The original version of the Brief Pain Inventory (BPI) was translated into a Malay version by the standard procedure and was then evaluated for its psychometric properties. Of 119 eligible patients, a total of 113 (95%) agreed to participate in this study. Ages ranged from 18 to 76 years and interviews were conducted between August, 2004 and November, 2004. The pain intensity items demonstrated high loading with one factor, whereas the pain interference items were loaded on another factor. Two factors explained 62% of the variance. Compared to the Karnofsky Performance Scale, the pain intensity scales had a moderate negative (Pearson's) correlation (-0.520, P < 0.001) and the pain interference scales had a high negative correlation (-0.732, P < 0.001), showing good concurrent validity. The coefficient alpha of both subscales demonstrated good internal consistency of the items. The intraclass correlation coefficient for the test-retest stability was 0.61 for the pain intensity scale and 0.88 for the pain interference scale. The Malay version of the BPI is a reliable and valid instrument for cancer pain assessment and is comparable with the original version of the BPI in terms of structure and psychometric properties.
This article illustrates a case of persistent trigeminal neuralgia in a medically compromised 65-year-old female who did not respond to pharmacotherapy. She had undergone several peripheral neurectomies as well as a failed right posterior fossa exploration that resulted in a cerebrospinal fluid leak. Persistent pain over the right external nasal area and right mental region was relieved for several hours after daily injections of bupivacaine. A trial of a single dose of 100 units of botulinum toxin type A (BOTOX) diluted in 2.5 mL saline was injected into the external nasal trigger zone (60 units) and to the mental nerve region (40 units). She achieved complete pain relief in the external nasal region for 5 months. Pain recurred and the site was again injected with 100 units of botulinum toxin type A (BOTOX). Pain relief at the mental region was partial. This was finally controlled with peripheral neurectomy. The patient was pain free with a maintenance dose of 200 mg carbamazepine daily for about 1 year, after which she elected to undergo stereotactic gamma knife radiosurgery when pain recurred at the external nasal region.