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The Spanish version of the Pain Anxiety Symptoms Scale (PASS-20):

preliminary data on its reliability, validity and factorial structure

Article  in  European Journal of Pain Supplements · September 2011

DOI: 10.1016/S1754-3207(11)70916-6

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Alicia E. López-Martínez Rosa Esteve

University of Malaga University of Malaga
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Table 1. Clinical characteristics Table 2. PASS-
PASS-20 2-
2-factor solution and communalities
Introduction Results

F1

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Variables N % Original items and Spanish translated items Conclusions
ht
Factor 1 Factor 2 h2
Pain-related anxiety is a construct of
Pain-

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1.II think that if my pain gets too severe, it will never decrease
1.
central importance in fear
fear--avoidance Site of Pain Factor Analysis Cuando me duele creo que el dolor nunca va a ir a This is the first study to examine the

p
ig

.11 .66 .50

models.
models. Sacral 289 61.80 menos
validity and reliability of the PASS-
PASS-

d.
Vertebral 285 60.90

e
2.
2.When
When I feel pain I am afraid that something terrible will
A PCA analysis with Oblimin rotation
yr

20 in a Spanish sample of

ht
The Pain Anxiety Symptom Scale Cervical 271 57.90 happen

st
.79 .09 .69
Leg below knee 158 33.80 performed.. Both the scree
was performed scree--plot and Cuando me duele siento que va a ocurrir algo terrible
musculoskeletal chronic pain

te
(PASS;; McCracken et al
(PASS al.., 1992
1992)) is a Lumbar 157 33.50
op

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self--report assessment tool designed
self the inspection of the eingenvalues patients (namely, spinal pain

Po
Thoracic 153 32.70 3.
3.II go immediately to bed when I feel severe “pain”
suggested a 2-factor solution

ec
Cuando me duele mucho me voy inmediatamente a la cama .56 .21 .44
to assess nonspecific pain- pain-related patients).
patients).

yr
anxiety.. The PASS consists of 40
anxiety Pain Medication accounting for 56 56..2 % of the variance
variance..
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4. I being trembling when engaged in an activity that

The results obtained indicate that a 2-
rationally derived items, each rated AINEs 172 36.80 One factor (43 43..90
90% % of the explanatory increases pain
.88 -.22 .69

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factor solution of the PASS-
PASS-20 is the

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Cuando hago una actividad que me duele empiezo a temblar

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Analgesics 150 32.10 variance) was composed of 14 items (2,
on a 5-point scale from 0 (never) to 5 Muscle Relaxants 104 22.20 most appropriate for Spanish pain
.

5. I can’t think straight when in pain

00
(always), intended to assess four 3, 4, 5, 7, 9, 10
10,, 11
11,, 12
12,, 13
13,, 14
14,, 15
15,, 16
16,, 17
17),
),

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Ansyolitics 89 19.00 Cuando me duele no puedo pensar claramente .84 -.08 -66 patients.
patients. Examination of the item
and the second one (12 12..3 % of the

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components of pain-
pain-related anxiety
anxiety:: Antidepressant 57 12.50
Opioids 53 11.30 content revealed that both factors
explanatory variance) comprised 6 6. I will stop any activity as soon as I sense pain coming on
e

a) fear of pain, (b) cognitive anxiety,

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Others 7 1.40 En cuento me duele abandono todo lo que estoy haciendo .36 .52 .52 contained items from the four

ro
ht
(c) physiological symptoms of items (1, 6, 8, 18
18,, 19
19,, 29
29)). Table 2 shows

.
st

components of the PASS-PASS-20:

20: fear,

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anxiety, and (c) escape
escape--avoidance the factor loadings and communalities 7. Pain seems to cause my heart to pound or race
Cuando me duele el corazón me late tan fuerte que parece escape/avoidance, phsysiological

p
ig

2 .77 -.03 .57

(h ) of the 2-factor solution.
solution.
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que se va a salir
behavior.
behavior. Later, a shorter 20 20--item anxiety, and cognitive anxiety.
anxiety. It

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version of the PASS was derived 8. As soon as pain comes on I take medication to reduce it

ed
yr

appears that these factors represent

ht
Methods En cuanto me duele me tomo la medicación para que se me

st
-.26 .60 .32
(McCraken and Dhingra, 20022002)). Reliability pase
the same construct.
construct.
Participants
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9. When I feel pain I think that I might be seriously ill
There is evidence in favor of that the

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t
The sample included 468 Cuando me duele creo que debe ser porque estoy Results of this study showed that the

ec
.78 .01 .60
PASS-
PASS-20 is a valid and reliable gravemente enfermo
Spanish version of the PASS-
PASS-20 has
chronicspinal pain patients Cronbach’s α was calculated to

yr
measure (Coons et al al.., 2004
2004;; 10
10.. During painful episodes it is difficult for me to think of
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(59
59..40
40%% females)
females).. Their mean determine the internal consistency of anything besides the pain
.80 -.14
good internal consistency and
McCracken and Dhingra, 2002 2002;; .58

t
Cuando me duele no puedo pensar en nada
the total and factor scores
scores.. construct validity, although small

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age was 4646..54 years (SD = 13 13..23
23))

0
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Roelofs et alal.., 2004
2004),
), offering the 11
11.. I avoid important activities when I hurt effect sizes were found with the
s.

and the mean pain duration was

00
advantage of brevity
brevity.. In spite of this, Cuando me duele abandono incluso mis obligaciones .47 .34 .55
Fear-
Fear- Avoidance Beliefs
70..11 months (SD = 93
70 93..18
18)). Table

