Advertisement

Journal of Behavioral Medicine

, Volume 21, Issue 4, pp 389–410 | Cite as

Development of the Fear of Pain Questionnaire-III

  • Daniel W. McNeil
  • Avie J. Rainwater
Article

Abstract

Fear and/or anxiety about pain is a useful construct, in both theoretical and clinical terms. This article describes the development and refinement of the Fear of Pain Questionnaire (FPQ), which exists in its most current form as the FPQ-III. Factor analytic refinement resulted in a 30-item FPQ-III which consists of Severe Pain, Minor Pain, and Medical Pain subscales. Internal consistency and test-retest reliability of the FPQ-III were found to be good. Four studies are presented, including normative data for samples of inpatient chronic pain patients, general medical outpatients, and unselected undergraduates. High fear of pain individuals had greater avoidance/escape from a pain-relevant Behavioral Avoidance Test with Video, relative to their low fear counterparts, suggesting predictive validity. Chronic pain patients reported the greatest fear of severe pain. Directions for future research with the FPQ-III are discussed, along with general comments about the relation of fear and anxiety to pain.

PAIN FEAR ANXIETY PAIN ASSESSMENT PAIN MEASUREMENT 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Absi, M., and Rokke, P. D. (1991). Can anxiety help us tolerate pain? Pain 46: 43-51.Google Scholar
  2. Appeldorf, W. J., Shear, K., Leon, A. C., and Portera, L. (1994). A brief screen for panic disorder. J. Anx. Dis. 8: 71-78.Google Scholar
  3. Arntz, A., Dreessen, L., and De Jong, P. (1994). The influence of anxiety on pain: Attentional and attributional mediators. Pain 56: 307-314.Google Scholar
  4. Bates, M. S., and Edwards, W. T. (1992). Ethnic variations in the chronic pain experience. Ethnic. Dis. 2: 63-83.Google Scholar
  5. Bobey, M. J., and Davidson, P. O. (1970). Psychological factors affecting pain tolerance. J. Psychosom. Res. 14: 371-376.Google Scholar
  6. Boeke, S., Duivenvoorden, H. J., Verhage, F., and Zwaveling, A. (1991). Prediction of postoperative pain and duration of hospitalization using two anxiety measures. Pain 45: 293-297.Google Scholar
  7. Bolles, R. C., and Fanselow, M. S. (1980). A perceptual-defensive-recuperative model of fear and pain. Behav. Brain Sci. 3: 291-323.Google Scholar
  8. Carter, L. E., McNeil, D. W., and Reed, T. L. (1991). Cardiac responsivity to combinations of anxiety and pain. Psychophysiology 28: S16 (abstract).Google Scholar
  9. Cornwall, A., and Donderi, D. C. (1988). The effect of experimentally induced anxiety on the experience of pressure pain. Pain 35: 105-113.Google Scholar
  10. Dannenbring, D., Stevens, M. J., and House, A. E. (1997). Predictors of childbirth pain and maternal satisfaction. J. Behav. Med. 20: 127-142.Google Scholar
  11. de Groot, K. I., Boeke, S., van den Berge, H. J., Duivenvoorden, H. J., Bonke, B., and Passchier, J. (1997). The influence of psychological variables on postoperative anxiety and physical complaints in patients undergoing lumbar surgery. Pain 69: 19-25.Google Scholar
  12. Dougher, M. J., Goldstein, D., and Leight, K. A. (1987). Induced anxiety and pain. J. Anx. Dis. 1: 259-264.Google Scholar
  13. Eifert, G. H., and Wilson, P. H. (1991). The triple response approach to assessment: A conceptual and methodological reappraisal. Behav. Res. Ther. 29: 283-292.Google Scholar
  14. Evans, R., Beckerman, S. (Producers), and Schesinger, J. (Director). (1976). Marathon Man (Film). Paramount Pictures, Los Angeles, CA.Google Scholar
  15. Frazer, M., and Hampson, S. (1988). Some personality factors related to dental anxiety and fear of pain. Br. Dent. J. 165: 436-439.Google Scholar
  16. Gil, K. M., Abrams, M. R., Phillips, G., and Keefe, F. J. (1989). Sickle cell disease pain: Relation of coping strategies to adjustment. J. Consult. Clin. Psychol. 57: 725-731.Google Scholar
