Background
Method
Subject recruitment and assessment
Cross-cultural adaptation of the original version (Additional file 1) of the pain medication questionnaire
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Step 1 – Initial translation
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Step 2 – Synthesis of the translations
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Step 3 – Back translation to the original language
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Step 4 – Revision by a committee of specialists
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Step 5 – Revision by a committee of specialists
Analysis
Descriptive statistics
Face validity of the PMQ assessed by the specialists and the target population in the pre-final sample
Content validity of the PMQ assessed by the specialists and the target population in the pre- final sample
PMQ items | Language clarity | Practical relevance | Theoretical relevance |
---|---|---|---|
1 | 1.000 | 1.000 | 1.000 |
2 | 1.000 | 0.778 | 1.000 |
3 | 1.000 | 1.000 | 1.000 |
4 | 0.889 | 0.333 | 0.889 |
5 | 1.000 | 1.000 | 1.000 |
6 | 1.000 | 1.000 | 1.000 |
7 | 1.000 | 1.000 | 1.000 |
8 | 1.000 | 1.000 | 1.000 |
9 | 1.000 | 1.000 | 1.000 |
10 | 1.000 | 0.778 | 0.778 |
11 | 1.000 | 0.667 | 0.667 |
12 | 1.000 | 1.000 | 1.000 |
13 | 1.000 | 1.000 | 1.000 |
14 | 1.000 | 0.778 | 1.000 |
15 | 1.000 | 1.000 | 1.000 |
16 | 1.000 | 1.000 | 1.000 |
17 | 1.000 | 1.000 | 1.000 |
18 | 1.000 | 1.000 | 1.000 |
19 | 1.000 | 0.778 | 0.778 |
20 | 1.000 | 0.778 | 0.778 |
21 | 1.000 | 1.000 | 1.000 |
22 | 1.000 | 1.000 | 1.000 |
23 | 1.000 | 1.000 | 1.000 |
24 | 1.000 | 1.000 | 1.000 |
25 | 1.000 | 1.000 | 1.000 |
26 | 0.889 | 0.667 | 0.667 |
Average | 0.991 | 0.906 | 0.945 |
PMQ items | Semantic equivalence | Idiomatic equivalence | Experiential equivalence | Conceptual equivalence |
---|---|---|---|---|
1 | 1.000 | 1.000 | 1.000 | 1.000 |
2 | 1.000 | 1.000 | 1.000 | 1.000 |
3 | 1.000 | 1.000 | 1.000 | 1.000 |
4 | 1.000 | 1.000 | 1.000 | 1.000 |
5 | 1.000 | 1.000 | 1.000 | 1.000 |
6 | 1.000 | 1.000 | 1.000 | 1.000 |
7 | 1.000 | 1.000 | 1.000 | 0.889 |
8 | 1.000 | 1.000 | 1.000 | 1.000 |
9 | 1.000 | 1.000 | 1.000 | 1.000 |
10 | 1.000 | 1.000 | 1.000 | 0.667 |
11 | 1.000 | 1.000 | 1.000 | 1.000 |
12 | 1.000 | 1.000 | 0.889 | 0.778 |
13 | 1.000 | 1.000 | 1.000 | 1.000 |
14 | 1.000 | 1.000 | 1.000 | 0.889 |
15 | 1.000 | 1.000 | 1.000 | 0.889 |
16 | 1.000 | 1.000 | 1.000 | 1.000 |
17 | 0.889 | 0.889 | 0.889 | 0.889 |
18 | 1.000 | 1.000 | 1.000 | 1.000 |
19 | 1.000 | 1.000 | 1.000 | 1.000 |
20 | 1.000 | 1.000 | 1.000 | 1.000 |
21 | 1.000 | 1.000 | 1.000 | 1.000 |
22 | 1.000 | 1.000 | 1.000 | 1.000 |
23 | 1.000 | 1.000 | 1.000 | 0.889 |
24 | 1.000 | 0.778 | 1.000 | 0.889 |
25 | 1.000 | 0.778 | 1.000 | 1.000 |
26 | 1.000 | 0.778 | 1.000 | 1.000 |
Average | 0.996 | 0.970 | 0.991 | 0.953 |
Item | PMQ – original scale | PMQ- adapted translated version (pre-final) | Back translation |
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i1 | I believe I am receiving enough medication to relieve my pain. | Eu acredito estar recebendo medicação suficiente para aliviar minha dor. | I believe I am receiving enough medication to relieve my pain. |
i2 | My doctor spends enough time talking to me about my pain medication during appointments. | Meu médico passa tempo suficiente falando comigo sobre minha medicação para dor durante as consultas. | My doctor spends enough time talking to me about my pain medication during appointments. |
i3 | I believe I would feel better with a higher dosage of my pain medication. | Eu acredito que me sentiria melhor com uma dosagem maior da minha medicação para dor. | I believe I would feel better with a higher dosage of my pain medication. |
