Fear Of Pain Questionnaire-III Research Articles

The Effect of Childhood Pain Experiences of Nursing Students on Fear of Pain in Adulthood

Fear of pain develops from negative interpretations and thinking that pain is equivalent to causing harm. The aim of this study is to determine the effect of childhood pain experiences of nursing students' on pain fear in adulthood. The research is descriptive and cross-sectional and its sample consisted of 176 nursing students at a state university An information form prepared by the researchers in line with the literature and the Fear of Pain Questionnaire-III were used to collect the data. When the pain experienced in the same medical procedures in childhood was compared with the pain they experienced at their current age, it was determined that 65.9% of the students experienced less pain now. The total score of the students on the Fear of Pain Questionnaire was 80.57±19.77. It has been determined that the painful experiences of students in childhood affect the fear of pain in adulthood (p

The Relationship Between Emotional Intelligence and Fear of Pain in Patients Undergoing Elective Surgery

This study aimed to investigate the effect of emotional intelligence levels on the fear of pain for patients undergoing surgical intervention. This descriptive and cross-sectional study consisted of 254 patients. Data were collected using the Personal Characteristics Information Form, Modified Schutte Emotional Intelligence Scale, Fear of Pain Questionnaire-III, and Numerical Pain Form. A correlational analysis was performed. The mean age of patients was 47.33±17.70 years, and 57.9% (n=147) were female. More than half of the patients (n=174) were experiencing a certain degree of preoperative pain. A positive and statistically significant correlation was observed between the mean scores of the Fear of Pain Questionnaire-III and the Emotional Intelligence Scale. Female patients had significantly more fear of pain and higher scores in the Fear of Pain Questionnaire-III (optimism/mood regulation, utilization of emotions) and the Emotional Intelligence Scale. The patients who manage "optimism/mood regulation" and have increasing levels of Emotional Intelligence could have a relatively higher fear of experiencing severe pain in the preoperative period. Despite the fear of experiencing severe pain, the patients tried to turn this negative situation into a positive one, as the dimensions of their emotional intelligence that provide and manage optimism/mood regulation were at a high level. The increasing level of Emotional Intelligence and "appraisal of emotions" might result in a decrease in the levels of fear of "minor pain" and "medical pain".

Psychometric evaluation of the Japanese version of the fear of pain questionnaire-III and its association with dental anxiety: a cross-sectional study

BackgroundFear of pain is a significant concern related to chronic pain and its impact on daily functioning. It is also associated with dental anxiety, highlighting its relevance in dental practice. This study aimed to validate the Japanese version of the Fear of Pain Questionnaire-III (FPQ-III) and explore its relationship with dental anxiety.Methods400 participants completed the Japanese version of the FPQ-III, with 100 participants re-evaluated after one month. Convergent validity was tested against dental anxiety and pain catastrophizing, while discriminant validity was assessed by examining general anxiety and depression correlations. Confirmatory factor analysis was used to examine the factorial validity of the FPQ-III and a shortened version of the FPQ-III (FPQ-9). Item response theory was applied for each subscale to estimate the discriminative power of each item and draw a test information curve. Structural equation modeling (SEM) was used to investigate the relationship between fear of pain and dental anxiety.ResultsData from 400 participants (200 women, 44.9 ± 14.5 years) were analyzed. The FPQ-III showed good internal validity, intra-examiner reliability, discriminant validity, and convergent validity. Confirmatory factor analysis results supported a three-factor structure, and the FPQ-9 showed a good fit. Test information curves demonstrated that the FPQ-9 maintained high accuracy over a similarly wide range as the FPQ-III. SEM revealed that fear of minor pain was associated with dental anxiety via fear of medical pain even in individuals without painful medical or dental experiences (indirect effect 0.48 [95% CI: 0.32–0.81]). Fear of severe pain tended to be higher in individuals with chronic pain compared to those without (latent mean values 0 vs. 0.27, p = 0.002) and was also associated with dental anxiety via fear of medical pain in women (indirect effect 0.15 [95% CI: 0.01–0.34]).ConclusionThe Japanese version of the FPQ-9 demonstrated high reliability and validity, making it a valuable tool in dental clinical and research settings. It provides insights into the fear of pain among individuals with chronic pain and dental anxiety, informing potential intervention strategies.

Electrophysiological markers for anticipatory processing of nocebo-augmented pain.

