Steven Wong

The Fear-Avoidance Model of Chronic Pain: Assessing the Role of Neuroticism and Negative Affect in Pain Catastrophizing Using Structural Equation Modeling

BackgroundPrevious research on the fear-avoidance model (FAM) of chronic pain suggests that the personality traits of neuroticism and negative affect (NA) influence pain catastrophizing. However, the mechanisms of their influence on pain catastrophizing remain unclear.PurposeThis study examined four possible models of relationships between neuroticism, NA, and pain catastrophizing within the FAM framework using structural equation modeling.MethodA total of 401 patients with chronic musculoskeletal pain completed measures of neuroticism, NA, three core FAM components (pain catastrophizing, pain-related fear, and pain anxiety), and adjustment outcomes (pain-related disability and depression).ResultsRegression analyses refuted the possibility that neuroticism and NA moderated each other’s effect on pain catastrophic thoughts (p > 0.05). Results of structural equation modeling (SEM) evidenced superior data-model fit for the collapsed models in which neuroticism and NA were two secondary traits underlying a latent construct, negative emotion (disability: comparative fit index (CFI) = 0.93; depression: CFI = 0.91).ConclusionThe results offer preliminary evidence that patients presenting with more neurotic symptom and heightened NA probably elicit more catastrophic thoughts about pain.

The Chinese version of the 8-item Committed Action Questionnaire (ChCAQ-8): A preliminary analysis of the factorial and criterion validity.

Committed action is a key component of the psychological flexibility model that recently has been applied in chronic pain settings. Developed within the Western context, the 8-item Committed Action Questionnaire (CAQ-8) demonstrated good psychometric properties. This study aimed to translate the original English version of the CAQ-8 into Chinese (ChCAQ-8) and to assess its reliability, factor structure and concurrent criterion validity. A total of 210 Chinese patients with chronic pain completed the ChCAQ-8, the Chronic Pain Grade, the Pain Catastrophizing Scale, and the depression subscale of the Hospital Anxiety and Depression Scale. Results of confirmatory factor analysis showed both the 2-factor correlated (CFI = .99) and hierarchical (CFI = .98) models met the minimum acceptable fit criterion. The 2 subscales and the entire scale of ChCAQ-8 demonstrated good internal consistency (Cronbachs αs ranging .70-.86). The ChCAQ-8 negative subscale score was significantly correlated with pain intensity, disability, pain catastrophizing, and depression in the expected direction. The ChCAQ-8 positive subscale was significantly correlated with pain castastrophizing and depression. Results of multivariate regression modeling showed the ChCAQ-8 negative subscale predicted depression (std β = .19, p < .01) and disability (std β = .14, p < .05), after adjusting for pain intensity, pain duration and pain catastrophizing. Our findings offer preliminary data for the reliability, factorial and concurrent criterion validity of the ChCAQ-8 in the Chinese population. (PsycINFO Database Record

A Study of the Reliability and Concurrent Validity of the Chinese Version of the Pain Medication Attitude Questionnaire (ChPMAQ) in a Sample of Chinese Patients with Chronic Pain

OBJECTIVES The Pain Medication Attitude Questionnaire (PMAQ) was designed to assess concerns about pain medication among patients with chronic nonmalignant pain. The instrument has been demonstrated to be a reliable measure with good psychometric properties, yet its validity among Chinese has not been evaluated. This study aimed to translate the English-language version of the PMAQ into Chinese (ChPMAQ) and to evaluate its reliability and concurrent validity. METHODS A total of 201 Chinese patients with chronic pain attending two multidisciplinary pain clinics in Hong Kong completed the ChPMAQ, the Chronic Pain Grade (CPG) questionnaire, the mental health subscale of the SF-12 (QoL-Mental), and questions assessing sociodemographic and pain characteristics. RESULTS Our results showed that the seven ChPMAQ scales possessed good internal consistency. Except for the correlation between Withdrawal and Mistrust (r = 0.13), all ChPMAQ scales were significantly correlated with each other (all p < 0.01). The scales also correlated with two concurrent criterion measures, QoL-Mental and Pain Disability, in a predictable direction. Results of hierarchical multiple regression analyses showed that the ChPMAQ scales predicted concurrent QoL-Mental (F(7,190) = 2.75, p < 0.05) and pain disability (F(7,188) = 3.00, p < 0.01). Need (std β = -0.23, p<0.05) and Side effects (std β = 0.27, p < 0.01) emerged as independent predictors of concurrent QoL-Mental and pain disability, respectively. CONCLUSION Despite the current preliminary findings for the reliability and concurrent validity of the ChPMAQ, more research is needed to substantiate the reliability, validity and other psychometric properties of the instrument.