i4 | In the past, I have had some difficulty getting the medication I need from my doctor(s). | No passado, eu tive algumas dificuldades em conseguir a medicação que eu precisava do(s) meus(s) médicos(s). | In the past, I have had some difficulty getting the medication I need from my doctor(s). |
i5 | I wouldn’t mind quitting my current pain medication and trying a new one, if my doctor recommends it. | Eu não me importaria em parar minha atual medicação para dor e tentar uma nova, se meu médico me recomendasse isso. | I wouldn’t mind quitting my current pain medication and trying a new one, if my doctor recommends it. |
i6 | I have clear preferences about the type of pain medication I need. | Eu tenho claras preferências sobre o tipo de medicação que preciso para dor. | I have clear preferences about the type of pain medication I need. |
i7* | Family members seem to think that I may be too dependent on my pain medication. | Pessoas da família parecem achar que eu posso estar muito dependente da minha medicação para dor. | People members seem to think that I may be too dependent on my pain medication. |
i8 | It is important to me to try ways of managing my pain in addition to the medication (such as relaxation, biofeedback, physical therapy, TENS unit, etc.). | É importante para mim, testar formas adicionais à minha medicação para administrar minha dor como: relaxamento, biofeedback, fisioterapia, uso de TENS (Estimulação Elétrica Nervosa Transcutânea), etc. | It is important to me to try ways of managing my pain in addition to the medication (such as relaxation, biofeedback, physical therapy, TENS unit, etc.). |
i9 | At times, I take pain medication when I feel anxious and sad, or when I need help sleeping. | Às vezes, eu tomo medicação para dor quando eu me sinto ansioso(a) e triste, ou quando preciso de ajuda para dormir. | At times, I take pain medication when I feel anxious and sad, or when I need help sleeping. |
i10* | At times, I drink alcohol to help control my pain. | Às vezes, eu tomo bebida alcoólica para ajudar a controlar minha dor. | At times, I drink alcohol to help control my pain. |
i11* | My pain medication makes it hard for me to think clearly sometimes. | Algumas vezes, minha medicação para dortorna difícil para mim pensar com clareza. | My pain medication makes it hard for me to think clearly sometimes. |
i12* | I find it necessary to go to the emergency room to get treatment for my pain. | Eu acho necessário ir a um serviço de urgência para conseguir tratamento para minha dor. | I find it necessary to go to the emergency service to get treatment for my pain. |
i13 | My pain medication makes me nauseated and constipated sometimes. | Minha medicação para dor às vezes me deixa enjoado e constipado. | My pain medication makes me nauseated and constipated sometimes. |
i14 | At times, I need to borrow pain medication from friends or family to get relief. | Às vezes, eu preciso pedir emprestado aos meus amigos ou familiares medicação para ter alívio. | At times, I need to borrow pain medication from friends or family to get relief. |
i15 | I get pain medication from more than one doctor in order to have enough medication for my pain. | Eu pego medicação para dor em mais de um médico a fim de ter medicação suficiente para minha dor. | I get pain medication from more than one doctor in order to have enough medication for my pain. |
i16 | At times, I think I may be too dependent on my pain medication. | Às vezes, eu acho que posso está muito dependente da minha medicação para dor. | At times, I think I may be too dependent on my pain medication. |
i17* | To help me out, family members have obtained pain medications for me from their own doctors. | Para me ajudar, pessoas da família obtêm medicamento para dor para mim, de seus próprios médicos. | To help me out, family people have obtained pain medications for me from their own doctors. |