Nocebo effects on pain are widely thought to be driven by negative expectations. This suggests that anticipatory processing, or some other form of top-down cognitive activity prior to the experience of pain, takes place to form sensory-augmenting expectations. However, little is known about the neural markers of anticipatory processing for nocebo effects. In this event-related potential study on healthy participants (n = 42), we tested whether anticipatory processing for classically conditioned nocebo-augmented pain differed from pain without nocebo augmentation using stimulus preceding negativity (SPN), and Granger Causality (GC). SPN is a slow-wave ERP component thought to measure top-down processing, and GC is a multivariate time series analysis used to measure functional connectivity between brain regions. Fear of pain was assessed with the Fear of Pain Questionnaire-III and tested for correlation with SPN and GC metrics. We found evidence that both anticipatory processing measured with SPN and functional connectivity from frontal to temporoparietal brain regions measured with GC were increased for nocebo pain stimuli relative to control pain stimuli. Other GC node pairs did not yield significant effects, and a lag in the timing of nocebo pain stimuli limited interpretation of the results. No correlations with trait fear of pain measured after the conditioning procedure were detected, indicating that while differences in neural activity could be detected between the anticipation of nocebo and control pain trials, they likely were not related to fear. These results highlight the role that top-down processes play in augmenting sensory perception based on negative expectations before sensation occurs.

Acupuncture on GB34 for immediate analgesia and regulating pain-related anxiety for patients with biliary colic: a protocol of randomized controlled trial

BackgroundBiliary colic (BC) is a frequent hepatobiliary disorder encountered in emergency departments. Acupuncture may be effective as an alternative and complementary medicine for BC. Nonetheless, rigorous trials investigating its efficacy are lacking. Therefore, the aim of this study protocol is to determine whether acupuncture provides immediate relief of pain and associated symptoms in BC patients.MethodEighty-six participants who aged from 18 to 60 years with BC will be recruited in the First People's Hospital of Longquanyi District, Chengdu (West China Longquan Hospital Sichuan University). All participants will be allocated into two treatment groups including acupuncture group and sham acupuncture group using a 1:1 ratio. Each group will only receive a single 30-min needle treatment while waiting for their test results after completing the routine examination for BC. The primary outcome of the study is to assess the change in pain intensity after the 30-min acupuncture treatment. The secondary outcomes of the study include the change in pain intensity at various time points, the degree of gastrointestinal symptoms at different time points, the level of anxiety experienced during pain episodes at different time points, the score of Pain Anxiety Symptoms Scale-20 (PASS-20), the score of Fear of Pain Questionnaire-III (FPQ-III), and the score of Pain Catastrophizing Scale (PCS), among others.DiscussionThe results of this research will provide substantial evidence regarding the efficacy of acupuncture in alleviating symptoms associated with BC.Trial registrationClinicalTrials.gov, ChiCTR2300070661. Registered on 19 April 2023.

The Effect of Preoperative Fear of Pain on Postoperative Pain Levels and the Amount of Analgesic Consumption

BackgroundPreoperative fear of pain can increase the surgical stress response along with anxiety, increasing postoperative pain and the amount of analgesia consumption. AimsTo determine the effect of preoperative fear of pain on postoperative pain level and analgesic consumption. DesignA descriptive, cross-sectional design was used. MethodsA total of 532 patients who were scheduled for a variety of surgical procedures in a tertiary hospital were included in the study. Data were collected using Patient Identification Information Form and Fear of Pain Questionnaire-III. Results86.1% of the patients thought that they would experience postoperative pain, and 70% of the patients reported moderate-to-severe postoperative pain. The examination of the postoperative first 24-hour pain levels indicated that there was a significant positive correlation between patients’ pain levels within 0-2 hours and their mean scores on the fear of severe and minor pain sub-dimensions and the total scale and between pain experienced within 3-8 hours and their scores on the fear of severe pain sub-dimension (p <.05). Also, a significant positive correlation was found between patients' mean scores on the total fear of pain scale and the amount of nonopioid (diclofenac sodium) consumption (p <0.05). ConclusionsThe fear of pain increased patients’ postoperative pain levels, and thus the amount of analgesic consumption. Therefore, patients' fear of pain should be determined in the preoperative period, and pain management practices should be initiated in this period. As a matter of fact, effective pain management will positively affect patient outcomes by reducing the amount of analgesic consumption.

