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Pain, 50 (1992) 67-73

 

0

1992 Elsevier

Science Publishers

B.V. All rights reserved

0304-3959/92/$05.00

PAIN 02068

 

67

The Pain Anxiety Symptoms

Scale: development

and validation

 

of a scale

to measure

fear of pain

 
 

Lance

M. McCracken

qb,Claudia

Zayfert

a and Richard

T. Gross

b*c

a De~art#lent

of Psychofogy,

West Virginia

U~~l~ersi~, ~o~a~town,

WV 265~6-#4U

IUSAI,

’ De~~t~ent

of BehaL,j~raf

~edicjne

and ~~chjat~,

 
 

and

c Department

ofAnesthesiology, West Virginia Unioersity Health Sciences Center, Margantown,

WV26506

(USA)

 

(Received

29 July 1991, revision received 30 December

1991, accepted

9 January

1992)

Summary

Fear

of pain

has been

implicated

in the

development

and maintenance

of chronic

pain behavior.

Consistent

with conceptualizations

of anxiety

as occurring

within

three

response

modes,

this paper

introduces

an

instrument

to measure

fear of pain across cognitive,

overt behavioral,

and physiological

domains.

The Pain Anxiety

Symptoms

Scale (PASS) was administered

to 104 consecutive

referrals

to a multidisciplinary

pain clinic. The

alpha

coefficients

were

0.94 for

the

total

scale and ranged

from

0.81

to

0.89 for

the

subscales.

Validity

was supported

by

significant

emotional

correlations

with

measures

of anxiety

and

distress

and pain showed

that

the PASS made

disability.

Regression

analyses

a significant

and unique

controlling

measures to the prediction

for

contribution

of

of

disability

due

to pain.

Evidence

presented

here

supports

the potential

utility

of the

PASS

in the

continued

and interference study of fear

of pain and its contribution

to the development

and maintenance

of pain behaviors.

Factor

analysis and behavioral

validation

studies

are in progress.

 

Key words:

Chronic

pain;

Pain behavior;

Fear

of pain; Anxiety;

Disability;

Pain assessment

 

introduction

 

tissue damage

decreases

or remits.

They

attribute

this

 

persistence

of

pain

 

indicators

to

the

emotional

re-

Medical

professionals

are

often

frustrated

by

the

sponse to pain. According

to their model,

as with other

intractable

nature

of

chronic

pain.

This

frustration

fears,

avoidance

associated

with fear

of pain

leads

to

results

from

the

frequent

 

failure

of medical

treatment

greater

fear

and

to

increasingly

limited

activity.

As

and the persistence

of pain,

suffering,

and disability

in

tissue

injury

remits

and

fear

remains,

pain

behaviors

the absence

of

organic

pathology

(Wall

1979).

Re-

are

no longer

elicited

by an internal

sensory

stimulus

cently, Lethem

et al. (1983) proposed

an explanation

of

but

rather

become largely avoidance

responses

main-

or persistent

pain

behavior

based

on fear

tained

by subsequent

reduction

of emotionai

distress.

exaggerated of pain. They

pointed

out that behaviora

indicators

of

Recent

data

support

the

analogy

between

pain be-

pain can become desynchronous with the organic/

haviors

and fear

behaviors.

For

example,

Phillips

and

sensory component

 

of

pain.

In

other

words,

verbal

Jahanshahi

(1985) demonstrated

that when chronic

pain

complaints

of pain,

reduced

activity,

and other

observ-

patients

were exposed

to an aversive stimulus,

avoid-

able

expressions

of

pain

can increase,

decrease,

or

ance

led

to increased

sensitivity

to

the

pain stimulus

remain

stable

independent

 

of changes

in tissue

dam-

and increased

avoidance

on subsequent

trials.

Phillips

age.

Specifically,

Lethem

et

al. (1983)

addressed

the

(1987) suggested

that

avoidance

in chronic

pain suffer-

problem

of behavioral

indicators

of pain that persist

as

ers

may

be

related

to

beliefs

and memories

of

the

 

sufferer

which lead to expectations

that

pain

wiI1 in-

crease

following

exposure

to .pain-related

stimuli.

