Development and Initial Validation of the PEG, a Three-item Scale Assessing Pain Intensity and Interference

Erin E. Krebs, Karl A. Lorenz, Matthew J. Bair, Teresa M. Damush, Jingwei Wu, Jason M. Sutherland, Steven M. Asch, Kurt Kroenke

Research output: Contribution to journalArticlepeer-review

469 Scopus citations


BACKGROUND: Inadequate pain assessment is a barrier to appropriate pain management, but single-item "pain screening" provides limited information about chronic pain. Multidimensional pain measures such as the Brief Pain Inventory (BPI) are widely used in pain specialty and research settings, but are impractical for primary care. A brief and straightforward multidimensional pain measure could potentially improve initial assessment and follow-up of chronic pain in primary care. OBJECTIVES: To develop an ultra-brief pain measure derived from the BPI. DESIGN: Development of a shortened three-item pain measure and initial assessment of its reliability, validity, and responsiveness. PARTICIPANTS: We used data from 1) a longitudinal study of 500 primary care patients with chronic pain and 2) a cross-sectional study of 646 veterans recruited from ambulatory care. RESULTS: Selected items assess average pain intensity (P), interference with enjoyment of life (E), and interference with general activity (G). Reliability of the three-item scale (PEG) was α∈=∈0.73 and 0.89 in the two study samples. Overall, construct validity of the PEG was good for various pain-specific measures (r∈=∈0.60-0.89 in Study 1 and r∈=∈0.77-0.95 in Study 2), and comparable to that of the BPI. The PEG was sensitive to change and differentiated between patients with and without pain improvement at 6 months. DISCUSSION: We provide strong initial evidence for reliability, construct validity, and responsiveness of the PEG among primary care and other ambulatory clinic patients. The PEG may be a practical and useful tool to improve assessment and monitoring of chronic pain in primary care.

Original languageEnglish (US)
Pages (from-to)733-738
Number of pages6
JournalJournal of general internal medicine
Issue number6
StatePublished - Jun 2009

Bibliographical note

Funding Information:
SCAMP was supported by a grant from the National Institute of Mental Health to Dr. Kroenke (MH-071268). HELP-Vets was supported by the Health Services Research & Development (HSR&D) service of the US Department of Veterans Affairs (IIR-03–150). Drs. Krebs, Lorenz, and Bair were supported by VA HSR&D Research Career Development Awards.

Funding Information:
Conflict of Interest Statement: We disclose the following financial relationships: 1) Drs. Lorenz and Asch have received research funding from the Amgen Corporation; 2) Dr. Bair has received research funding and honoraria from Eli Lilly and served on an advisory board for Abbott.


  • Measurement
  • Pain
  • Primary care


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