A psychometric evaluation of the Italian short version of the Fear of Pain Questionnaire-III: Psychometric properties, measurement invariance across gender, convergent, and discriminant validity.

The Fear of Pain Questionnaire-III (FPQ-III) is a self-assessment instrument developed specifically to measure fear based on various pain stimuli converging on three factors: severe pain, medical pain, and minor pain. It actually remains the most studied and internationally used tool even in its short versions. The aim of this work was to propose a new validation study oriented to confirm the good psychometric properties of a short model of the FPQ-III for the Italian context. A large sample of participants was recruited (n = 1,064) and Exploratory Factor Analysis (EFA) as well as Confirmatory Factor Analysis (CFA) were performed. Measurement invariance of the FPQ-III across gender was also evaluated. In order to examine convergent validity, a further convenient sample (n = 292) was used and variables related to the individual's pain experience, locus of control and coping orientations were assessed. A final discriminant assessment using experimental manipulation through fear eliciting videos was performed. The three factors structure of the 13-item version of the questionnaire was confirmed (χ2 = 148.092, CFI = 0.971, TLI = 0.962, RMSEA = 0.046, RMSEA 90% CI = 0.037-0.056) as well as the measurement invariance across gender. Item internal reliability was satisfactory. The results provided evidence of the good predictive validity of the FPQ-III and the discriminant assessment demonstrated that the instrument is suitable in detecting changes in fear of pain induced by specific situational conditions. The scale in this short version is suitable for quickly and efficiently gathering information about the perceived intensity of such anticipatory fears that might affect even the healthy person dysfunctionally.

Assessment of Pain-Related Fear in Indigenous Australian Populations Using the Fear of Pain Questionnaire-9 (FPQ-9).

In this study, we examined the psychometric properties of the Fear of Pain Questionnaire (FPQ-9) in Indigenous Australian people. FPQ-9, a shorter version of the original Fear of Pain Questionnaire-III, was developed to support the demand for more concise scales with faster administration time in the clinical and research setting. The psychometric properties of FPQ-9 in Indigenous Australian participants (n = 735) were evaluated with network psychometrics, such as dimensionality, model fit, internal consistency and reliability, measurement invariance, and criterion validity. Our findings indicated that the original FPQ-9 three-factor structure had a poor fit and did not adequately capture pain-related fear in Indigenous Australian people. On removal of two cross-loading items, an adapted version Indigenous Australian Fear of Pain Questionnaire-7 (IA-FPQ-7) displayed good fit and construct validity and reliability for assessing fear of pain in a sample of Indigenous Australian people. The IA-FPQ-7 scale could be used to better understand the role and impact of fear of pain in Indigenous Australian people living with chronic pain. This could allow for more tailored and timely interventions for managing pain in Indigenous Australian communities.

Pain fear levels and affecting factors of health students in the university.

Fear of pain, which is defined as verbal, physiological, and behavioral responses against potentially painful situations, refers to extreme fear of pain, painful sensation, and anything that may cause this sensation. This study aimed to determine the pain fear levels of students and factors affecting fear of pain. The study sample consisted of 544 students. To measure the students' pain fear levels, a 12-item questionnaire, developed by the researchers, and 30-item Fear of Pain Questionnaire-III (FPQ-III) was used. Data were analyzed using the SPSS software. Students the severity of pain subscale, 31.9±8.9; mild pain subscale, 23.8±7.5; medical pain subscale, 27.5±9.0; and average total FPQ score, 83.1±22.0 was foud as. Of the students participating in the study, 80% reported that they had previously experienced pain. Of those who experienced pain, 32.9% reported dysmenorrhea, 18.2% reported headache, and 16.6% reported posttraumatic pain. Moreover, 61.0% of the students attempted to relieve their pain by their own means (medicine, herbal medicine, hot-cold application, etc.), while 70.6% stated that they do not frequently use painkillers. It is recommended to develop multidisciplinary and interdisciplinary approaches in the management of fear of pain, which has biological, psychological, social, cultural, economic aspects.

