Introduction:Pain intensity is the domain most often assessed in pain research. Although the Numerical Rating Scale is recommended for use in western countries, the utility and validity of this scale, relative to others, has not been established in non–western developing countries, such as Nepal.Objectives:Here, we sought to (1) identify which of 4 commonly used pain scales is most preferred by Nepalese, (2) compare error rates, (3) determine whether preference and error rates are influenced by age or education level, and (4) evaluate construct validity of each scale using factor analysis.Methods:Two hundred two adults with musculoskeletal pain from Nepal rated their worst and average pain intensity using all 4 scales and selected their most preferred scale.Results:The results indicate that the Faces Pain Scale-Revised is the most preferred scale, followed by a Verbal Rating Scale. The Numerical Rating Scale and Visual Analogue Scale were both least preferred and had higher rates of incorrect responses, especially among the older participants. However, all the scales demonstrated adequate construct validity as measures of pain intensity among those participants who could accurately use all 4 scales.Conclusion:The findings indicate that the Faces Pain Scale-Revised should be the first choice for assessing pain intensity in Nepalese adults. Research is needed to determine whether these findings replicate in other non–western and developing countries, to identify the pain intensity measure that would be the best choice for use in cross-cultural pain research.

BackgroundResilience is an individual’s ability to recover or “bounce back” from stressful events. It is commonly identified as a protective factor against psychological dysfunctions in wide range of clinical conditions including chronic pain. Resilience is commonly assessed using the Connor Davidson Resilience Scale (CD-RISC). Translation and cross-cultural adaptation of the CD-RISC into Nepali will allow for a deeper understanding of resilience as an important domain in health in Nepal, and will allow for cross-cultural comparison with other cultures. Therefore, the aims of the study were to translate and culturally adapt 10- and 2-item versions of the CD-RISC into Nepali and evaluate their psychometric properties.MethodsAfter translating the measures, we performed exploratory and confirmatory factor analyses of the 10-item version in two independent samples (ns = 131 and 134) of individuals with chronic pain. We then evaluated the internal consistency, test-retest stability, and construct validity of the 10- and 2-item measures in these samples. We also evaluated the internal consistency, and the construct and concurrent validity of the 2-item version in an additional sample of 140 individuals.ResultsThe results supported a single factor model for the 10-item measure; this measure also evidenced good to excellent internal consistency and excellent test-retest stability. Construct validity was supported via moderate associations with pain catastrophizing. The internal consistency of 2-item version was marginal, although construct validity was supported via weak to moderate associations with measures of pain catastrophizing, depression and anxiety, and concurrent validity was supported by strong association with the 10-item CD-RISC scale.ConclusionThe findings support the reliability and validity of the 10-item Nepali version of the CD-RISC, and use of the 2-item version in survey studies in individuals with chronic pain. The availability of these translated measures will allow for cross-cultural comparisons of resilience in samples of individuals with chronic pain.

Objective To evaluate the extent to which pain-related beliefs, appraisals, coping, and catastrophizing differ between countries, language groups, and country economy. Design Systematic review. Methods Two independent reviewers searched 15 databases without restriction for date or language of publication. Studies comparing pain beliefs/appraisals, coping, or catastrophizing across two or more countries or language groups in adults with chronic pain (pain for longer than three months) were included. Two independent reviewers extracted data and performed the quality appraisal. Study quality was rated as low, moderate, or high using a 10-item modified STROBE checklist. Effect sizes were reported as small (0.20–0.49), medium (0.50–0.79), or large (≥0.80). Results We retrieved 1,365 articles, read 42 potential full texts, and included 10 (four moderate-quality, six low-quality) studies. A total of 6,797 adults with chronic pain (33% with chronic low back pain) were included from 16 countries. Meta-analysis was not performed because of heterogeneity in the studies. A total of 103 effect sizes were computed for individual studies, some of which indicated between-country differences in pain beliefs, coping, and catastrophizing. Of these, the majority of effect sizes for pain beliefs/appraisal (60%; eight large, eight medium, and eight small), for coping (60%; seven large, 11 medium, and 16 small), and for catastrophizing (50%; two medium, one small) evidenced statistically significant between-country differences, although study quality was low to moderate. Conclusions In 50% or more of the studies, mean scores in the measures of pain beliefs and appraisals, coping responses, and catastrophizing were significantly different between people from different countries.

