Background & Aims
The construct of pain acceptance has gained increasing attention in the management of chronic pain, and the Chronic Pain Acceptance Questionnaire – 20 (CPAQ-20) is the primary instrument used to measure it. The objectives of this study were to psychometrically evaluate the CPAQ-20 in a Chilean sample with chronic pain (N=401, 87% women). For this purpose, the factorial structure, reliability, and concurrent validity of the CPAQ-20 were analyzed. Using Confirmatory Factor Analysis, the two-factor structure—Activities Engagement and Pain Willingness—proposed by McCracken et al. (2004) was confirmed. Additionally, this model showed metric invariance across different administration modalities (e.g., telephone survey vs. self-report). The subscales exhibited good internal consistency (α= 0.85 and 0.83) and moderate to good test-retest reliability (Intraclass Correlation Coefficient of 0.65 and 0.75). Pain interference, depression, and kinesiophobia showed significant associations with activities engagement and pain willingness. The two subscales demonstrated unique predictive ability in each of the seven hierarchical regressions conducted using pain-associated variables as dependent variables (e.g., pain intensity, catastrophizing). In conclusion, the results provide evidence supporting the reliability and concurrent validity of measuring pain acceptance in a Chilean sample with chronic pain.
Methods
401 adults with non-cancer chronic pain (81,2% women) completed a set of scales with pain-related measures and the Chilean culturally adapted CPAQ-20 (C-CPAQ-20). An ordinal Confirmatory Factor Analysis was used, including the analysis of a three-factor model, with a unidimensional factor of 20 items and two method factors: one factor with the direct worded items (DF), the other with inverse worded items (IF), to explore possible method bias in item formulation. There were two types of scale application modalities, so Measurement Invariance Analysis was used. SEM correlations with pain-related and sociodemographic variables were estimated. Also, seven hierarchical regression analyses were employed to analyze the prediction of C-CPAQ-20 on pain-related variables, adjusting for modality and sociodemographic variables. Internal consistency was examined through polychoric Cronbach’s Alpha and a two weeks’ separation test-retest using Intraclass Correlation Coefficient, on 106 participants.
Results
Confirmatory Factor Analyses supported the three-factor model, which had the best goodness of fit compared to other models. Except for item 2, the method factors items loadings were adequate. The results support the invariance of the model across modalities. Results for Alpha showed a good internal consistency of the C-CPAQ-20 (? ranging from .89 to .81) and moderate test-retest stability (ICC from .79 to .68). Few correlations with relevant outcomes were observed: unidimensional factor and IF had low associations with pain interference, and moderate to low with depression, while IF alone had low correlations with kinesiophobia and pain catastrophizing, all inversely. Significant predictiveness of two out of the three C-CPAQ-20 factors was found in each criterion variable, and the percentage of explained variance of all the models improved significantly after the introduction of the C-CPAQ-20 factors. Higher change in R2 in pain interference (?R2=.18) than in pain intensity (?R2=.05).
Conclusions
The C-CPAQ-20 has evidence of good reliability and construct validity for the measurement of pain acceptance in a Chilean sample with non-cancer chronic pain. The results in this study bring the opportunity to examine the two theory-driven subscales of the original CPAQ-20 in a more detailed manner, by investigating potential method bias. Notably, there was no correlation with the traditionally used pain intensity variable, and the explained variance of the C-CPAQ-20 in this variable was low compared with the significant and stronger association and predictiveness that the two method factors had with pain interference. These findings are more coherent with what ACT defines as acceptance of pain: to willingly experience pain without trying to control or avoid it, while engaging in meaningful activities despite the presence of pain. Findings emphasize the importance of prioritizing acceptance of pain in chronic pain treatment, aligning with ACT principles.
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Presenting Author
María Labbé
Poster Authors
María S. Labbé
MSc
Pontificia Universidad Católica de Chile
Lead Author
Álvaro Vergés
Lead Author
Lydia Gómez-Pérez PhD.
Universidad de Málaga
Lead Author
Camila Román MSc
Pontificia Universidad Católica de Chile
Lead Author
Paula Padilla
Pontificia Universidad Católica de Chile
Lead Author
Josefina Durán
Pontificia Universidad Católica de Chile
Lead Author
Beatriz Pérez
CRS Cordillera Poniente
Lead Author
Patricio Cumsille
Lead Author
Topics
- Assessment and Diagnosis