The Effect of Pain Experienced During the COVID-19 Infection on the Fear of Pain and Quality of Life

AimsThis study was conducted to determine the effect of pain experienced during the COVID-19 infection on the fear of pain and quality of life of individuals. BackgroundPain is a complex, multidimensional, neurophysiological and psychosocial experience known only to the person experiencing pain. Although there are studies showing that individuals with COVID-19 experience pain, there are no studies that evaluate the relationship between fear of pain and quality of life of people after COVID-19 infection. DesignThe study was carried out as descriptive, comparative and correlational design. MethodsSnowball sampling method was used in the research and the data were collected online. A total of 404 individuals participated in the study. The data were collected using the Descriptive Characteristics Questionnaire, Numeric Rating Scale, Fear of Pain Questionnaire-III and The 36-Item Short Form Health Survey Questionnaire. ResultsIt was determined that 87.1% of the individuals experienced pain during COVID-19 and the mean intensity of this pain was 6.16 ± 2.75. In addition, 37.1% of the individuals experienced pain for a while after COVID-19 and the mean intensity of this pain was 3.81 ± 3.00. The individuals who experienced pain during COVID-19 had higher fear of pain and lower quality of life than those who did not experience pain. There was a significant correlation between the severity of pain experienced during COVID-19 with the fear of pain and the quality of life. ConclusionsAccording to the results of the study, it can be said that individuals who experienced intense pain during COVID-19 infection have higher fear of pain and lower quality of life. In addition, as the fear of pain increases, the quality of life of individuals decreases.

Cognitive and Emotional Aspects of Cupping Therapy

Cupping therapy has recently gained public attention and is widely used in many regions. Some patients are resistant to being treated with cupping therapy, as visually unpleasant marks on the skin may elicit negative reactions. This study aimed to identify the cognitive and emotional components of cupping therapy. Twenty-five healthy volunteers were presented with emotionally evocative visual stimuli representing fear, disgust, happiness, neutral emotion, and cupping, along with control images. Participants evaluated the valence and arousal level of each stimulus. Before the experiment, they completed the Fear of Pain Questionnaire-III. In two-dimensional affective space, emotional arousal increases as hedonic valence ratings become increasingly pleasant or unpleasant. Cupping therapy images were more unpleasant and more arousing than the control images. Cluster analysis showed that the response to cupping therapy images had emotional characteristics similar to those for fear images. Individuals with a greater fear of pain rated cupping therapy images as more unpleasant and more arousing. Psychophysical analysis showed that individuals experienced unpleasant and aroused emotional states in response to the cupping therapy images. Our findings suggest that cupping therapy might be associated with unpleasant-defensive motivation and motivational activation. Determining the emotional components of cupping therapy would help clinicians and researchers to understand the intrinsic effects of cupping therapy.

(262) Increased Heat Pain Sensitivity and Pain-Related Anxiety in Individuals with Autism

Pain-related anxiety can contribute to increased pain sensitivity and create a barrier to receiving routine medical care. For individuals with autism spectrum disorders (ASD), behavioral response patterns suggest increased pain sensitivity. Neuroimaging studies in ASD suggest altered evaluation or emotional processing of pain which could contribute to pain-related anxiety. However, the relationship between pain sensitivity and pain-related anxiety is not clear in ASD. We hypothesized that individuals with ASD would report higher pain intensity during supra-threshold pain stimuli and endorse more pain-related anxiety, compared to a typical comparison group. We recruited 29 adults (ASD, n=15; TD, n=14) for a series of heat pain tasks (applied to the calf), including heat pain thresholds using a method of limits approach and two supra-threshold tasks. We examined supra-threshold pain using a pain-rating curve, where 7 temperatures (40-48°C) were presented for 5s (5 trials each), and a sustained heat pain task with alternating low (42°C) and high (46°C) temperatures for 21s (6 trials each, 30s inter-trial rest). Pain-related anxiety was assessed using the Pain Anxiety Symptoms Scale-20 (PASS), Fear of Pain Questionnaire-III (FOP-III), and the Situational Pain Catastrophizing Scale (regarding the sustained pain task). While there were no group differences in pain thresholds, mean pain ratings were higher in the ASD group for all temperatures in the pain rating curve (all p

The Fear of Pain Questionnaire: Factor structure, validity and reliability of the Italian translation.

