Descriptors of Pain Sensation: A Dual Hierarchical Model of Latent Structure


      Recently, the lexicon of pain was refined into a parsimonious set of words making up the Pain Descriptor System (PDS). The present study investigated the latent structure of the sensory category of the PDS with its 24 descriptors distributed equally across 8 subcategories. A sample of 629 chronic pain patients rated the degree to which each of these words described their pain. It was found that coldness-related words were rarely used and shared high covariance with other descriptors, thus warranting their removal as a subcategory. Confirmatory factor analysis of a previously theorized single higher-order model of 7 latent factors (each with 3 observed variables) resulted in poor fit, x2(181) = 377.72, P < .05; comparative fit index (CFI) = .915; root mean square error of approximation (RMSEA) = .04. This model was replaced with a dual higher-order model retaining the same 7 latent factors plus 2 higher-order factors corresponding to deep pain versus superficial pain. This model provided a good representation of the data, x2(181) = 301.07, P < .05; CFI = .948; RMSEA = .032. Therefore, descriptors of pain sensation differentiate sensory quality while also reflecting a fundamental dichotomy supported by neurophysiological research. Thus, the lexicon can illuminate pathophysiology, thereby clarifying pain diagnoses.


      Confirmatory factor analysis was performed on pain sensation descriptors used by 629 patients. This supported a hierarchical model with 7 lower-order factors plus 2 higher-order factors corresponding to deep pain versus superficial pain. By reflecting neurophysiology, this lexicon of pain can offer diagnostic clues.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Becker F.C.
        Acute low back pain: Diagnostics and treatment.
        Clin Excell Nurse. 2001; 5: 80-84
        • Bible D.
        Pain assessment at nurse triage: A literature review.
        Emerg Nurse. 2006; 14: 26-29
        • Biro D.
        The Language of Pain: Finding Words, Compassion, and Relief.
        W.W. Norton & Company, London, UK2010
        • Brown T.A.
        Confirmatory Factor Analysis for Applied Research.
        Guilford Press, New York, NY2006
      1. Cervero F: The gate theory, then and now, in Villanueva L, Dickenson A, Ollat H (eds): The Pain System on Normal and Pathological States: A Primer for Clinicians. Prog Pain Res Manag 31:33-48, 2005

      2. Chapman CR, Okifuji A: Pain: Basic mechanisms and conscious experience, in Dworkin RH, Breitbart WS (eds): Psychosocial Aspects of Pain: A Handbook for Healthcare Providers. Prog Pain Res Manag 27:3-27, 2004

        • Dehghani M.
        • Sharpe L.
        • Nicholas M.K.
        Selective attention to pain-related information in chronic musculoskeletal pain patients.
        Pain. 2003; 105: 37-46
        • Donaldson G.W.
        • Chapman C.R.
        • Nakamura Y.
        • Bradshaw D.H.
        • Jacobson R.C.
        • Chapman C.N.
        Pain and the defense response: Structural equation modeling reveals a coordinated psychophysiological response to increasing painful stimulation.
        Pain. 2003; 102: 97-108
      3. Fernandez E: The Pain Descriptor System: A cumulative refinement of the vocabulary for pain assessment. Presented at the 27th Annual Scientific Meeting of the American Pain Society, Tampa, FL, 2008

        • Fernandez E.
        • Towery S.
        A parsimonious set of verbal descriptors of pain sensation derived from the McGill Pain Questionnaire.
        Pain. 1996; 66: 31-37
        • Fernandez E.
        • Krusz J.C.
        • Hall S.
        Parsimonious collection of pain descriptors: Classification and calibration by pain patients.
        J Pain. 2011; 12: 440-450
        • Head H.
        Studies in Neurology.
        Oxford University Press, London, UK1920
        • Henderson L.A.
        • Bandler R.
        • Gandevia S.C.
        • Macefield V.G.
        Distinct forebrain activity patterns during deep versus superficial pain.
        Pain. 2006; 120: 286-296
        • Hu L.
        • Bentler P.M.
        Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives.
        Struct Equ Modeling. 1999; 6: 1-55
        • Lewis T.
        McMillan, London, UK1942
        • Lin C.P.
        • Kupper A.E.
        • Gammaitoni A.R.
        • Galer B.S.
        • Jensen M.P.
        Frequency of chronic pain descriptors: Implications for assessment of pain quality.
        Eur J Pain. 2011; 15: 628-633
        • Melzack R.
        The McGill Pain Questionnaire: Major properties and scoring method.
        Pain. 1975; 1: 277-299
        • Muthén L.K.
        • Muthén B.O.
        Mplus User’s Guide.
        Muthén & Muthén, Los Angeles, CA2010
        • Nash P.G.
        • Macefield V.G.
        • Klineberg I.J.
        • Murray G.M.
        • Henderson L.A.
        Differential activation of the human trigeminal nuclear complex by noxious and non-noxious orofacial stimulation.
        Hum Brain Mapp. 2009; 30: 3772-3782
        • Price D.D.
        Psychological Mechanisms of Pain and Analgesia.
        IASP Press, Seattle, WA1999
        • Teanby S.
        A literature review into pain assessment at triage in accident and emergency departments.
        Accid Emerg Nurs. 2003; 11: 12-17
        • Towery S.
        • Fernandez E.
        Reclassification and rescaling of MPQ verbal descriptors of pain sensation: A replication.
        Clin J Pain. 1996; 12: 270-276