  17. Goldfried, M. R., and D'Zurilla, T. J. (1969). A behavioral-analytic model for assessing competence. In Spielberger, C. D. (ed.), Current Topics in Clinical and Community Psychology, Academic Press, New York, pp. 151-196Google Scholar
  18. Gross, P.R. (1992). Is pain sensitivity associated with dental avoidance?. Behav. Res. Ther. 30: 7-13.Google Scholar
  19. Gross, R. T., and Collins, F. L., Jr. (1981), On the relationship between anxiety and pain: A methodological confounding. Clin. Psychol. Rev. 1: 375-386.Google Scholar
  20. Hursey, K. G., and Jacks, S. D. (1992). Fear of pain in recurrent headache sufferers. Headache 32: 283-286.Google Scholar
  21. Jensen, M. P., and Karoly, P. (1992). Self-report scales and procedures for assessing pain in adults. In: Turk, D. C. and Melzack, R. (eds.), Handbook of Pain Assessment, Guilford, New York, pp. 135-151.Google Scholar
  22. Kaiser, R. S., Primavera, J. P., and Schwartz, A. L. (1993). Perceived competence and fear of pain as contributory factors in analgesic rebound headache. Paper presented at the meeting of the American Association for the Study of Headache, San Francisco, CA.Google Scholar
  23. Kaloupek, D.G., Peterson, D. A., and Levis, D. J. (1981). An investigation of the normative and factor analytic composition of six questionnaires used for subject selection. J. Behav. Assess. 3: 149-165.Google Scholar
  24. Keefe, F. J., Dunsmore, J., and Burnett, R. (1992). Behavioral and cognitive-behavioral approaches to chronic pain: Recent advances and future directions. J. Consult. Clin. Psychol. 60: 528-536.Google Scholar
  25. Kleinknecht, R. A., Klepac, R. K., and Alexander, L. D. (1973). Origins and characteristics of fear of dentistry. J. Am. Dent. Assoc. 86: 842-848Google Scholar
  26. Klorman, R., Weerts, T. C., Hastings, J. E., Melamed, B. G., and Lang, P. J. (1974). Psychometric description of some specific-fear questionnaires. Behav. Ther. 5: 401-409.Google Scholar
  27. Kori, S. H., Miller, R. P., and Todd, D. D. (1990). Kinisophobia: A new view of chronic pain behavior. Pain Manage. 3: 35-43.Google Scholar
  28. Larsen, D. K., Taylor, S., and Asmundson, G. J. G. (1997). Exploratory factor analysis of the Pain Anxiety Symptoms Scale in patients with chronic pain complaints. Pain 69: 27-34.Google Scholar
  29. Lethem, J., Slade, P. D., Troup, J. D. G., and Bentley, G. (1983). Outline of a fear-avoidance model of exaggerated pain perception—I. Behav. Res. Ther. 21: 401-408.Google Scholar
  30. Leventhal, H., and Everhart, D. (1979). Emotion, pain, and physical illness. In Izard, C. E. (ed.), Emotions in Personality and Psychopathology, Plenum Press, New York, pp. 263-299.Google Scholar
  31. Levine, F. M., and De Simone, L. L. (1991). The effects of experimenter gender on pain report in male and female subjects. Pain 44: 69-72.Google Scholar
  32. Marks, I. M. (1987). Fears, Phobias, and Rituals: Panic, Aanxiety, and Their Disorders, Oxford, New York, pp. 5-8.Google Scholar
  33. Martinez-Urrutia, A. (1975). Anxiety and pain in surgical patients. J. Consult. Clin. Psychol. 43: 437-452.Google Scholar
  34. Maser, J. D (1985). List of phobias. In Tuma, A. H. and Maser. J. D. (eds.) Anxiety and the Anxiety Disorders, Lawrence Erlbaum, Hillsdale, New Jersey, pp. 805-813.Google Scholar
  35. McCracken, L. M. (1997). “Attention” to pain in persons with chronic pain: A behavioral approach. Behav. Ther. 28: 271-284.Google Scholar
  36. McCracken, L. M., Gross, R. T., Sorg, P. J., and Edmands, T. A. (1993a). Prediction of pain in patients with chronic low back pain: Effects of inaccurate prediction and pain-related anxiety. Beh. Res.Ther. 31: 647-652.Google Scholar
  37. McCracken, L. M., Zayfert, C., and Gross, R. T. (1992). The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain. Pain 50: 67-73.Google Scholar
  38. McCracken, L. M., Zayfert, C., and Gross, R. T. (1993b). The Pain Anxiety Symptoms Scale (PASS): A multi-modal measure of pain-specific anxiety symptoms. The Behavior Therapist. 16: 183-184.Google Scholar