BackgroundPain intensity and patients’ impression of global improvement are widely used patient-reported outcome measures (PROMs) in clinical practice and research. They are commonly assessed using the Numerical Pain Rating Scale (NPRS) and Global Rating of Change (GROC) questionnaires. The GROC is essential as an anchor for evaluating the psychometric properties of PROMs. Both of these PROMs are translated to many languages and have shown excellent psychometric properties. Their availability in Nepali would facilitate pain research and cross-cultural comparison of research findings. Therefore, the objectives of this study were to translate and cross-culturally adapt the NPRS and GROC into Nepali and to assess the psychometric properties of the Nepali version of the NPRS (NPRS-NP).MethodsAfter translating and cross-culturally adapting the NPRS and GROC into Nepali using recommended guidelines, NPRS-NP was administered to 104 individuals with musculoskeletal pain twice. The Nepali version of the GROC (GROC-NP) was administered at the follow-up for anchor-based assessment. (1) Test-retest reliability and minimum detectable change (MDC) among the stable group, (2) construct validity (by single sample t-test within the improved group and independent sample t-test between groups), and (3) concurrent validity were assessed. Receiver operating characteristic (ROC) curves were plotted to determine the responsiveness of the NPRS-NP using the area under the curve (AUC), and minimum important changes (MIC) for small, medium and large improvements.ResultsSignificant cultural adaptations were required to obtain relevant Nepali versions of both the NPRS and GROC. The NPRS-NP showed excellent test-retest reliability and a MDC of 1.13 points. NPRS-NP demonstrated a good construct validity by significant within-group difference in mean of NPRS score- t(63)= 7.57, P < 0.001 and statistically significant difference of mean score- t(98)= -4.24, P < .001 between the stable and improved groups. It demonstrated moderate concurrent correlation with the GROC-NP; r = 0.43, P < 0.01. Responsiveness of the NPRS-NP was shown at three levels with AUC = 0.68–0.82, and MIC = 1.17–1.33.ConclusionsThe NPRS and GROC were successfully translated and culturally adapted into Nepali. The NPRS-NP demonstrated good reliability, validity and responsiveness in assessing musculoskeletal pain intensity in a Nepali population.Electronic supplementary materialThe online version of this article (10.1186/s12955-017-0812-8) contains supplementary material, which is available to authorized users.

ObjectivesThe aims of this study were to: (1) develop pain education materials in Nepali and (2) determine the feasibility of conducting a randomised clinical trial (RCT) of a pain education intervention using these materials in Nepal.DesignA two-arm, parallel, assessor-blinded, feasibility RCT.SettingA rehabilitation hospital in Kathmandu, Nepal.ParticipantsForty Nepalese with non-specific low back pain (mean [SD] age 41 [14] years; 12 [30%] women).InterventionsEligible participants were randomised, by concealed, 1:1 allocation, to one of two groups: (1) a pain education intervention and (2) a guideline-based physiotherapy active control group intervention. Each intervention was delivered by a physiotherapist in a single, 1-hour, individualised treatment session.Primary outcome measuresThe primary outcomes were related to feasibility: recruitment, retention and treatment adherence of participants, feasibility and blinding of outcome assessments, fidelity of treatment delivery, credibility of, and satisfaction with, treatment. Assessments were performed at baseline and at 1 week post-treatment.Secondary outcome measuresPain intensity, pain interference, pain catastrophising, sleep disturbance, resilience, global rating of change, depression and quality of life. Statistical analyses were conducted blind to group allocation.ResultsForty participants were recruited. Thirty-eight participants (95%) completed the 1-week post-treatment assessment. Most primary outcomes surpassed the a priori thresholds for feasibility. Several findings have important implications for designing a full trial. Secondary analyses suggest clinical benefit of pain education over the control intervention, with larger decrease in pain intensity (mean difference=3.56 [95% CI 0.21 to 6.91]) and pain catastrophising (mean difference=6.16 [95% CI 0.59 to 11.72]) in the pain education group. Pain intensity would seem an appropriate outcome for a full clinical trial. One minor adverse event was reported.ConclusionWe conclude that a full RCT of pain education for back pain in Nepal is feasible and warranted.Trial registration numberNCT03387228; Results.