If

 

Correspondence

to:

Richard

T.

Gross,

Ph.D.,

Department

of

this model

is correct,

processes

which explain

the mod-

Behavioral Medicine and Psychiatry, West Virginia University Health

ification

of fear and anxiety,

such as habituation,

sensi-

Sciences Center, Morgantown, WV 26506 (USA)

 

tization,

and disconfirmation

may also be applicable

to

68

understanding

changes in pain behavior

as well (Phil-

vote

little

or

no

attention

to overt behavioral

and

lips 1987).

physiological

responses

to pain which

are of particular

In a related area, several researchers

have chosen

to

interest in the study of anxiety states.

examine

the relationship

between

anxiety

and

pain.

 

This

paper

describes

the

development

of

a self-re-

Studies

 

of induced

anxiety

on responses

port

instrument,

the

Pain

Anxiety

Symptoms

Scale

to

acute

of the effects laboratory

pain

stimuli

suggest

that

anxiety

(PASS), to measure

fear

of

pain.

This

measure

is

related

to

pain

increases

ratings

of

perceived

pain

intended

to provide

a means of evaluating

the

impor-

intensity

(Weisenberg

et

al.

1984; Cornwall

and

Don-

tance

of fear

of pain in exaggerated

or persistent

pain

deri 1988; Al Absi and Rokke 19911 while anxiety

behaviors.

As a research

tool,

it may prove

useful

for

unrelated

to pain increases

pain tolerance

(Bobey

and

classifying

pain

patients

with respect

to

their

level of

Davidson

19’70) and decreases

galvanic

skin responses

pain-related

anxiety.

This

information

will,

in

turn,

to pain (Weisenberg

et al. 1984). Results

of Arntz

et

al.

allow

examination

of

how

anxiety

responses

interact

(19911 suggest

that

attention

to

pain increases

the

with other

factors

 

to enhance

the experience

of pain.

impact

of pain

and

that

anxiety

about pain directs

Furthermore,

it may facilitate development

of individu-

attention

to pain. Researchers

have afso suggested

that

ahzed

treatment

inte~entions

based

on

the

degree

to

pain-related

anxiety

may influence

the

emotional

re-

which

fear

is

a

in an individual’s

pain

sponse

to pain (Cornwall

and Donderi

1988) and thus

experience.

Thus,

component as we gain

a better

understanding

of

may increase

what

Fordyce

(1976) refers

to

as

the

the

role of anxiety

in clinical pain, this instrument

may

suffering component of the pain experience.

 

have important clinical utility as well.

 
 

Recognizing the importance

of emotional

and cogni-

 

This

instrument

also

contribute

to available

tive

responses

to

pain

in determining

the

extent

of

measures

may of pain behavior

by broadening

the scope

of

suffering

experienced

by pain patients,

researchers

have

assessment

to

include

physiological

and

motoric

re-

developed

a variety

of measures

to

assess these

re-

sponse

domains.

Consistent

with

the

Three-Systems

sponses

indirectly.

Thus,

self-report

measures

of

pa-

Model

of fear (Lang

1968; Hugdahl

19811, this instru-

tient

behavior

in response

to pain

evaluate

subjective

ment

assesses

fear

of

pain

behaviors

in

3 response

aspects

of the pain experience

such as negative

cogni-

modalities:

cognitive,

physiologic

and

motoric.

Thus,

tions

(Cognitive

Error Questionnaire,

Lefebvre

1981;

patients

are asked

 

to respond

to items which describe

Inventory

of Negative

Thoughts

 

in Response

to Pain,

(a> fearful

thoughts

and

ruminations

about

the

conse-

Gil

et

al.