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a Spanish Version of the PASS PASS--20
er

1 shows the clinical 12 . When I sense pain I feel dizzy or faint Questionnaire..
Questionnaire
has not been available up to now.
now. α = .93 for PASS-
PASS-20. Cuando me duele me siento mareado .57 .16 .41

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characteristics of the
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Future studies are still required to

.
st

Therefore, the aim of this study is participants..

participants α = .92 for PASS-
PASS-F1 13.
13.Pain
Pain sensations are terrifying
.84 .04 .68
explore this Spanish version
version..

rs
Cuando me duele tengo una gran sensación de miedo
threefold::
threefold
ig

α = .86 for PASS-

PASS-F2
Po

14.
14.When
When I hurt I think about pain constantly
.53 .33 References

.
.51

e
Cuando me duele pienso en el dolor constantemente
Measures

ed
yr

Coons MJ, Hadjistavropoulos HD, Asmundson GJG GJG.. Factor

st
15
15.. Pain makes me nauseous .41 structure and psychometric properties of the Pain Anxiety
1. To determine the factor • Pain Anxiety Symptoms Scale Scale--20 Cuando me duele tengo náuseas
.64 .01
Symptoms Scale
Scale--20 in a community physiotherapy clinic
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structure of the Spanish version (McCracken and Dhingra, 2002 2002)).

0

sample
sample.. Eur J Pain 2004
2004;; 8:511-
511-16
16..

Po
ct
16
16.. When pain comes on strong I think that I might become
of the PASS
PASS--20 . • Anxiety Sensitivity Index Validity paralysed or more disabled McCracken LM, Dhingra L. A short version of the Pain Anxiety
00

Cuando me duele creo que me voy a quedar paralizado .76 .09 .63
Symptoms Scales (PASS(PASS--20
20)): preliminary development and

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2. To examine its reliability (Peterson and Reiss, 1992 1992)). validity
validity.. Pain Res Manage 2002
2002;; 7:45
45--50
50..
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17
17.. I find it hard to concentrate when I hurt
Cuando me duele me resulta difícil concentrarme McCracken LM, Zayfert C, Gross RT. RT. The Pain Anxiety
(internal consistency)
consistency).. Fear-- Avoidance
• Fear Beliefs Table 3 presents descriptive statistics .44 .37 .45

00
F1

Symptoms Scale
Scale:: development and validation of a scale to

o
18
18.. I find it difficult to calm my body down after periods of
Questionnaire (Waddell et al al.., and Pearson correlations coefficients measure fear of pain.
pain. Pain 1992
1992;; 50
50::67
67--73
73..
s.

3. To examine its validity pain

pr
.55
(construct) by exploring 1993
1993)). between PASS
PASS--20
20,, factor 1, factor 2, Cuando me duele me resulta difícil relajarme .05 .73 Roelofs J, McCracken LM, Peters ML, Crombez G, van
Breukelen G, Vlaeyen JWSJWS.. Psychometric Evaluation of the

10
er

relationships with other fear and • Pain Catastrophizing Scale and the pain
pain--related measures (all 19
19.. I worry when I am in pain
.02 .80 .66 Pain Anxiety Symptoms Scale (PASS) in chronic pain
d.

Cuando me duele me preocupo

patients
patients.. J Behav Med 2004
2004;; 27
27::167
167--83
83..
pain measures
measures.. (Sullivan et al.
al., 1995
1995)). correlations significant at p < .01
01)).
ht
st

20.
20.II try to avoid activities that cause pain

.F
.47
te

.19 .60
• Pain Vigilance and Awareness Cuando me duele intento evitar hacer cosas
ig

Questionnaire (McCracken,
Po
ec

e
1997
1997)). Table 3. Descriptive statistics and correlation matrix of PASS
PASS--20, PASS-
PASS-20 factors, and pain
pain--related measures

d
yr

st
• Roland-
Roland-Morris Questionnaire Chronic spinal pain sample(n
sample(n = 468)

te
(Roland and Morris, 1983 1983)).
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00

Variables Mean SD PASS

PASS--20 PASS
PASS--F1 PASS
PASS--F2

Po
• Pain numerical rating scale

ec
(Jensen et al
al.., 1999
1999)). PASS
PASS--20 35.73 17.30 _
Corresponding author:
.C
10

PASS
PASS--F1 20.48 13.41 .94 _

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Alicia E. López-
López-Martínez

00
Procedure PASS
PASS--F2 15.20 6.01 .75 .63 _ E-mail: aelm@uma.es
.F

pr
s

A battery of questionnaires wa Anxiety sensitivity 47.73 7.99 .49 .39 .51

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er

completed by each participant.

participant.
Fear-
Fear-avoidance 31.26 21.09 .18 .17 .17
Poster presented at the 7th Congress of
ed

The research project was

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st

the European Federation of IASP® approved by the “Carlos Haya” Catastrophizing 23.75 9.02 .49 .42 .48

.F
Chapters (EFIC®), Hamburg, Germany, University Hospital Ethics
ig

Pain vigilance 24.04 7.56 .40 .38 .31

Po
ct

2011 Committee at Málaga (Spain).

(Spain).

ed
Disability 9.18 3.28 .34 .21 .50
yr

Informed consent was obtained

te

prior to data collection

collection.. Pain intensity 5.31 1.61 .27 .27 .17