BackgroundPain catastrophizing is an exaggerated negative cognitive response related to pain. It is commonly assessed using the Pain Catastrophizing Scale (PCS). Translation and validation of the scale in a new language would facilitate cross-cultural comparisons of the role that pain catastrophizing plays in patient function.PurposeThe aim of this study was to translate and culturally adapt the PCS into Nepali (Nepali version of PCS [PCS-NP]) and evaluate its clinimetric properties.MethodsWe translated, cross-culturally adapted, and performed an exploratory factor analysis (EFA) of the PCS-NP in a sample of adults with chronic pain (N=143). We then confirmed the resulting factor model in a separate sample (N=272) and compared this model with 1-, 2-, and 3-factor models previously identified using confirmatory factor analyses (CFAs). We also computed internal consistencies, test–retest reliabilities, standard error of measurement (SEM), minimal detectable change (MDC), and limits of agreement with 95% confidence interval (LOA95%) of the PCS-NP scales. Concurrent validity with measures of depression, anxiety, and pain intensity was assessed by computing Pearson’s correlation coefficients.ResultsThe PCS-NP was comprehensible and culturally acceptable. We extracted a two-factor solution using EFA and confirmed this model using CFAs in the second sample. Adequate fit was also found for a one-factor model and different two- and three-factor models based on prior studies. The PCS-NP scores evidenced excellent reliability and temporal stability, and demonstrated validity via moderate-to-strong associations with measures of depression, anxiety, and pain intensity. The SEM and MDC for the PCS-NP total score were 2.52 and 7.86, respectively (range of PCS scores 0–52). LOA95% was between −15.17 and +16.02 for the total PCS-NP scores.ConclusionThe PCS-NP is a valid and reliable instrument to assess pain catastrophizing in Nepalese individuals with chronic pain.

Background Central sensitization is thought to be an important contributing factor in many chronic pain disorders. The Central Sensitization Inventory (CSI) is a patient-reported measure frequently used to assess symptoms related to central sensitization. The aims of the study were to translate and cross-culturally adapt the CSI into Nepali (CSI-NP) and assess its measurement properties. Methods The CSI was translated into Nepali using recommended guidelines. The CSI-NP was then administered on 100 Nepalese adults with sub-acute and chronic musculoskeletal pain with additional demographic and pain-related questions. The CSI-Nepali was administered again about 2 weeks later. Four measurement properties of the CSI-NP were evaluated: (1) internal consistency using Cronbach’s alpha, (2) test-retest reliability using intraclass correlation coefficient (ICC 2,1 ), (3) measurement errors, and (4) construct validity testing five a priori hypotheses. Confirmation of construct validity was determined if a minimum of 75% of the hypotheses were met. Results The CSI was successfully translated into Nepali. Internal consistency and test-retest reliability were both excellent (Cronbach’s alpha = 0.91, and ICC = 0.98). The standard error of measurement was 0.31 and the smallest detectable change was 0.86. Four out of five (80%) a priori hypotheses were met, confirming the construct validity: the CSI-NP correlated strongly with the Pain Catastrophizing Scale total scores ( r = 0.50); moderately with the total number of pain descriptors ( r = 0.35); weakly with the Numerical Rating Scale ( r = 0.25); and women had significantly higher CSI scores than men. However, the CSI scores did not correlate significantly with the total duration of pain, as hypothesized ( r = 0.10). Conclusions The Nepali translation of the CSI demonstrated excellent reliability and construct validity in adults with musculoskeletal pain. It is now available to Nepali health care providers to help assess central sensitization-related signs and symptoms in individuals with musculoskeletal pain in research or clinical practice to advance the understanding of central sensitization in Nepalese samples.

Background The Patient-Specific Functional Scale (PSFS) is among the most commonly used measures to assess physical function. Objectives We aimed to translate and cross-culturally validate the PSFS to Nepali and further assess its psychometric properties. Methods This longitudinal, single-arm cohort study translated and cross-culturally adapted the PSFS to Nepali (PSFS-NP) following recommended guidelines. A sample of 104 Nepalese with musculoskeletal pain was recruited to evaluate the psychometric properties of the PSFS-NP. We assessed the internal consistency (Cronbach alpha), 2-week test-retest reliability (intraclass correlation coefficient [ICC]), the smallest detectable change at the 90% confidence interval (CI), and construct validity. Concurrent validity was assessed against the Nepali versions of the Oswestry Disability Index, global rating of change, and numeric pain-rating scale. Receiver operating characteristic curves were plotted to measure responsiveness and area under the curve, and the minimum important change (MIC) was estimated. Results The PSFS-NP showed good reliability, with a Cronbach alpha of .75, an ICC of 0.89 (95% CI: 0.78, 0.94), and a smallest detectable change at the 90% CI of 1.46. It demonstrated significant correlations with the Nepali versions of the Oswestry Disability Index (r = -0.47, P = .001), global rating of change (r = 0.71, P<.001), and numeric pain-rating scale (r = -0.32 and -0.55, P<.001). Areas under the curve ranged from 0.72 to 0.99. The MIC was 2.00 in the main analysis. Secondary analyses revealed MICs of 0.50, 0.66, and 2.00 for small, medium, and large improvement, respectively. Conclusion The PSFS-NP is a reliable, valid, and responsive measure. It can be used in clinical practice and research in Nepalese with musculoskeletal pain. J Orthop Sports Phys Ther 2018;48(8):659-664. Epub 6 Apr 2018. doi:10.2519/jospt.2018.7925.