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J Pain Res. 2016 Nov 16;9:1057-1066. eCollection 2016.

Words that describe chronic musculoskeletal pain: implications for assessing pain quality across cultures.

Author information

Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel.
Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.



People from different cultures who speak different languages may experience pain differently. This possible variability has important implications for evaluating the validity of pain quality measures that are directly translated into different languages without cultural adaptations. The aim of this study was to evaluate the impact of language and culture on the validity of pain quality measures by comparing the words that individuals with chronic pain from Nepal use to describe their pain with those used by patients from the USA.


A total of 101 individuals with chronic musculoskeletal pain in Nepal were asked to describe their pain. The rates of the different pain descriptor domains and phrases used by the Nepali sample were then compared to the published rates of descriptors used by patients from the USA. The content validity of commonly used measures for assessing pain quality was then evaluated.


While there was some similarity between patients from Nepal and the USA in how they describe pain, there were also important differences, especially in how pain quality was described. For example, many patients from Nepal used metaphors to describe their pain. Also, the patients from Nepal often used a category of pain descriptor - which describes a physical state - not used by patients from the USA. Only the original McGill Pain Questionnaire was found to have content validity for assessing pain quality in patients from Nepal, although other existing pain quality measures could be adapted to be content valid by adding one or two additional descriptors, depending on the measure in question.


The findings indicate that direct translations of measures that are developed using samples of patients from one country or culture are not necessarily content valid for use in other countries or cultures; some adaptations may be required in order for such measures to be most useful in new language and culture.


chronic pain; cross-cultural adaptation; musculo-skeletal pain; pain assessment; pain quality

Conflict of interest statement

One of the authors (MPJ) is a co-developer of two of the measures discussed in this article (the Pain Quality Assessment Scale and Revised Pain Quality Assessment Scale) and receives royalties for sponsored use of these measures. The other authors (SS and AP) report no conflicts of interest in this work.

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