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PROMIS Pain Behavior Short Form
Please visit this website for more information about the instrument: PROMIS Pain Behavior Short Forms
The PROMIS Pain Behavior short forms include:
The PROMIS Pain Behavior item banks are available on the HealthMeasures website which is the official information and distribution center for PROMIS, Neuro-QoL™, NIH Toolbox®, and ASCQ-Me®
Exploratory: Cerebral Palsy (CP) and Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS)
Short Description of Instrument
The PROMIS Pediatric and Parent Proxy Short Forms are 8-item self-reported measures to rate behaviors of individuals experiencing pain.
Construct measured: External manifestations of pain.
Generic vs. disease specific: Generic.
Means of administration: Short-forms or computerized adaptive testing (CAT).
Intended respondent: Patient.
Comments/Special Instructions
The PROMIS Pain Behavior item banks measure self-reported external manifestations of pain: behaviors that typically indicate to others that an individual is experiencing pain. These actions or reactions can be verbal or nonverbal, and involuntary or deliberate. They include observable displays (sighing, crying), pain severity behaviors (resting, guarding, facial expressions, and asking for help), and verbal reports of pain. The Pain Behavior short form is universal rather than disease specific. It assesses pain behavior over the past seven days.
CP-specific Pain Category: Pain Behavior
CP-specific ICF Domain: Body Functions (World health Organization, 2001)
Scoring and Psychometric Properties
Scoring: All PROMIS instruments including the Pain Behavior short form item banks are scored using item-level calibrations. The most accurate way to score the instrument is to utilize the PROMIS Scoring Manuals measures The PROMIS Pain Behavioral Manual is available here: PROMIS Scoring Manual - Pain Behavior
Higher scores indicate greater symptoms or a higher level of impairment. A higher PROMIS T-score represents more of the concept being measured. For negatively worded concepts like pain behavior, a T-score of 60 is one SD worse than average. By comparison, a pain behavior T-score of 40 is one SD better than average.
Standardization Population: For most domains, T-scores relate to the US General Population. See PROMIS Calibrations Testing for further details regarding sample for specific ages and domains.
Psychometric Properties: Scores on the PROMIS Pain Behavior short form were significantly positively correlated with scores on PROMIS fatigue, depressive symptoms, and pain interference measures. Cronbach's alpha is .92 for the short form pain behavior scale (Cunningham et al., 2017).
Strengths: The PROMIS pediatric pain behavior 8-item short form and calibrated item bank complements other validated measures in the suite of PROMIS measures for pain interference, fatigue, depressive symptoms, anxiety, and mobility that have strong psychometric properties in pediatric pain populations (Varni et al., 2014). It is easily accessible with multiple data collection tools and may be the potential to be linked with the adult PROMIS pain behavior measure for use in studies, that include adult and pediatric populations or longitudinal research of youth with pain (since two of the items on the pediatric version come from the adult version) (Cunningham et al., 2017).
Weaknesses: Reliability and validation was done in US populations, and it would be informative to do research to determine whether child reports of pain behaviors and implications for pain-related disability differ across cultures (Cunningham et al., 2017).
This tool does not differentiate between behavior changes (e.g., resting/guarding) caused by pain and other ME/CFS symptoms, especially post-exertional malaise (PEM). Because of this, it is recommended that other instruments to measure pain and PEM be used in conjunction with the PROMIS Pain Behavior Short Forms.
This measure was validated with children who had chronic conditions including juvenile fibromyalgia, juvenile idiopathic arthritis, and sickle cell disease.  Half of the measures in this tool relate to some physical function and/or communication ability. It is not clear how significant in physical function and/or ability to verbally communicate would impact response. Because of this it is recommended that when using this tool for assessment of pain impact on behavior in children with cerebral palsy other instruments to measure pain be used in conjunction.
Cook KF, Keefe F, Jensen MP, Roddey TS, Callahan LF, Revicki D, Bamer AM, Kim J, Chung H, Salem R, Amtmann D. Development and validation of a new self-report measure of pain behaviors. Pain. 2013 Dec;154(12):2867-2876.
Cunningham NR, Kashikar-Zuck S, Mara C, Goldschneider KR, Revicki DA, Dampier C, Sherry DD, Crosby L, Carle A, Cook KF, Morgan EM. Development and validation of the self-reported PROMIS pediatric pain behavior item bank and short form scale. Pain. 2017 Jul;158(7):1323-1331.
Jacobson CJ Jr, Kashikar-Zuck S, Farrell J, Barnett K, Goldschneider K, Dampier C, Cunningham N, Crosby L, DeWitt EM. Qualitative Evaluation of Pediatric Pain Behavior, Quality, and Intensity Item Candidates and the PROMIS Pain Domain Framework in Children with Chronic Pain. J Pain. 2015 Dec;16(12):1243-1255.
Pain Behavior A brief guide to the PROMIS® Pain Behavior instruments. (2018) Accessed: 06Oct2021. Available from:
Singh A, DasGupta M, Simpson PM, Panepinto JA. Use of the new pediatric PROMIS measures of pain and physical experiences for children with sickle cell disease. Pediatr Blood Cancer. 2019 May;66(5):e27633.
Varni JW, Magnus B, Stucky BD, Liu Y, Quinn H, Thissen D, Gross HE, Huang IC, DeWalt DA. Psychometric properties of the PROMIS ® pediatric scales: precision, stability, and comparison of different scoring and administration options. Qual Life Res. 2014 May;23(4):1233-43.
World health Organization (2001). International Classification of Functioning, Disability and Health (ICF) Retrieved 19August2021
Document last updated August 2022
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