ORIGINAL RESEARCH article
Front. Pain Res.
Sec. Abdominal and Pelvic Pain
Minimally Important Difference and Responsiveness to Change for Numerical Rating Scale of Menstrual Pain Severity: A Psychometric Study
Provisionally accepted
- 1The University of Arizona College of Nursing, Tucson, United States
- 2The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, United States
- 3Indiana University School of Medicine, Indianapolis, United States
- 4Regenstrief Institute Inc, Indianapolis, United States
- 5VA Center for Health Information and Communication, Indianapolis, United States
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Background: Menstrual pain affects 45%-95% of reproductive-age females and increases the risk of other chronic pain conditions. Psychometrically sound measurement tools are essential for advancing research and clinical care in menstrual pain. Numerical rating scales (NRS) are widely used to measure pain severity. However, the minimally important difference (MID) and responsiveness to change of the NRS in the context of menstrual pain are not well understood. Understanding MID and responsiveness to change helps guide the evaluation of treatment efficacy and clinical decision-making. This study evaluated the MID and responsiveness to change in the NRS, ranging from 0 to 10, for menstrual pain severity. Methods: Participants who were menstruating (aged 14-42, N=100) completed two surveys 24 hours apart. In both surveys, we measured menstrual pain severity (worst, least, average menstrual pain in the past 24 hours, and current menstrual pain) on a 0 (no pain) to 10 (extremely severe) NRS. MIDs were estimated using distribution-based approaches (standard error of measurement and effect size) and anchor-based approaches (using symptom interference and retrospective recall of change as anchors). Responsiveness to change was evaluated using standard response means and area-under-the-curve analysis. Results: The MID estimates were close to 1 point. The NRS of menstrual pain severity was responsive to menstrual pain improvement (standard response means ranged from 0.44 to 0.61, p<0.001 for between-group comparisons). Area-under-the-curve estimates ranged from 0.66 to 0.70. Conclusions: The findings can inform the design and
Keywords: Dysmenorrhea, Pelvic Pain, Psychometrics, Patient reported outcome measures, minimally important clinical difference
Received: 27 Jun 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Chen, Wu, Lee, Park, Ahn, Lin and Kroenke. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chen X. Chen, cxchen@arizona.edu
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