Validity of Turkish form of Pain Catastrophizing Scale and modeling of the relationship between pain-related disability with pain intensity, cognitive, and emotional factors

Objective: Pain is one of the significant physical manifestations leading to disability. When investigating disability due to painful chronic diseases, either the particular effect of pain is not adequately separated from other symptoms of the disease, or only the focus is on the physical component of the pain. Therefore, the role of cognitive and emotional factors on disability has been reversed. But recently, attention is increasingly drawn to the role of cognitive and emotional factors in the pathophysiology and treatment of pain. The purpose of this study is to investigate the validity and reliability of the Turkish version of the Pain Catastrophizing Scale (PCS) evaluating cognitive characteristics of pain and is to reveal the relationship between the severity of pain, cognitive and emotional factors and disability through a model.

Methods: The study was conducted with 216 patients with the rheumatologic disease with chronic pain for at least six months. In the validity–reliability analyses, Cronbach’s alpha, inter-item and item-total correlations, test–retest correlation, and confirmatory factor analysis were applied. Automatic Thoughts Questionnaire was given for parallel test validity. The effects of the physical, cognitive, and emotional components of the pain on disability were assessed with Brief Symptom Inventory, Visual Analog Scale, PCS, and Pain Disability Index and analyzed with Structural Equation Modelling.

Results: Cronbach’s alpha for PCS’ Turkish form was 0.955. Inter-item and item-total correlation were between 0.488 and 0.848. Intraclass correlation coefficient was 0.830. Confirmatory factor analysis confirmed the three-factor model of PCS. Path model showed that pain-related disability is affected not only by the physical properties of the pain but also by the direct and indirect cognitive and emotional factors. Gender and duration of pain are covariates.

Discussion: It is important to determine the severity of pain in the evaluation of pain, but the emotional and cognitive characteristics of the pain should also be in this assessment. Turkish version of the PCS can be used in this evaluation. Our study showed that cognitive and emotional interventions, both directly and indirectly, may be positively reflected in the results of attempts to reduce pain-related disability.