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Papers of the Week

Papers: 12 Aug 2023 - 18 Aug 2023

Clinical, Methodology, Psychology, Resource

Human Studies, Neurobiology


2023 Aug 11

J Pain


The Pain Anxiety Symptom Scale: Initial development and evaluation of four and eight item short forms.


Vowles KE, Kruger ES, Bailey RW, Ashworth J, Hickman J, Sowden G, McCracken LM


Elevated levels of anxiety in relation to chronic pain have been consistently associated with greater distress and disability. Thus, accurate measurement of pain-related anxiety is an important requirement in modern pain services. The Pain Anxiety Symptom Scale (PASS) was introduced over 30 years ago, with a shortened 20 item version introduced 10 years later. Both versions of the PASS were derived using principal components analysis, an established method of measure development with roots in classical test theory. Item Response Theory is a complementary approach to measure development that can reduce the number of items needed and maximize item utility with minimal loss of statistical and clinical information. The present study used IRT to shorten the 20 item PASS (PASS-20) in a large sample of people with chronic pain (N = 2669). Two shortened versions were evaluated, one composed of the single best performing item from each of its four subscales (PASS-4) and the other with the two best performing items from each subscale (PASS-8). Several supplementary analyses were performed, including comparative item convergence evaluations based on sample characteristics (i.e., female/male sex; clinical/online sample), factor invariance testing, and criterion validity evaluation of the 4, 8, and 20 item version of the PASS in hierarchical regression models predicting pain-related distress and interference. Overall, both shortened PASS versions performed adequately across these supplemental tests, although the PASS-4 had more consistent item convergence between samples, stronger evidence for factor invariance, and accounted for 83% of the variance accounted for by the PASS-20 and 92% of the variance accounted for by the PASS-8 in criterion variables. Consequently, the PASS-4 is recommended for use in situations where a briefer evaluation of pain-related anxiety is appropriate. PERSPECTIVE: The Pain Anxiety Symptom Scale (PASS) is an established measure of pain-related fear. This study derived four and eight item versions of the PASS using Item Response Theory. Both versions showed strong psychometric properties, stability of factor structure, and relation to important aspects of pain-related functioning.