19901, adaptive

and

maladaptive

thoughts

quences

of their

pain,

(b) physiological

symptoms

of

(Pain

Cognitions

Questionnaire,

 

Boston

et

al

19901

fear

associated

with

the

experience

of

pain,

and

(c>

positive

and

negative

cognitive

and

overt

behavioral

avoidance

and

escape

of activities

which they

believe

pain

coping

strategies

(Coping

Strategies

Question-

may increase

pain. Such a tri-modal

assessment

of fear

naire

(CSQ),

Rosenstiel

and

Keefe

19831, and beliefs

of pain will facilitate

its study within the current

frame-

and

attitudes

associated

with

functional

impairment

work

employed

in

the

study

of anxiety

disorders.

For

(Pain

and

Impairment

Relationship

Scale,

Riley

et

al.

exampie.

it has been shown that individuals

who report

1988; Slater

et al. 1991). While

these

are clearly impor-

specific

fears

(i.e., phobias)

often

show discordance

or

tant dimensions

to assess, they do not yield information

desynchrony

of response modalities

in

the

expression

which

directly

pertains

 

to pain-related

anxiety

and

of their

fears (Hodgson

and Rachman

1974; Rachman

which

would

further

our understanding

of

its

role

in

and

Hodgson

1974). Similarly,

fear

of

pain

may

be

the chronic pain experience.

 

expressed

disproportionately

among

the

3

response

 

There has been one

attempt

to assess fear responses

channels,

and behaviors

of

these

separate

channels

pain

patients.

This was a 6-item

Fear

may respond

differently

to inte~entions.

If, like

other

to pain in chronic Self-Statements

subscale included

in an expanded

ver-

phobias,

fear

of pain exhibits

individual

differences

in

sion of the

CSQ

(Gil

et

al.

19891. In

their

study

of

the

dominant

response channel,

the

information

patients

 

with

pain

from

sickle

cell disease,

Gil

et

al.

gleaned

from a multimodal

assessment

may have

im-

(1989) found

that

high scores

on

a negative

thinking

portant

implications for treatment

of

chronic

pain

and

passive

adherence

coping factor

(which included

problems.

 

the

Fear

Self-Statements

subscale)

predicted

greater

 

severity

of

painful

episodes,

lower

Ievels

of

activity,

more

psychological

distress,

and more

frequent

health

Method

 

care utiiization. The numerous self-report

measures discussed above.

including

the CSQ Fear Self-Statements

subscale

 

of

Subjects

     

The

subjects

were

104 outpatients

(48

males,

56

females)

evaiu-

Gil

et

al. (19891, focus

of

the

on

~ognitions

includes

only.

With

behavioral

the

ated

consecutively

at

a

multidiscipljna~

pain

management

center.

exception

CSQ, which

pain

Mean

age

of

the

sample

was

45.0

years

(SD.

=

13.4).

Seventy-five

coping

responses,

these

 

commonly

used

measures

de-

percent

of

the

patients

were

married,

12%

single,

9%

divorced.

and

69

4% widowed. Mean years of education

was

12.0 (SD.

= 2.3).

The

Patients

were

instructed

62 behaviors

total

score

to

rate

the

frequency

of occurrence

of

majority of patients

presented

with back pain (69%), but

the sample

each of the

on

a 6-point

scale

from

0 ‘never’

to

5

also included

patients

with

extremity,

facial/head,

and

torso

pain

‘always’. The

was

computed

by reversing

11 negatively

complaints.

Pain

complaints

were chronic

in nature.

All

patients

keyed

items

and

summing

the

ratings

across

the

entire

measure.

reported

pain that persisted despite multiple medical interventions.

Subscale scores were computed

by totaling

responses

to items desig-

The mean duration

of pain

was 63.1 months

(SD.

= 105.8). Forty

nated for each subscale.

 

percent

of patients

had

undergone

at least

1 pain-related

surgery,

Beck

Depression Incwntory (BDI).

The

BDI (Beck

et

al.

1961) is a

and 52% were

taking narcotic

analgesics on a regular basis.

21-item, self-report measure of depression.

It assesses

common cog-

The

PASS was administered

as

part

of a comprehensive pain

nitive and vegetative symptoms of depression.

More than

25 years of

assessment procedure.