BackgroundThe Fear of Pain Questionnaire-III (FPQ-III) is a self-report instrument developed to assess fear of different stimuli usually causing pain. The present study aimed to construct an Italian version of the FPQ-III and examine its psychometric properties in a heterogeneous sample of Italian healthy individuals.MethodsThe questionnaire was translated following the forward-backward method and completed by 511 Italian adults who met the inclusion criteria. Within 2 months of the first assessment, a subgroup of participants (n = 164) was re-tested. The factorial structure of the FPQ-III was assessed by confirmatory factor analysis (CFA). To better comprehend the FPQ-III’s factorial structure, a CFA was also performed for each of the two reduced versions of the FPQ-III, namely the FPQ-Short Form and the FPQ-9. Divergent validity, test-retest reliability, and gender/age measurement invariance were also evaluated.ResultsThe results of the CFA revealed that the original three-factor model poorly fitted the data, but it became satisfactory after allowing correlated error terms. Concerning divergent validity, correlations between FPQ-III scores and pain intensity, depression, and anxiety were found to be positive but weak in magnitude (< .20). FPQ-III subscales and total scores showed good internal consistency and time reliability. Finally, scalar invariance was only partially obtained, whereas all the other types of invariance were fully respected both for gender and age.ConclusionsThe current findings indicate that the Italian version of the FPQ-III provides valid and reliable scores for the assessment of fear of pain in the Italian population.

Assessment of pain-related fear in individuals with chronic painful conditions.

BackgroundHeightened fear and anxiety related to pain may result in emotional and behavioral avoidance responses causing disability, distress, and depression. Fear and anxiety associated with pain can potentially change the course of the pain experience. It is plausible that fear and anxiety related to pain affect the duration and frequency of pain experienced by the patient.AimThe study aimed to examine the applicability of the Fear of Pain Questionnaire-III (FPQ-III) in identifying who are likely to report longer duration and greater frequency of pain experience.MethodsTo test this hypothesis, a cross-sectional study was conducted with 579 individuals from a community-based sample living with chronic pain. The factor structure and validity of FPQ-III in the community-based sample were also tested.ResultsThe findings suggest higher fear of severe pain but lower fear of medical pain, associated with longer duration and more frequent pain experience. The analysis also confirmed the three-factor structure of FPQ-III, demonstrating good internal consistency for fear of severe pain (0.71) and fear of medical pain (0.73) and acceptable range for fear of minor pain (0.65).ConclusionThese findings suggest that the FPQ-III can be potentially applied to identify individuals at risk for prolonged continuous pain and as a screening tool to measure fear and anxiety related to pain.

Developing a model for measuring fear of pain in Norwegian samples: The Fear of Pain Questionnaire Norway

BackgroundFear of pain is highly correlated with pain report and physiological measures of arousal when pain is inflicted. The Fear of Pain Questionnaire III (FPQ-III) and The Fear of Pain Questionnaire Short Form (FPQ-SF) are self-report inventories developed for assessment of fear of pain (FOP). A previous study assessed the fit of the FPQ-III and the FPQ-SF in a Norwegian non-clinical sample and proved poor fit of both models. This inspired the idea of testing the possibility of a Norwegian FOP-model. Aims and methodsA Norwegian FOP-model was examined by Exploratory Factor Analysis (EFA) in a sample of 1112 healthy volunteers. Then, the model fit of the FPQ-III, FPQ-SF and the Norwegian FOP-model (FPQ-NOR) were compared by Confirmatory Factor Analysis (CFA). Sex neutrality was explored by examining model fit, validity and reliability of the 3 models amongst male and female subgroups. ResultsThe EFA suggested either a 4-, a 5- or a 6-factor Norwegian FOP model. The eigenvalue criterion supported the suggested 6-factor model, which also explained most of the variance and was most interpretable. A CFA confirmed that the 6-factor model was better than the two 4- and 5-factor models. Furthermore, the CFA used to test the fit of the FPQ-NOR, the FPQ-III and the FPQ-SF showed that the FPQ-NOR had the best fit of the 3 models, both in the whole sample and in sex sub-groups. ConclusionA 6-factor model for explaining and measuring FOP in Norwegian samples was identified and termed the FPQ-NOR. This new model constituted six factors and 27 items, conceptualized as Minor, Severe, Injection, Fracture, Dental, and Cut Pain. The FPQ-NOR had the best fit overall and in male- and female subgroups, probably due to cross-cultural differences in FOP. ImplicationsThis study highlights the importance on exploratory analysis of FOP-instruments when applied to different countries or cultures. As the FPQ-III is widely used in both research and clinical settings, it is important to ensure that the models construct validity is high. Country specific validation of FOP in both clinical and non-clinical samples is recommended.