  39. McNeil, D. W., and Berryman, M. L. (1989). Components of dental fear in adults? Behav. Res. Ther. 27: 233-236.Google Scholar
  40. McNeil, D. W., and Brunetti, D. G. (1992). Pain and fear: A bioinformational perspective on responsivity to imagery. Behav. Res. Ther. 30: 513-520.Google Scholar
  41. McNeil, D. W., Vrana, S. R., Melamed, B. G., Cuthbert, B. N., and Lang, P. J. (1992). Emotional imagery in simple and social phobia: Fear vs. anxiety. J. Abnorm. Psychol. 102: 212-225.Google Scholar
  42. McNeil, D. W., Carter, L. E., Lejuez, C. W., and Hopko, D. R. (1998). Responsivity to fear and pain (submitted for publication).Google Scholar
  43. Melzack, R., and Wall, P. D. (1988). The Challenge of Pain (rev. ed.), Penguin Books, New York.Google Scholar
  44. Miller, B. V., and Bernstein, D. A. (1972). Instructional demand in a behavioral avoidance test for claustrophobic fears. J. Abnorm. Psychol. 80: 206-210.Google Scholar
  45. Novy, D. M., Nelson, D. V., Goodwin, J., and Rowzee, R. D. (1993). Psychometric comparability of the State-Trait Anxiety Inventory for different ethnic subpopulations. Psychol. Assess. 5: 343-349.Google Scholar
  46. Osman, A., Barrios, F. X., Osman, J. R., Schneekloth, R., and Troutman, J. A. (1994). The Pain Anxiety Symptoms Scale: Psychometric properties in a community sample. J. Behav. Med. 17: 511-522.Google Scholar
  47. Papciak, A. S., and Feuerstein, M. (1991). Fear of pain in work rehabilitation. In McNeil, D. W. (Chair), Relationships between pain and anxiety: Theoretical formulations and clinical applications. Symposium presented at the meeting of the Association for Advancement of Behavior Therapy, New York.Google Scholar
  48. Philips, H. C. (1987). Avoidance behaviour and its role in sustaining chronic pain. Behav. Res. Ther. 25: 273-279.Google Scholar
  49. Rainwater, A. J., III, and McNeil, D. W. (1990). Behavioral Assessment Test with Video (BATV): Assessment of phobic disorders. J. Anx. Dis. 4: 163-170.Google Scholar
  50. Reiss, S., Peterson, R. A., Gursky, D. M., and McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav. Res. Ther. 24: 1-8.Google Scholar
  51. Romano, J. M., and Turner, J. A. (1985). Chronic pain and depression: Does the evidence support a relationship? Psychol. Bull. 97: 18-34.Google Scholar
  52. Rosenstiel, A. K., and Keefe, F. J. (1983). The use of coping strategies in low back pain patients: Relationship to patient characteristics and current adjustment. Pain 17: 33-40.Google Scholar
  53. Slade, P. D., Troup, J. D. G., Lethem, J., and Bentley, G. (1983). The fear-avoidance model of exaggerated pain perception—II: Preliminary studies of coping strategies for pain. Behav. Res. Ther. 21: 409-416.Google Scholar
  54. Spielberger, C. D., Gorsuch, R. L., and Lushene, R. E. (1970). Manual for the State-Trait Anxiety Inventory (Form X), Consulting Psychologists Press, Palo Alto, CA.Google Scholar
  55. Sullivan, M. J. L., Bishop, S. R., and Pirik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychol. Assess. 7: 524-532.Google Scholar
  56. Taal, L. A., and Faber, A.W. (1997). The Burn Specific Pain Anxiety Scale: Introduction of a reliable and valid measure. Burns 23: 147-150.Google Scholar
  57. Thonsgaard, S., Hursey, K. G., Oliver, K. C., and McGruder, A. K. (1992). The Fear of Pain Questionnaire: Reliability and validity in recurrent tension headache sufferers. Poster presented at the meeting of the Association for Advancement of Behavior Therapy, Boston, MA.Google Scholar
  58. Waddell, G., Newton, M., Henderson, I., Somerville, D., and Main, C. J. (1993). A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52: 157-168.Google Scholar
  59. Wolpe, J., and Lang, P. J. (1977). Manual for the Fear Survey Schedule, Educational and Industrial Testing Service, San Diego, CA.Google Scholar

Copyright information

© Plenum Publishing Corporation 1998

Authors and Affiliations

  • Daniel W. McNeil
  • Avie J. Rainwater

There are no affiliations available

Personalised recommendations