Patients

completed

the

PASS and other

stan-

research evaluating the psychometric properties of the BDI has

dardized

inventories

at home

several weeks prior to their

scheduled

indicated

that

it

has

excellent

reliability

and

validity

(Beck

et

al.

appointment

in

the

pain

management

center. The standardized

1988).

inventories

included commonly employed measures of depression,

 

Cognirive Somatic

Anxiety

Questionnaire

(C&IQ).

Symptoms

of

anxiety, pain, and disability and are described below.

anxiety were assessed with the CSAQ (Schwartz et al. 1978). The CSAQ consists of a list of 14 symptoms of anxiety, including both cognitive and somatic aspects. Respondents are asked to rate the degree to which they experience each of these symptoms when they

Measures

 

are

anxious.

Factor

analyses

of

the

CSAQ

have identified

distinct

PASS. The

initial scale consisted

of 62 rationally

derived

items

 

somatic and cognitive factors (Steptoe

and Kearsley

1990). The scale

generated to assess fear of pain in each of the 3 response modes.

yields separate

scores

for each

of these

aspects.

Items were modeled

after items of commonly

used anxiety measures

Coping Strategies Questionnaire

(CSQ).

The CSQ (Rosenstiel

and

and the criterion

for

item inclusion was a logical rather

than empiri-

Keefe 1983) is a 42-item questionnaire

which assesses

self-reported

cal relationship

with

the fear of pain construct.

Item content

repre-

use

of 7 different

cognitive

and behavioral

pain coping strategies.

sented

anxiety symptoms

frequently

described

in

the

anxiety disor-

Only the Catastrophizing

subscale was calculated for this study. This

ders

literature

and

patients’

descriptions

of their

fears

related

to

‘6-item scale assesses

negative thinking

in response

to pain.

 

pain.

McCiN Pain

Questionnaire

(MPQ).

The

MPQ

(Melzack

1975)

Items were

developed

for inclusion

 

in 4 subscales.

The

1st sub-

 

consists of 20 subclasses of 78 adjectives divided among 4 dimen-

scale, Fear of Pain (19 items), was intended to measure fearful

sions: sensory,

is to

affective,

evaluative,

and miscellaneous.

The purpose

thoughts

related

to

the

experience

of pain

or anticipated

negative

of the MPQ

provide

quantitative indices of the subjective pain

consequences

of pain.

The 2nd subscale,

Cognitive

Anxiety

(10

experience. It has become

the most widely used measure of pain and

items),

was designed

to assess cognitive symptoms

related

to

the

has demonstrated

acceptable reliability and face, construct, discrimi-

experience

of pain,

such

as racing thoughts

or impaired

concentra-

nant, and concurrent validity (Reading 1983). The MPQ yields sev-

tion. The

3rd subscale,

Somatic

Anxiety (16 items),

assessed

symp-

eral variables including scores for each of the separate dimensions

toms

reflecting

physiological

arousal

related

to

the

experience

of

and

a total score.

pain.

Escape

and Avoidance

(17 items),

assessed

Mu~tidimensionnl Pain Inventory

(MPI).

The

MPI (formerly

the

overt

The 4th subscale, behavioral responses

to pain.

Table

 

I shows sample

items for

 

WHYMPI,

Kerns

et

al.

1985) is a brief, comprehensive

measure

of

each of these subscales.

 

important

aspects

of the subjective experience

of chronic

pain based

TABLE

I

 

SAMPLE

ITEMS FROM

THE PAIN ANXIETY

SYMPTOMS

SCALE (PASS)

 

Subscale

 

Item content

 

Somatic anxiety

I

become

sweaty when in pain.

 
 

Pain seems to cause my heart

to pound

or race.

When

I sense

pain,

I feel

dizzy or faint.

I

have pressure

or tightness

in my chest when in pain.

 

I

can stay relaxed when I hurt.

 

Cognitive Anxiety

 

I

feel disoriented

and confused

when I hurt.

 
 

When I hurt, I think about the pain constantly.

I

am bothered

by unwanted

thoughts when I’m in pain.

My thoughts are agitated and keyed up as pain approaches.

 

During painful episodes it is difficult for me to

think of anything besides

the pain.

I

worry when

I am in pain.

Fear

I

think that pain is a signal that means I am damaging myself.