Influence of catechol-O-methyltransferase Val158Met on fear of pain and placebo analgesia.

Higher levels of fear have been shown to partly explain individual differences in placebo analgesic responding. The catechol-O-methyltransferase (COMT) rs4680 Val158Met polymorphism has been associated with both increased placebo analgesia and increased fear-related behavior, in what appears to be inconsistent findings in the literature. The aim of the study was therefore to investigate placebo analgesia and fear-related processes with regard to the COMT genotype, to sort out whether the Met-allele is associated with increased placebo analgesia or increased fear of pain (FOP). A 3 Group (Emla, placebo and natural history) by 5 Test (2 pretest, 3 posttests) mixed design was used (N = 223). A contact heat-evoked stimulator was used to induce pain, and FOP was quantified with the Fear of Pain Questionnaire-III. Saliva was obtained for genotyping. As expected, we observed a significant interaction of test by group (P < 0.01), with lower pain report in the placebo group compared with the natural history group (P < 0.01). There was a main effect of the COMT genotype on fear of medical pain (P = 0.032), and Met-allele carriers reported significantly higher fear of medical pain compared with the Val-allele (P = 0.044). We observed no effect of the COMT genotype on mean pain-level report or placebo analgesia. Thus, we conclude that the Met-allele seems to be associated with the negative emotional process of fear, but not with placebo analgesia.

Influence of Fear of Pain and Coping Strategies on Health-Related Quality of Life and Patient-Anticipated Outcomes in Patients With Chronic Pain: Cross-Sectional Study Protocol.

BackgroundFear of pain and coping strategies are emotional-behavioral responses to pain and are known to play an important role in the development and maintenance of pain. It is highly likely that fear of pain and coping strategies influence each other, potentially affecting the course of chronic pain. To our knowledge, the relationship between pain, fear of pain and coping strategies, and how they influence patient-anticipated outcomes and health-related quality of life, have not been investigated.ObjectiveThe aims of this study are to test (1) if both fear of pain and/or coping strategies are sufficient causes for maintaining pain; and (2) whether fear of pain influences coping strategies and pain intensity. The study will also examine the impact of fear of pain and coping strategies on health-related quality of life and patient-anticipated outcomes.MethodsThe cross-sectional study will be conducted using an online survey. The Fear of Pain Questionnaire-III (FPQ-III), the Brief Coping Inventory (COPE), and EuroQoL-5d (EQ-5D) validated questionnaires will be used to collect data. Information pertaining to demographic factors, pain-related factors, and patient-anticipated outcomes will also be collected. The study has ethics approval from the Human Research Ethics Committee of the University of Adelaide. Study participants will be individuals aged 18 years and above who are experiencing chronic pain (ie, pain lasting more than 6 months). Effect measure modification technique (EMMM) will be used to examine if fear of pain acts as a moderator or mediator between coping strategies and pain. Simple and multinomial logistic regression analysis will be used to examine the effect of fear of pain and coping strategies on health-related quality of life and patient-anticipated outcomes.ResultsRecruitment began July 2017 and it is anticipated that data collection will be completed by October 2017. Findings from this study will help to extend our understanding of fear of pain and coping strategies, their interaction, and their impact on health-related quality of life and patient-anticipated outcomes.ConclusionsFear of pain and coping strategies have significant influence on the experience of chronic pain and its course. This study will help enhance our understanding of the relationship between fear of pain and coping strategies, which may help in developing patient-centered care practices.

The Fear of Pain Questionnaire-III and the Fear of Pain Questionnaire-Short Form: a confirmatory factor analysis

