Exploring the cognitive processes of both Arabic and English-speaking patients when completing the brief pain inventory: A qualitative study

BackgroundBrief Pain Inventory (BPI) is one of the most commonly used self-initiated questionnaire for people with chronic pain. Although the questionnaire has been translated into multiple different languages and tested for its inter-tester reliability, no study has currently explored the differences in interpretation of this questionnaire between non-English speakers as compared to English-speakers.PurposeUsing the Arabic-language group as the comparator, this study explored the interpretation of the English and Arabic language Brief Pain Inventory (BPI) among participants living with chronic neuromusculoskeletal pain from Arabic- and English-speaking backgrounds.MethodsThis qualitative study utilises the Think Aloud method to explore the differences in the interpretation of the BPI between two language groups. Consecutive consenting adults attending a tertiary pain clinic for management of a chronic neuromusculoskeletal pain condition and self-identifying with a native English-speaking (n = 15) or Arabic-speaking (n = 15) background were included. Structured interviews using the think-aloud method were conducted, audio-recorded and analysed using coding and thematic analysis.ResultsInterpretation errors across three or more questions were recorded for all Arabic-speaking participants and two English-speaking participants. Three themes characterised appraisals of pain and interpretation of the BPI across the two cohorts: 1) pain constancy vs. variability, 2) the ability-disability spectrum and 3) variance in expression of pain.ConclusionCross-cultural differences in the appraisal of pain influenced participants' interpretation of the BPI. The cultural influences on conceptualisation of pain need to be considered when using the BPI across different cultures.