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Rehab Measures: Classification for Chronic Pain in SCI/Cardenas Pain Classification

Link to instrument

 

Title of Assessment

Classification for Chronic Pain in SCI/Cardenas Pain Classification 

Acronym

Instrument Reviewer(s)

Initially reviewed by Rachel Tappan, PT, NCS and the SCI EDGE task force of the Neurology Section of the APTA in 3/2012

Summary Date

12/13/2013 

Purpose

The Classification for Chronic Pain in Spinal Cord Injury (SCI) classifies pain after SCI as either neurologic or musculoskeletal pain and further into one of six subcategories.

This pain classification is a system for classifying type of pain rather than a true outcome measure that can measure change in pain over time.

Description

  • 2 categories of pain: Neurologic and Musculoskeletal
  • Neurologic Pain is subclassified into: 1) SCI Pain, 2) Transition Zone Pain, 3) Radicular Pain, 4) Visceral Pain
  • Musculoskeletal pain is subclassified into: 1) Mechanical Spine Pain, 2) Overuse Pain
  • Classification is determined via interview or questionnaire

Area of Assessment

Pain 

Body Part

 

ICF Domain

Body Structure 

Domain

Sensory 

Assessment Type

Patient Reported Outcomes 

Length of Test

06 to 30 Minutes 

Time to Administer

5-15 Minutes

Number of Items

2 categories of pain with a total of 6 subcategories, each area of pain is classified 

Equipment Required

None

Training Required

No training required

Type of training required

No Training 

Cost

Free 

Actual Cost

Free

Age Range

 

Administration Mode

 

Diagnosis

Spinal Cord Injury 

Populations Tested

  • Spinal Cord Injury (SCI)

Standard Error of Measurement (SEM)

Not Applicable

Minimal Detectable Change (MDC)

Not Applicable

Minimally Clinically Important Difference (MCID)

Not Applicable

Cut-Off Scores

Not Applicable

Normative Data

Not Applicable

Test-retest Reliability

Not Applicable

Interrater/Intrarater Reliability

Chronic SCI:

(Cardenas et al, 2002; n = 163; mean time post-SCI = 8.3 (8.9) years)

 

Interrater reliability tested on subset of subjects, n = 56

  • Adequate Interrater Reliability (kappa = 0.66-0.68)

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Not Established

Construct Validity (Convergent/Discriminant)

Not Established

Content Validity

SCI:

(Bryce et al, 2007; n = 59 participants in a course on outcome measures at a meeting of American Spinal Injury Association and the International Spinal Cord Society)

 

  • In a vote on validity and usefulness, the Cardenas Pain Classification was determined to be less valid and useful than both the Bryce-Ragnarsson Pain Taxonomy (BRPT) and the International Association for the Study of Pain (IASP) SCI Classification.

 

Voting on Pain Classification Validity/Usefulness:

Instrument

Valid and useful % (N)

Useful but requires more validation % (N)

Useful but requires changes/improvement then further validation % (N)

Not useful or valid for research in SCI % (N)

Cardenas

4 (2)

20 (11)

52 (29)

25 (14)

BRPT

14 (8)

42 (25)

36 (21)

8 (5)

IASP

19 (11)

47 (28)

31 (18)

3 (2)

BRPT: Bryce Ragnarsson Pain Taxonomy

IASP: International Association for the Study of Pain Scale

Face Validity

Not Established

Floor/Ceiling Effects

Not Applicable

Responsiveness

Not Applicable

Professional Association Recommendations

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 months post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

NR

NR

NR

 

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

NR

NR

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

No

No

Not reported

Considerations

The Classification for Chronic Pain in SCI/Cardenas Pain Classification is one of many systems that have been developed to classify pain in people with spinal cord injury. A group of experts met in 2009 and developed a new pain classification system for people with spinal cord injury (the ISCIP classification), which incorporates elements of the many pre-existing classification systems. Consider using the ISCIP classification system rather than the Classification for Chronic Pain in SCI/Cardenas Pain Classification for consistency of pain classification across settings.
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Bibliography

Bryce, T. N., Budh, C. N., et al. (2007). "Pain after spinal cord injury: an evidence-based review for clinical practice and research: Report of the National Institute on Disability and Rehabilitation Research Spinal Cord Injury Measures meeting." The journal of spinal cord medicine 30(5): 421. Find it on PubMed

Cardenas, D. D. and Felix, E. R. (2009). "Pain after spinal cord injury: a review of classification, treatment approaches, and treatment assessment." PM R 1(12): 1077-1090. Find it on PubMed

Cardenas, D. D., Turner, J. A., et al. (2002). "Classification of chronic pain associated with spinal cord injuries." Archives of Physical Medicine and Rehabilitation 83(12): 1708-1714. Find it on PubMed

Year published

2002 

Instrument in PDF Format

No 
Approval Status Approved 
 
Attachments
Created at 9/26/2012 9:52 AM  by Jason Raad 
Last modified at 8/29/2014 1:57 PM  by Jason Raad