Psychometric Properties of an Arabic Pain Anxiety Symptoms Scale-20 (PASS-20) in Healthy Volunteers and Patients Attending a Physiotherapy Clinic
Int.J. Behav. Med.
Psychometric Properties of an Arabic Pain Anxiety Symptoms Scale-20 (PASS-20) in Healthy Volunteers and Patients Attending a Physiotherapy Clinic
Osama A. Tashani 0 1 2 3
Oras A. AlAbas 0 1 2 3
Raafat A.M. Kabil 0 1 2 3
Mark I. Johnson 0 1 2 3
Osama A. Tashani 0 1 2 3
0 Sirte University , Sirte , Libya
1 MENA research group, Leeds Beckett University , Leeds , UK
2 Centre for Pain Research, Leeds Beckett University , Leeds , UK
3 Sohag University , Sohag , Egypt
Purpose The aim of this study was to cross-culturally adapt the PASS-20 questionnaire for use in Libya. Methods Participants were 71 patients (42 women) attending the physiotherapy clinic, Ibn Sina Hospital, Sirt, Libya for management of persistent pain and 137 healthy unpaid undergraduate students (52 women) from the University of Sirt, Libya. The English PASS-20 was translated into Arabic. Patients completed the Arabic PASS-20 and the Arabic Pain Rating Scales on two occasions separated by a 14-day interval. Healthy participants completed the Arabic PASS-20 on one occasion. Results The internal consistency (ICC) for pain patient and healthy participant samples yielded a good reliability for the total score, cognitive anxiety, fear of pain, and physiological anxiety. The test-retest reliability of the Arabic PASS-20 score showed high reliability for the total score (ICC = 0.93, p < 0.001), escape/avoidance (ICC = 0.93, p < 0.001), fear of pain (ICC = 0.94, p < 0.001), and physiological anxiety subscales (ICC = 0.96, p < 0.001) and good reliability for the cognitive anxiety (ICC = 0.85, p < 0.001). Inspection of the Promax rotation showed that each factor comprised of five items were consistent with the theoretical constructs of the original PASS-20 subscales. Conclusion The Arabic PASS-20 retained internal consistency and reliability with the original English version and can be used to measure pain anxiety symptoms in both pain and healthy individual samples in Libya.
Pain; Anxiety; Fear of pain; Psychometric analysis; Libya
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Published online: 10 November 2016
# The Author(s) 2016. This article is published with open access at Springerlink.com
Introduction
Psychosocial factors such as fear of pain, catastrophizing,
depression, and anxiety are determinants of differences in pain
responses. Anxiety, a negative emotional response to an
anticipated threat, is linked with increased pain sensitivity in
patients with chronic pain [
1
] and in pain-free individuals
exposed to painful stimuli [
2
]. Studies on patients with
musculoskeletal pain have found that aspects of behaviour such as
fear-avoidance beliefs, pain-related fear, and thought
suppression are associated with pain and disability [
1
]. Indeed, fear of
pain and fear-avoidance behaviour were developed as a
concept to explain exaggerated pain perceptions in patients and
might help in understanding how and why some individuals
with musculoskeletal pain develop a chronic pain syndrome
[
3
]. Anxiety that is specifically relevant to pain, called
painrelated anxiety, is more likely to be correlated with pain
sensitivity than general anxiety [
4
].
Several measures are used to assess pain-related anxiety.
The multi-dimensional Pain Anxiety Symptom Scale (PASS)
is one of the most commonly used pain-specific anxiety
scales. The PASS is a 40-item self-report scale which was
developed to measure the fear of pain along four dimensions;
fearful interpretations, avoidance and escape, physiological
responses, and cognitive interference [
5, 6
]. There is strong
empirical evidence that the PASS is associated with pain
severity and other measures such as patient functioning [4]. In
addition, several psychometric studies have shown that the
four dimensions (factors) of the PASS are consistently
reproducible in patients and healthy participants [
6
]. McCracken
et al. found that scores from the PASS and the Fear
Avoidance Beliefs Questionnaire (FABQ) Baccounted for
more variability in pain, disability, and pain behaviour
compared with scores from the FPQ [Fear of Pain Questionnaire]
and STAI [the State-Trait Anxiety inventory]^ [
6
]. This
suggests that the PASS is a more appropriate tool to measure
multiple anxiety response categories toward pain and is
preferable than measuring general response tendencies.
The short form of the PASS is a 20-item self-report scale
that measures four components of fear of pain, including
cognitive anxiety, escape and avoidance, fearful appraisals of
pain, and physiological anxiety (PASS-20, Appendix 1, (8)).
Items are rated for frequency of occurrence on a 6-point Likert
scale anchored at 0 (never) and 5 (always), providing scores
for the four dimensions and total. The PASS-20 has been
validated in chronic pain patients [
7
] and healthy individuals
[
8
]. Cross-cultural adaptation of the questionnaire to other
languages has been performed in South Korea [
9
], Germany
[
10
], and China [
11
]. To our knowledge, there are no (...truncated)