i18 | At times, I need to take pain medication more often than it is prescribed in order to relieve my pain. | Às vezes, eu tenho que tomar medicação para dor com mais frequência do que está prescrito, a fim de aliviar minha dor. | At times, I need to take pain medication more often than it is prescribed in order to relieve my pain. |
i19 | I save any unused pain medication I have in case I need it later. | Eu guardo qualquer medicação para dor que não usei, caso precise dela mais tarde. | I save any unused pain medication I have in case I need it later. |
i20 | I find it helpful to call my doctor or clinic to talk about how my pain medication is working. | Eu acho útil ligar para meu médico ou para a clínica para falar sobre como meu medicamento para dor está agindo. | I find it helpful to call my doctor or clinic to talk about how my pain medication is working. |
i21 | At times, I run out of pain medication early and have to call my doctor for refills. | Às vezes, meus medicamentos acabam antecipadamente e eu tenho que ligar para meu médico para reabastecer. | At times, I run out of pain medication early and have to call my doctor for refills. |
i22 | I find it useful to take additional medications (such as sedatives) to help my pain medication work better. | Eu acho útil tomar medicamentos adicionais (como sedativos) para ajudar minha medicação para dor funcionar melhor. | I find it useful to take additional medications (such as sedatives) to help my pain medication work better. |
i23* | How many painful conditions (injured body parts or illnesses) do you have? | Quantas partes do corpo doloridas (partes do corpo lesionadas ou enfermidade) você tem? | How many painful conditions (injured body parts or illnesses) do you have? |
i24* | How many times in the past year have you asked your doctor to increase your prescribed dosage of pain medication in order to get relief? | Quantas vezes, no último ano, você pediu para o seu médico para aumentar a dosagem prescrita de medicação para dor a fim de ter alívio? | How many times in the last year have you asked your doctor to increase your prescribed dosage of pain medication in order to get relief? |
i25* | How many times in the past year have you run out of pain medication early and had to request an early refill? | Quantas vezes, no último ano, você ficou sem medicação para dor antecipadamente e teve que pedir um reabastecimento antecipado? | How many times in the last year have you run out of pain medication early and had to request an early refill? |
i26* | How many times in the past year have you accidentally misplaced your prescription for pain medication and had to ask for another? | Quantas vezes, no último ano, você acidentalmente perdeu sua prescrição de medicação para dor e teve que pedir outra? | How many times in the last year have you accidentally misplaced your prescription for pain medication and had to ask for another? |
Semantic assessment by the target population
Original PMQ, pre-final adapted translated version and back translation
PMQ reliability based on data collected in the pre-final sample
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Item 5: I wouldn’t mind quitting my current pain medication and trying a new one, if my doctor recommends it.
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Item 6: I have clear preferences about the type of pain medication I need.
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Item 8: It is important to me to try ways of managing my pain in addition to the medication (such as relaxation, biofeedback, physical therapy, TENS (transcutaneous nervous electrical stimulation) etc. [15].
