The assessment of cancer pain in north India: the validation of the Hindi Brief Pain Inventory--BPI-H

Abstract

The status of pain treatment for cancer patients in India is largely undocumented. Although many languages and dialects are spoken throughout the country, millions of persons in North India speak Hindi. This project developed and validated a Hindi version of the Brief Pain Inventory (BPI-H), a short measure of pain and pain interference that has been shown to be relatively free of cultural or linguistic influences. In the validation process, we were able to administer both the Hindi and English versions of the BPI to a sample of bilingual (Hindi and English) patients. The English and Hindi versions of the BPI were very similar in their psychometric properties, supporting the reliability and construct validity of the Hindi version. As with other language versions of the BPI, factor analysis of the BPI-H items results in severity and interference subscales. We followed the validation with an examination of the status of cancer pain management in a major northern Indian cancer center, based on 200 patients with pain who spoke only Hindi. Using a conservative measure of analgesic prescription adequacy (the Pain Management Index), three-fourths of Hindi-speaking cancer patients in this study were inadequately treated by World Health Organization (WHO) recommendations. The results of this study encourage the development of other forms of the BPI in the many languages of India, and the use of the instrument in studies of the epidemiology and treatment of cancer pain.