyndaele J. Comparison of Questionnaires Used for the Evalution of Patients with Chronic Pelvic Pain. Neurology and Urodynamics. 32:1074-1079 (2013).

Pelvic Physiotherapy Think Tank
December 4, 2013
Michelle Spicka, DPT

Objective:  Comparison of questionnaires for the evaluation of symptoms and quality of life in patients with chronic pelvic pain syndrome (CPPS).

Study Design/Method: 

                Different questionnaires are used by researchers and clinicians for the evaluation of patients with CPPS but it is uncertain if their results are comparable.

The questionnaires used were:

1.       McGill pain questionnaire (MPQ)

2.       National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI)

3.       Interstitial Cystitis Symptom and Problem Questionnaire (ICSI)

4.       Pelvic Pain and Urgency/Frequency Questionnaire (PUF)

Twenty-six CPPS patients were included and each participant filled out all questionnaires during consultation and at the same sequence.

Outcome/Results:  

1.       The interclass correlation was compared for pain intensity, bladder complaints and quality of life.

2.       The interclass correlation for pain intensity of the McGill pain questionnaire was moderate to good.  All other questionnaires showed a bad agreement.

3.       The NIH-CPSI/ICSI showed a very good agreement for bladder complaints and the other questionnaires showed moderate to good agreement.

4.       Mixed results were noted for comparing quality of life. 

 Conclusion:

1.       There is quite some difference between questionnaires in how pain intensity is evaluated.

2.       If someone with chronic pain at the moment of questioning does not have pain, this can include bias evaluating the chronic pain state, depending on how the individual interprets the pain questions (pain yesterday, now, today or in general)

a.       The biggest difference in comparing the questionnaires is the concept of when the pain occurred

b.      The moment of assessment influences the results!

3.       The evaluated questionnaires assess a different set of symptoms or the same “symptom complex” in a different way.

a.       They all have their specific properties and are not always sufficient to evaluate the various aspects of CPPS.

b.      The difficulties in combing these questionnaires indicates the need for a unified questionnaire containing all aspects with the objective of standardization for future research and clinic applications.

4.       This study clearly indicates that results from one questionnaire can’t be used for overall conclusions concerning pain intensity and quality of life. 

 Thought Questions:

1.       What are the biggest barriers to using objective questionnaires?

2.       Is there a better questionnaire for CPPS?

3.       More standardization is needed but can you really standardize individual pain?

 Other objective measures to consider:

1.       Female Sexual Function Index

a.       Showed good ability to discriminate between women with and without sexual dysfunctions in the CPPS population (Verit, et al. J Sex Med. 2007 Nov;4(6):1635-41)

2.       International Prostate Symptom Score

a.       Found to determine similar symptomatic findings as the NIH-CPSI (Schneider et al. World J Urol. 2003Aug;21(3):116-8)

3.       Genitourinary Pain Index

a.       Found to be a valid, reliable and responsive instrument that can be used to assess the degree of symptoms in both men and women with genitourinary pain complaints. (Clemens et al. Urology. 2009Nov;74(5):983-7)

4.       Bladder Pain/Interstitial Cystitis Symptom Score

a.       Found to be a reliable, valid and appropriate questionnaire to select for bladder pain syndrome/interstitial cystic patients for clinical trials (Humphrey et al. Eur Urol.2012 Feb;61(2):271-9)