BackgroundThe Fear of Pain Questionnaire-III (FPQ-III) is a widely used instrument to assess the fear of pain (FOP) in clinical and nonclinical samples. The FPQ-III has 30 items and is divided into three subscales: Severe Pain, Minor Pain and Medical Pain. Due to findings of poor fit of the original three-factor FPQ-III model, the Fear of Pain Questionnaire-Short Form (FPQ-SF) four-factor model has been suggested as an alternative. The FPQ-SF is a revised version of the FPQ-III, reduced to 20 items and subdivided into four subscales: Severe Pain, Minor Pain, Injection Pain and Dental Pain.Aims and methodsThe purpose of the study was to investigate the model fit, reliability and validity of the FPQ-III and the FPQ-SF in a Norwegian nonclinical sample, using confirmatory factor analysis (CFA). The second aim was to explore the model fit of the two scales in male and female subgroups separately, since previous studies have uncovered differences in how well the questionnaires measure FOP across sex; thus, the questionnaires might not be sex neutral. It has been argued that the FPQ-SF model is better because of the higher fit to the data across sex. To explore model fit across sex within the questionnaires, the model fit, validity and reliability were compared across sex using CFA.ResultsThe results revealed that both models’ original factor structures had poor fit. However, the FPQ-SF had a better fit overall, compared to the FPQ-III. The model fit of the two models differed across sex, with better fit for males on the FPQ-III and for females on the FPQ-SF.ConclusionThe FPQ-SF is a better questionnaire than the FPQ-III for measurement of FOP in Norwegian samples and across sex subgroups. However, the FPQ-III is a better questionnaire for males than for females, whereas the FPQ-SF is a better questionnaire for females than for males. The findings are discussed and directions for future investigations outlined.

Fear of Pain Questionnaire-9: Brief assessment of pain-related fear and anxiety.

BackgroundFear and anxiety are important considerations in both acute and chronic pain. Effectively and efficiently measuring fear and anxiety associated with pain in healthcare settings is critical for identifying vulnerable patients. The length and administration time of current measures of pain‐related fear and anxiety inhibit their routine use, as screening tools and otherwise, suggesting the need for a shorter, more efficient instrument.MethodsA 9‐item shortened version of the Fear of Pain Questionnaire – III (FPQ‐III), the Fear of Pain Questionnaire‐9 (FPQ‐9), was developed based upon statistical analyses of archival data from 275 outpatients with chronic pain and 275 undergraduates. Additionally, new data were collected from 100 outpatients with chronic pain and 190 undergraduates to directly compare the standard and short forms. Exploratory and confirmatory factor analyses, and other psychometric analyses, were conducted to examine and establish the FPQ‐9 as a reliable and valid instrument.ResultsThe original three‐factor structure of the FPQ‐III was retained in the shortened version; a confirmatory factor analysis produced good model fit (RMSEA = 0.00, CFI = 1.00, TLI = 1.00, SRMR = 0.03). Results suggested a high degree of correlation between the original FPQ‐III and the new FPQ‐9 (r = 0.77, p < 0.001). Measures of internal consistency for FPQ‐9 subscales were high; correlations with other pain and anxiety instruments suggested concurrent, convergent and divergent validity.ConclusionsThe FPQ‐9 is a psychometrically sound alternative to longer instruments assessing fear and anxiety associated with pain, for use in both clinical and research situations that only allow brief screening.SignificanceThe FPQ‐9 has considerable potential for dissemination and utility for routine, brief screening, given its length (completion time ~2 min; scoring time ~1 min), reading level and psychometric properties.

Sex differences in fear of pain: item-level analysis of the Fear of Pain Questionnaire III.

ObjectivesThis study aimed to investigate sex differences in fear of pain (FOP) measured by the Fear of Pain Questionnaire III (FPQ-III) in a nonclinical sample. The FPQ-III is a self-report inventory measuring FOP, with 30 items, divided into three subscales: Severe, Minor and Medical Pain.MethodsA total of 185 subjects participated (49.7% females) in this study. Sex differences on overall FOP, the subscales, and at item level were examined. One-way analysis of variance tested the association between sex and FOP, measured by overall FOP and the subscales. Ordinal regression analysis enabled item-level analysis of the FPQ-III and was conducted to explore further specificity of FOP in males compared to females.ResultsOverall FOP and fear of Severe Pain was significantly higher in females than in males, as measured by the FPQ-Total and the FPQ-Severe. Moreover, females were more likely to report higher FOP than males on 16 items (p<0.05). Further inspection revealed that females scored significantly higher than males on all items on the Severe Pain subscale. When controlling for multiple comparisons six items reached significance (p<0.001). Five of these items belonged to the subscale Severe Pain. When controlling for overall FOP one item, also from the Severe Pain subscale, reached significance (p<0.001).ConclusionThere are sex differences in severe FOP, with higher FOP in females compared to males. Potential explanations are sex differences in the 1) psychosocial mechanisms of fear and anxiety, and 2) emotional reactions to and interpretation of FPQ-III Severe Pain items.