 

I

dread feeling pain.

 

When pain comes on strong,

I think that

I might become

paralyzed

or totally disabled.

I

am afraid that I will have more pain if I am not careful.

 

I

think that

if my pain gets too severe, it will never decrease.

Escape/Avoidance

 

When

I feel

pain

I try to stay as still as possible.

 
 

I

try to avoid activities which cause pain.

 

As soon as pain comes

on I take medication

to reduce

it.

I

seek reassurance

that

I am OK during

times of more severe pain.

 

I

go immediately

to bed when

I feel severe pain.

 

Note: subjects

respond

to each item by selecting

a frequency

rating

from

0 ‘never’

to 5 ‘always’.

 

70

TABLE

II

SUMMARY

STATISTICS

FOR

PASS

SUBSCALES

AND

 

TOTAL

Subscale

 

No.

of items

 

Item

means

S.D.

Somatic

14

1.73

1.12

Cognitive

 

10

2.56

1.10

Fear

14

2.21

1.04

Est./Avoid

 

15

2.54

0.92

Total

53

2.24

0.88

All

correlations

significant

at

P

< 0.001.

N

=

104

on

the

cognitive-behavioral

 

perspective

 

of

chronic

pain.

 

The

52

items

of

the

MPI

divide

into

3 major

parts,

each

containing

several

subscales.

The

inventory

examines

the

impact

of pain

on

the

patient’s

life,

responses

of

significant

others

to

the

patient’s

pain

behaviors,

and

level of participation

in typical

daily

activities.

Research

 

with

the

MPI

suggests

that

it

has

achieved

adequate

 

reliability,

validity,

and

clinical

utility

(Kerns

et

al.

1985).

 

Pain Disability Index (PDI).

The

PDI

(Pollard

19841

is

a

7-item,

self-report

 

measure

which

assesses

patients’

perceived

level

of

dis-

ability

in

7

life

areas.

The

PDI

yields

a

total

score,

as

well

as factor

scores

for pain-related

disability

in discretionary

and

obligatory

activ-

ities.

Recent

research

 

has

supported

the

factor

structure,

 

validity,

and

retest

 

reliability

of

the

PDI

(Tait

et

al.

19901

and

its construct

validity

(Jerome

and

Gross

1991).

 

Spielberger Truit Anxiety Scale (STAI-T). The STAI-T (Spiel-

berger

et

al.

1970)

is

a

20-item

inventory

 

which

assesses

individuals’

predisposition

to judge

situations

 

as dangerous

or threatening

 

and

to

respond

with increased

levels

of

state

anxiety.

The

scale

is widely

used

and

has

been

found

to

have

high

internal

consistency

as well

as

high

retest

reliability

 

and

expected

correlations

with

personality

based

measures

of anxiety

such

as

the

Taylor

Manifest

Anxiety

Scale.

TABLE

III

CORRELATIONS

 

OF

PASS

SUBSCALES

AND

TOTAL

SCORES

DISABILITY

 
 

PASS

scores

Somatic

 

Cognitive

CSAQ

Cognitive

 

0.49

**

0.61

**

Somatic

 

0.74

**

0.55

* *

McGill

Sensory

 

0.45

**

0.26

*

Affective

 

0.51

**

0.33

**

STAI-T

0.52

**

0.67

**

MPI

Pain

severity

 

0.35

**

0.25

*

Interference

 

0.28

*

0.33

**

CSQ

Catastrophizing

 

0.67

**

0.67

**

BDI

0.51

**

0.67

**

PDI

0.39

**

0.39

**

Tranquilizer/anxiolytic

 

use

0.25

*

0.27

*

Note:

*

P <

0.01,

* *

P < 0.001.

All

probability

values

are

l-tailed.

SCALE

 

SCORES

Alpha

Intercorrelations

I

2

3

4

0.89

0.87

0.68

0.85

0.64

0.70

0.8 I

0.48

0.5 I

0.45

 

0.94

0.85

0.86

0.85

 

0.74

Results

 

Scale development

and psychometrics

 
 

Preliminary

analyses

included

examination

of

fre-

quency

distributions

for item

responses

and corrected

item-scale

correlations

(correlations

of items with their

respective

scale

 

scores

computed

with the

item

omit-

ted).