Items | Correlation (23) | Alpha if the item was not detected (26) | Alpha if the item was detected (23) | Increase (%) |
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P1 - I believe I am receiving enough medication to relieve my pain.b | 0.802a | 0.516 | 0.641 | 19.50% |
P2 - My doctor spends enough time talking to me about my pain medication during appointments. b | −0.072 | 0.651 | 0.736 | 11.55% |
P3 - I believe I would feel better with a higher dosage of my pain medication. | 0.653a | 0.576 | 0.687 | 16.16% |
P4 - In the past, I have had some difficulty getting the medication I need from my doctor(s). | 0.348a | 0.615 | 0.717 | 14.23% |
P7 –Family members seem to think that I may be too dependent on my pain medication. | 0.485a | 0.581 | 0.686 | 15.31% |
P9 - At times, I take pain medication when I feel anxious and sad, or when I need help sleeping. | 0.370a | 0.585 | 0.69 | 15.22% |
P10 – At times, I drink alcohol to help control my pain. | 0.284 | 0.605 | 0.703 | 13.94% |
P11 – My pain medication makes it hard for me to think clearly sometimes. | 0.308 | 0.597 | 0.693 | 13.85% |
P12 – I find it necessary to go to the emergency room to get treatment for my pain. | 0.586a | 0.582 | 0.685 | 15.04% |
P13 – My pain medication makes me nauseated and constipated sometimes. | 0.1 | 0.627 | 0.719 | 12.80% |
P14 – At times, I need to borrow pain medication from friends or family to get relief. | 0.387a | 0.582 | 0.686 | 15.16% |
P15 – I get pain medication from more than one doctor in order to have enough medication for my pain. | 0.534a | 0.581 | 0.687 | 15.43% |
P16 – At times, I think I may be too dependent on my pain medication. | 0.434a | 0.578 | 0.687 | 15.87% |
P17 – To help me out, family members have obtained pain medications for me from their own doctors. | 0.443a | 0.581 | 0.687 | 15.43% |
P18 – At times, I need to take pain medication more often than it is prescribed in order to relieve my pain. | 0.492a | 0.557 | 0.672 | 17.11% |
P19 – I save my unused pain medication I have in case I need it later. | −0.132 | 0.629 | 0.723 | 13.00% |
P20 – I find it helpful to call my doctor or clinic to talk about how my pain medication is working. | 0.177 | 0.598 | 0.702 | 14.81% |
P21 – At times, I run out of pain medication early and have to call my doctor for refills. | 0.566a | 0.568 | 0.679 | 16.35% |
P22 – I find it useful to take additional medications (such as sedatives) to help my pain medication work better. | 0.142 | 0.602 | 0.713 | 15.57% |
P23 – How many painful conditions (injured body parts or illnesses) do you have? | 0.075 | 0.623 | 0.721 | 13.59% |
P24 – How many times in the past year have you asked your doctor to increase your prescribed dosage of pain medication in order to get relief? | 0.326a | 0.594 | 0.699 | 15.02% |
P25 – How many times in the past year have you run out of pain medication early and had to request an early refill? | 0.623a | 0.549 | 0.666 | 17.57% |
P26 – How many times in the past year have you accidentally misplaced your prescription for pain medication and had to ask for another? | 0.418a | 0.59 | 0.692 | 14.74% |
Results
PMQ items
Item | Answer | |||||||||
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0 | 1 | 2 | 3 | 4 | ||||||
n | % a | n | % | n | % | N | % | n | % | |
P1 | 17 | 42.50 | – | – | – | – | 3 | 7.50 | 20 | 50.00 |
P2 | 7 | 17.50 | 2 | 5.00 | – | – | 14 | 35.00 | 17 | 42.50 |
P3 | 5 | 12.50 | 1 | 2.50 | – | – | 11 | 27.50 | 23 | 57.50 |
P4 | 7 | 17.50 | 3 | 7.50 | – | – | 12 | 30.00 | 18 | 45.00 |
P5 | 12 | 30.00 | 1 | 2.50 | 2 | 5.00 | 5 | 12.50 | 20 | 50.00 |
P6 | 11 | 27.50 | – | – | – | – | 4 | 10.00 | 25 | 62.50 |
P7 | 27 | 67.50 | – | – | 2 | 5.00 | 4 | 10.00 | 7 | 17.50 |
P8 | 5 | 12.50 | – | – | – | – | 7 | 17.50 | 28 | 70.00 |
