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

BACKGROUND: Fear 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. METHODS: A 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. RESULTS: The 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. CONCLUSIONS: The 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. SIGNIFICANCE: The 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.

Social interaction effects on restrained eating.

The eating behavior of college women scoring within either the above-average or middle ranges on the Restraint Scale was compared following brief social encounters with male students or other female students, or a no-encounter control situation. The eating of average restraint women was significantly depressed following interaction with a partner whom the subjects considered attractive. For high restraint women a nonsignificant tendency towards disinhibition of eating following interaction with an attractive other occurred. Personality ratings by partners indicated that high restraint women presented a distinct social persona to male, but not female, strangers in the brief experimental interaction.

Assessment of chronic refractory headache: the role of the MMPI-2.

We investigated the utility of the newly revised version of the Minnesota Multiphasic Personality Inventory, the MMPI-2, for assessing psychopathology in three diagnostic headache groups, Post Traumatic, Status Migrainosus, and Status Migrainosus with Analgesic Rebound. We also investigated whether distinct clusters of headache sufferers could be identified using the MMPI-2 clinical scales, and whether these clusters coincide with headache diagnosis. Eighty-one patients in treatment at the Houston Headache Clinic were diagnosed and administered the MMPI-2. Significant levels of psychopathology were found in all three diagnostic groups. Furthermore, Cluster analysis identified three clusters of patients with equal proportions of patients from the three diagnostic groups. Cluster 1 patients were abnormally high on many MMPI-2 clinical scales; Cluster 2 patients showed more moderate elevations, and Cluster 3 patients had essentially normal profiles. We concluded that the MMPI-2 offers additional information not available through medical diagnosis alone. Thus, it is crucial to include psychological assessment in any comprehensive evaluation of chronic headache patients. Further implications for treatment planning and effectiveness are discussed.

Fear of pain in recurrent headache sufferers.

We investigated the role of fear of pain in headache sufferers using the Fear of Pain Questionnaire (FPQ). Seventy-six headache sufferers and 58 controls completed the FPQ and measures of depression, anxiety, and anger. Headache sufferers also completed measures of stress-related physical symptoms and coping with pain. We found that the FPQ has excellent internal consistency as well as good concurrent and construct validity indicated by the high correlations between the FPQ subscales and both anxiety and depression but low correlations with anger. There were marked differences between headache sufferers and controls on the FPQ; headache sufferers showed much greater fear of severe and medical pain and lower fear of minor pain. Fear of pain was generally not related to headache characteristics such as frequency, severity, or duration. On the other hand, it was related to headache impact such as disruption of pleasurable activities. These results are consistent with models of chronic pain disorders which emphasize the role of fear of pain over the nociceptive intensity of the pain stimulus.

Long-term maintenance of improvements achieved with (abortive) pharmacological and nonpharmacological treatments for migraine: preliminary findings.

This report presents the first prospective comparison of the long-term maintenance of reductions in recurrent migraine headaches achieved with (abortive) pharmacological and nonpharmacological (combined relaxation training and thermal biofeedback training) treatments. Nineteen of 21 (90%) successfully treated patients (50% or greater reduction in headache activity) were contacted for follow-up evaluation 3 years later. Migraine sufferers who had been treated with ergotamine were less likely to still be relying on the treatment they had received and more likely to have additional medical treatment for their headaches and to be using prophylactic or narcotic medication than were migraine sufferers who had been treated with relaxation/biofeedback training. However, daily headache recordings revealed that patients in both treatment groups continued to show lower headache activity at 3-year follow-up than prior to treatment. Although preliminary, these findings raise the possibility that improvements achieved with nonpharmacological treatment are more likely to be maintained without additional treatment than are similar improvements achieved with abortive pharmacological treatment.

Labeling of participants in high blood pressure screening programs. Implications for blood cholesterol screenings.

Screening programs have expanded to identify the many persons who are unaware of their high blood cholesterol level and thus are at an increased risk for coronary heart disease. These programs bring both potential benefits and potential risks to the participant. One potential risk is that of iatrogenic effects of learning one's risk status, often referred to as the "labeling phenomenon." Research that has addressed the labeling phenomenon in blood pressure screening programs has important implications for blood cholesterol screenings. Detrimental effects on screening participants are possible, but they can be attenuated by careful attention to characteristics of the debriefing and counseling that should be included in screening protocols.

The effects of anticipatory stress on heart rate and T-wave amplitude.

The purpose of the present study was to examine the effects of an anticipatory stressor on three measures of cardiovascular activity: heart rate (HR), T-wave amplitude (TWA) and blood pressure (BP). Twenty-eight males were assigned to either a stress or no-stress group. All subjects reviewed a brief section of prose and then read it aloud during two sessions. The stress group was told that the reading task was a speech and that their performance would be evaluated. The no-stress group was told that the reading task was a part of the readability evaluation of the text material. Reliable increases in HR were observed during both sessions with the stress group exhibiting greater accelerations than the no-stress group. Though TWA and BP varied with periods, no reliable group differences were observed. Degree of threat or aversiveness appears to be indexed more reliably by HR changes than by changes in TWA.