Based

on these

analyses,

1 item was eliminated

because

of

a highly

skewed

distribution

and

7 items

were

eliminated

 

because

they

correlated

more

highly

with a subscale

other

than

the one

for which they were

written.

In

these

cases,

examination

of item

content

indicated

that

these

items were

not conceptually

simi-

lar

to

the

other

subscales.

A final item was eliminated

from

further

analyses

because

it was

not

significantly

correlated

(at

P

<

0.05)

with

any

of

the

PASS sub-

scales. The

submitted

to further

analy-

ses consisted

final inventory of 53 items,

14 assessing somatic

anxiety,

WITH

MEASURES

OF

PAIN,

ANXIETY,

DEPRESSION

AND

Fear

Est./Avoid

 

Total

0.53

**

0.25

0.54

**

0.56

* *

0.17

0.61

**

0.20

0. I6

0.31

**

0.36

**

0.31

**

0.44

**

0.53

**

0.29

*

0.60

* *

0.28

*

0.18

0.32

* *

0.31

**

0.36

**

0.39

**

0.66

* *

0.42

**

0.73

**

0.50

**

0.30

**

0.57

**

0.40

**

0.30

* *

0.45

**

0.19

0.16

0.29

*

71

10 assessing cognitive

anxiety,

14 assessing fear,

and

15

spective

somatic and cognitive

factors

of

the

CSAQ.

assessing escape and avoidance responses.

 

Significance

tests for differences

between

correlated

TS

Table

II includes

summary

statistics

for

the

4

sub-

confirmed

the statistical

 

significance

of these

results

in

scales

and the

total

scale score.

Cronbach’s

coefficient

 

comparisons

of the correlations

of the PASS Cognitive

alpha was computed

for each scale demonstrating

 

ade-

Anxiety

and Somatic

Anxiety

subscales with the CSAQ

quate internal

consistency

(see

Table

II).

Scale

inter-

 

cognitive

factor

(t

(101) = 1.92;

P < 0.05)

and

the cor-

correlations

indicate

that the subscales

significantly

relations

of

these

PASS subscales with the CSAQ

intercorrelate.

Squaring

the

interscale

correlations

 

re-

somatic

factor

(t

(101) = 7.61;

P < 0.001).

 

veals that overlapping

variance

ranges

from

 

0.20

to

All

PASS

variables

 

demonstrated

higher correla-

0.45, indicating

that

each

scale

provides

unique infor-

tions

with

the

affective

dimension

of

the

MPQ

than

mation.

with the

sensory

dimension.

Finally,

the

trait

form

of

the

STAI,

the

pain severity

scale

of the

MPI,

and the

Construct

validity

 

catastrophizing

 

scale

of

the

CSQ

showed

consistent

Construct

validity

represents

the

extent

to which

a

significant

correlations

with

PASS

subscales,

demon-

to measure

a theoretical

construct

strating

predictable

overlap

between

these

concepts

test is demonstrated non-operationalized

or

evidence

for

construct

variable.

validity

way is to examine

One

to

provide

the corre-

and

III).

the

behaviors

assessed

on

the

PASS

(see

Table

lations

of

a measure

with

theoretically

related

mea-

 

sures. To assess the construct

validity

of the

PASS, the

 

Concurrent

validity

 

relationships

between

the

various

PASS

scores

and

While

construct

validity

involves theoretical

consid-

measures

of

anxiety,

pain,

and

maladaptive

coping

 

erations,

it also is important

to demonstrate

the practi-

responses to pain were assessed with Pearson

cal

or

criterion-related

 

validity

of

a measure.

