RAP Project-An Instrument Development Study to Determine Common Attributes for Pain Assessment among Men and Women Who Represent Multiple Pain-Related Diagnoses

Inadequate pain assessment by nurses is a primary barrier to provision of optimum pain relief and may contribute, in part, to the epidemiologic health problem of unrelieved pain. In this three-phase study, both qualitative and quantitative methods were used to develop, revise, and test a multidimensional pain assessment instrument, theoretically supported for use with all adult patients experiencing pain, for the purpose of contributing to a systematic global approach to comprehensive pain assessment. In phase 1, instrument items were inductively derived from interviews of participants experiencing homogeneous pain. In phase 2, sensitivity of items to heterogeneous pain was established through focus groups and interviews of participants reporting multiple pain problems. In phase 3, psychometric properties were evaluated with subjects representing a variety of pain-related diagnoses. Cronbach's alpha for the global score of the instrument was 0.89. Factor analysis indicated three domains of heterogeneous pain: “learning to live with pain” (nine items), “thinking and feeling pain” (fifteen items), and “perceiving controllability of pain” (six items). Triangulation of phase 3 item clusters with phase 2 data provided a framework for substantive interpretation of factors, identification of heterogeneous pain attributes, and validation of category themes that emerged in phase 1. Preliminary evidence supported initial reliability and validity, indicating sensitivity of the Richards Assessment of Pain (RAP) instrument to heterogeneous pain. Substantive interpretation of RAP factors revealed attributes of heterogeneous pain that may contribute to global pain assessment for all patients with pain.