P9 | 36 | 90.00 | 1 | 2.50 | 2 | 5.00 | – | – | 1 | 2.50 |
P10 | 37 | 92.50 | 3 | 7.50 | – | – | – | – | – | – |
P11 | 17 | 42.50 | 6 | 15.00 | 7 | 17.50 | 1 | 2.50 | 9 | 22.50 |
P12 | – | – | 3 | 7.50 | 18 | 45.00 | 13 | 32.50 | 6 | 15.00 |
P13 | 4 | 10.00 | 7 | 17.50 | 18 | 45.00 | 4 | 10.00 | 7 | 17.50 |
P14 | 19 | 47.50 | 4 | 10.00 | 10 | 25.00 | 6 | 15.00 | 1 | 2.50 |
P15 | 10 | 25.00 | 8 | 20.00 | 16 | 40.00 | 3 | 7.50 | 3 | 7.50 |
P16 | 27 | 67.50 | 2 | 5.00 | – | – | 5 | 12.50 | 6 | 15.00 |
P17 | 31 | 77.50 | 4 | 10.00 | – | – | 3 | 7.50 | 2 | 5.00 |
P18 | 15 | 37.50 | 9 | 22.50 | 10 | 25.00 | 2 | 5.00 | 4 | 10.00 |
P19 | 1 | 2.50 | – | – | 2 | 5.00 | 2 | 5.00 | 35 | 87.50 |
P20 | 28 | 70.00 | 8 | 20.00 | 1 | 2.50 | – | – | 3 | 7.50 |
P21 | 21 | 52.50 | 8 | 20.00 | 4 | 10.00 | 2 | 5.00 | 5 | 12.50 |
P22 | 12 | 30.00 | – | – | 19 | 47.50 | 3 | 7.50 | 6 | 15.00 |
P23 | 6 | 15.00 | 7 | 17.50 | 13 | 32.50 | 6 | 15.00 | 8 | 20.00 |
P24 | 24 | 60.00 | 7 | 17.50 | 5 | 12.50 | 1 | 2.50 | 3 | 7.50 |
P25 | 14 | 35.00 | 6 | 15.00 | 8 | 20.00 | 9 | 22.50 | 3 | 7.50 |
P26 | 27 | 67.50 | 10 | 25.00 | 2 | 5.00 | – | – | 1 | 2.50 |
Sociodemographic and clinical aspects
Variable | PMQ classification | p-value | |||||
---|---|---|---|---|---|---|---|
Low | Medium | High | |||||
N | % | n | % | N | % | ||
HEMOPE (Blood Center of Pernambuco)/emergency sector | 5 | 18.50 | 16 | 59.30 | 6 | 22.20 | pb = 0,105 |
Outpatient | 7 | 53.80 | 4 | 30.80 | 2 | 15.40 | |
Age range (years) | pb = 0.346 | ||||||
18 to 29 | 4 | 19.00 | 12 | 57.10 | 5 | 23.80 | |
30 to 53 | 8 | 42.10 | 8 | 42.10 | 3 | 15.80 | |
Sex | pb = 0.691 | ||||||
Male | 4 | 26.70 | 9 | 60.00 | 2 | 13.30 | |
Female | 8 | 32.00 | 11 | 44.00 | 6 | 24.00 | |
Color | pb = 0.229 | ||||||
White | 0 | 0.00 | 1 | 50.00 | 1 | 50.00 | |
Black | 3 | 16.70 | 11 | 61.10 | 4 | 22.20 | |
Brown | 9 | 45.00 | 8 | 40.00 | 3 | 15.00 | |
Marital status | pb = 0.206 | ||||||
Married/common law | 6 | 54.50 | 4 | 36.40 | 1 | 9.10 | |
Single | 4 | 19.00 | 13 | 61.90 | 4 | 19.00 | |
Separated/divorced | 2 | 25.00 | 3 | 37.50 | 3 | 37.50 | |
Schooling | pb = 0.391 | ||||||
Incomplete elementary | 6 | 50.00 | 4 | 33.30 | 2 | 16.70 | |
Elementary | 2 | 15.40 | 7 | 53.80 | 4 | 30.80 | |
Secondary | 3 | 25.00 | 8 | 66.70 | 1 | 8.30 | |
University | 1 | 33.30 | 1 | 33.30 | 1 | 33.30 | |
Occupation | pb = 0.025a | ||||||
Student | – | – | 1 | 33.30 | 2 | 66.70 | |
Casual labor | 4 | 57.10 | 2 | 28.60 | 1 | 14.30 | |
Unemployed | 3 | 21.40 | 8 | 57.10 | 3 | 21.40 | |
Formally employed | 2 | 66.70 | – | – | 1 | 33.30 | |
Homemaker | 2 | 100.00 | – | – | – | – | |
Others | 1 | 9.10 | 9 | 81.80 | 1 | 9.10 | |
Current religion | pb = 0.825 | ||||||
Catholic | 2 | 20.0 | 6 | 60.00 | 2 | 20.00 | |
Evangelical | 9 | 39.1 | 9 | 39.10 | 5 | 21.70 | |
None | 1 | 20.0 | 3 | 60.00 | 1 | 20.00 | |
Others | 0 | 0.0 | 2 | 100.00 | 0 | 0.00 |
Variable | PMQ classification | p-value | |||||
---|---|---|---|---|---|---|---|
Low | Medium | High | |||||
N | % | N | % | N | % | ||
P20b | pa = 0.412 | ||||||
Yes | 9 | 27.30 | 16 | 48.50 | 8 | 24.20 | |
No | 3 | 42.90 | 4 | 57.10 | – | – | |
P21c | pa = 0.150 | ||||||
Yes | 9 | 30.00 | 13 | 43.30 | 8 | 26.70 | |
No | 3 | 30.00 | 7 | 70.00 | 0 | 0.00 | |
P23d | pa = 0.132 | ||||||
SBP | 3 | 60.00 | 1 | 20.00 | 1 | 20.00 | |
Leg ulcers | 0 | 0.00 | 6 | 85.70 | 1 | 14.30 | |
Unknown | 9 | 32.10 | 13 | 46.40 | 6 | 21.40 | |
P24e | pa = 0.366 | ||||||
Yes | 4 | 25.00 | 7 | 43.80 | 5 | 31.30 | |
No | 8 | 33.30 | 13 | 54.20 | 3 | 12.50 |
Score for risk of opioid abuse in people with heterogeneous chronic pain
PMQ classification (23 questions) | n | % |
---|---|---|
Very low / Low | 12 | 30.00 |
Medium | 20 | 50.00 |
High/Very High | 8 | 20.00 |
TOTAL | 40 | 100.00 |