In

the

product-moment

correlations

(see Table

III). The

va-

case

of

the

PASS,

criterion-related

validity

can

be

lidity of the somatic

and cognitive

anxiety scales of the

 

assessed

by examining

correlations

of

the

PASS

sub-

PASS is supported

by higher

correlations

between

 

re-

scales

with

patient

outcome

variables

that

it

should

TABLE

IV

RESULTS

OF

HIERARCHICAL

REGRESSION

ANALYSES

 

EMPLOYING

COMMON

MEASURE

 

OF

PAIN

AND

PSYCHOLOGICAL

 

DISTRESS

IN ADDITION

TO

THE

PASS

TOTAL

SCORE

AS

PREDICTORS

 

OF

SELF-RATED

 

DISABILITY

(PDI),

AND

INTERFER-

ENCE

DUE

TO

PAIN

(MPI)

Dependent

variable

 

R2

Beta

St.2

Fchange

 

Probability

Step

Interference

Equation

1

BDI

  • 0.23 0.096

0.38

 

27.43

 

0.0000

PASS

  • 0.24 0.019

0.17

 

2.36

0.12

Equation

2

STAI-T

 
  • 0.11 0.018

0.17

 

11.54

 

0.001

PASS

  • 0.17 0.052

0.28

 

5.46

0.02

Equation

3

MPQ

sensory

 

0.008

-

0.030

0.0008

 

0.82

0.37

PASS

  • 0.15 0.14

0.39

 

15.39

 

0.0002

Equation

4

Pain

severity

 
  • 0.18 0.10

0.33

 

20.47

 

0.0000

PASS

  • 0.25 0.070

0.28

 

8.76

0.004

Disability

Equation

1

BDI

  • 0.18 0.035

0.23

 

19.32

 

0.0000

PASS

  • 0.24 0.068

0.32

 

8.41

0.005

Equation

2

STAI-T

 
  • 0.12 0.008

0.11

 

11.70

 

0.0009

PASS

  • 0.21 0.094

0.38

10.44

 

0.002

Equation

3

MPQ

sensory

 
  • 0.03 0.0015

0.04

 

3.03

0.085

PASS

  • 0.20 0.17

0.44

 

20.39

 

0.0000

Equation

4

Pain

severity

 

0.40

  • 0.25 0.14

 

31.51

 

0.0000

PASS

  • 0.34 0.095

0.32

13.60

0.0004

72

predict.

When

criterion-related

validity

is evaluated

by

struct

validity

of these

PASS

subscales.

All subscales

correlating

measures

administered

at one point

in time,

and

the

total

PASS

score

showed

higher

correlations

this type

of validity

is referred

to

as concurrent.

Con-

with the MPQ affective

dimension

 

than

with the MPQ

current

validity

 

for

the

PASS was assessed

by examin-

sensory

dimension,

indicating

that

fear

related

to pain

ing

the

relationships

between

the

PASS

scores

and

is

not

simply a function

of

the

sensory

experience

of

common

measures

of disability and depression.

Corre-

pain.

 

lational

analyses

indicated

that

PASS scores

related

 

The

results

also confirm

the concurrent

validity

of

significantly

to scores from the interference

scale of the

the PASS in relation

to measures

of disability, depres-

MPI, scores

from

the BDI,

and self-rated

disability

as

sion, and medication

use, all pervasive consequences

of

measured

by the

PDI.

In addition,

point biserial

corre-

chronic

pain. Correlation

analyses revealed

that

pain-

lations

between

PASS scores

and a dichotomous

vari-

related

fear and anxiety, as measured

 

by the

PASS, are

able

representing

use of tranquilizing

or

anxiolytic

significant

predictors

of disability and interference

with

medications

indicated

that

the

Somatic

and Cognitive

daily

activities

due

to pain.

Regression

analyses

con-

Anxiety

subscales

as well

as

the

total

score were

posi-

trolling

for measures

of pain and psychological

distress

tively related

to

use

of these

medications

(see Table

revealed

that,

with one exception,

the

PASS

made

a

III).

significant

unique

contribution

to

the

prediction

of

 

Next,

a

series

of

hierarchical

multiple regression

disability.

The

PASS

was

a much

better

predictor

of

analyses

were

performed.

 

These

assessed

the

signifi-

disability and interference

than the Sensory

subscale of

cance

of

the

unique

increment

in variance