Extending PROMIS Pain Item Banks: Pain Self-Efficacy and Pain Castrophizing

12/01/2014 to 03/01/2018
Patient-Centered Outcomes Research Institute (PCORI)
Principal Investigator:
Dagmar Amtmann, PhD
Unrelieved pain can result in excessive diagnostic tests, increased outpatient services and decreased ability to function, resulting in lost income and disability. While acute pain is normal indicating possible injury, chronic pain associated with a wide array of conditions (e.g., cancer, arthritis) and specific disorders (e.g., low back pain, painful diabetic neuropathy) is different and persists. Pain is typically assessed by a self-report of severity, but severity is too narrow to capture its complexity and impact. Patient Reported Outcomes Measurement Information System (PROMIS) is a system of reliable, precise and flexible measures of patient–reported health status. PROMIS has developed several specific pain item banks and measures including pain intensity, quality, interference, and behaviors. However, two important pain-related domains are missing from PROMIS: Pain Catastrophizing (PC) and Pain-Related Self-efficacy (PRSE). Pain catastrophizing refers to the exaggerated negative thoughts and feelings about pain that some people have when they are in pain (e.g., because of my pain, my life is over). PC is a form of “cognitive distortion” that is hypothesized to contribute to the development and maintenance of depression and negative affect. Understanding and measuring the belief that people with chronic pain can successfully self-manage and live effectively with pain (i.e., PRSE) is important for designing treatments that can lead to an improved quality of life. Adding measures of these domains would greatly enhance the utility of PROMIS pain instruments for conducting comparative effectiveness research in chronic pain.
Study Aims
To develop brief, flexible, item response theory (IRT)-based, psychometrically sound, patient-centered, and clinically meaningful measures of PC and PRSE.
Development of both item banks followed the PROMIS methodology. Patient advisors worked with investigators on every aspect of the study. A panel of pain researchers defined the PC construct. Focus groups and cognitive interviews with people living with chronic pain reviewed the definitions and provided feedback on meaningfulness and clarity of all items. Individuals with chronic pain completed the candidate items via online or paper surveys. Pain Catastrophizing Scale and Pain Self-Efficacy Questionnaire were used as legacy measures. Retest data were collected from a subset of respondents 40-80 hours after initial administration. IRT was used to calibrate the items.
Final banks included 24 PC and 29 PRSE items calibrated on a demographically (e.g., gender, age, race) and clinically (i.e., various chronic pain conditions) heterogeneous sample of people with chronic pain (n=795). The PC instrument was renamed “Pain Appraisal Scale” (PAS) after feedback from patient groups indicated “catastrophizing” was perceived as stigmatizing. Items for short forms were selected by considering item parameters and content coverage. Six items that captured the trait continuum were selected for each short form. Correlations between the 6-item short forms and the full item bank scores (PAS r=0.99; PRSE r=0.85) and test-retest reliability evaluated using intraclass correlations (ICC) were excellent (PAS ICC=0.93; PRSE ICC=0.90). Correlations of short form scores with legacy measures of related constructs were high (>0.8).
The short form and the full item bank are free and publicly available:
  • University of Washington Pain Appraisal Scale (UW-PAS)
  • University of Washington Pain Related Self-Efficacy Scale (UW-PRSE)
Under Development:
  • Amtmann D, Bamer A, Liljenquist K, Bocell F, Jensen M, Turk D. Development and validation of the pain appraisal scale.
  • Amtmann D, Liljenquist K, Bamer A, Bocell F, Jensen M, Turk D. Development and validation of the pain related self-efficacy scale.