Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA.
J Neurosurg. 2010 Sep;113(3):516-23. doi: 10.3171/2010.1.JNS09669.
Outcomes in clinical trials on trigeminal pain therapies require instruments with demonstrated reliability and validity. The authors evaluated the Brief Pain Inventory (BPI) in its existing form plus an additional 7 facial-specific items in patients referred to a single neurosurgeon for a diagnosis of facial pain. The complete 18-item instrument is referred to as the BPI-Facial.
This study was a cross-sectional analysis of patients who completed the BPI-Facial. The diagnosis of classic versus atypical trigeminal neuralgia (TN) was made before analyzing the questionnaire results. A hypothesis-driven factor analysis was used to determine the principal components of the questionnaire. Item reliability and questionnaire validity were tested for these specific constructs.
Data from 156 patients were analyzed, including 114 patients (73%) with classic and 42 (27%) with atypical TN. Using orthomax rotation factor analysis, 3 factors with an eigenvalue > 1.0 were identified-pain intensity, interference with general activities, and facial-specific pain interference-accounting for 97.6% of the observed item variance. Retention of the 3 factors was confirmed via a Cattell scree plot. Internal reliability was demonstrated by calculating Cronbach's alpha: 0.86 for pain intensity, 0.89 for interference with general activities, 0.95 for facial-specific pain interference, and 0.94 for the entire instrument. Initial validity of the BPI-Facial instrument was supported by the detection of statistically significant differences between patients with classic versus atypical pain. Patients with atypical TN rated their facial pain as more intense (atypical 6.24 vs classic 5.03, p = 0.013) and as having greater interference in general activities (atypical 6.94 vs classic 5.43, p = 0.0033). Both groups expressed high levels of facial-specific pain interference (atypical 6.34 vs classic 5.95, p = 0.527).
The BPI-Facial is a rigorous measure of facial pain in patients with TN and appears to have sound psychometric properties and is responsive to differences between classic and atypical TN. Future studies must assess the instrument's test-retest reliability, validity in additional populations, and responsiveness with respect to changes in patient outcomes following neurosurgical interventions and medical therapies.
三叉神经痛治疗临床试验的结果需要使用可靠性和有效性得到证实的工具。作者评估了在一位神经外科医生处就诊诊断为面部疼痛的患者中，现有形式的简明疼痛量表（BPI）加上另外 7 个面部特定项目的情况。完整的 18 项量表称为 BPI-Facial。
本研究为接受 BPI-Facial 评估的患者的横断面分析。在分析问卷结果之前，先对经典与非典型三叉神经痛（TN）的诊断进行了假设驱动的因子分析。使用正交极大旋转因子分析确定问卷的主要成分。针对这些特定结构测试了项目可靠性和问卷有效性。
共分析了 156 例患者的数据，包括 114 例（73%）经典 TN 和 42 例（27%）非典型 TN。使用正交极大旋转因子分析，确定了 3 个特征值>1.0 的因子，即疼痛强度、一般活动干扰和面部特定疼痛干扰，可解释观察到的项目方差的 97.6%。保留的 3 个因子通过 Cattell 峭度图得到确认。通过计算 Cronbach's alpha 来证明内部可靠性：疼痛强度为 0.86，一般活动干扰为 0.89，面部特定疼痛干扰为 0.95，整个仪器为 0.94。BPI-Facial 仪器的初步有效性得到了支持，因为它检测到了经典与非典型疼痛之间的统计学显著差异。非典型 TN 患者对其面部疼痛的评分更高（非典型为 6.24，经典为 5.03，p=0.013），并且一般活动干扰更大（非典型为 6.94，经典为 5.43，p=0.0033）。两组患者均表示面部特定疼痛干扰程度较高（非典型为 6.34，经典为 5.95，p=0.527）。
BPI-Facial 是评估 TN 患者面部疼痛的严格工具，似乎具有良好的心理测量学特性，并且对经典与非典型 TN 之间的差异有反应。未来的研究必须评估该工具的重测信度、在其他人群中的有效性以及在神经外科干预和医学治疗后患者结局变化方面的反应性。
