Development and Initial Validation of a Questionnaire for Measuring Fear-Avoidance Associated with Pain: The Fear-Avoidance of Pain Scale

Abstract

Objectives: A scale to measure fear-avoidance in chronic musculoskeletal pain has been developed and its internal consistency, reliability, sensitivity to treatment change and concurrent validity was investigated.Methods: The Fear-Avoidance of Pain Scale [FAPS] was administered to 62 subjects at three time points: prior to entering a cognitive behavioral pain management program [pre-treatment], at completion of the program [post-treatment] and at a three month follow-up [follow-up]. Along with the FAPS, five other questionnaires were administered at each time point. These were; Visual Analog Scale, Zung Depression Scale, Pain-Related Self Statements [PRSS-Cat], Multidimensional Pain Inventory [MPI] and Functional Limitations Profile [FLP]. Changes in these measures due to the treatment were investigated as well as the relationship between measures.Results: The FAPS showed good internal consistency and reliability. There was a significant reduction in FAPS score from pre-treatment to post-treatment. At follow-up the FAPS was significantly reduced compared to pre-treatment but not post-treatment. The PRSS-Cat and MPI scales of Pain Severity, Interference, Affective Distress and Life Control all significantly changed at post-treatment. These changes were maintained on the Interference and Life Control scales at follow-up. The FAPS correlated strongly with the Zung, the PRSS-Cat, the Interference scale of the MPI and all three FLP scores.Conclusions: The FAPS appears to be a useful measure of fear-avoidance in chronic pain. It shows good internal consistency and temporal stability, is sensitive to treatment changes and relates to other measures in an understandable way. It consists of 21 items, is easy to administer and quick to fill out.