Chronic Pain Acceptance Questionnaire Useful Tool in Chronic Pain Assessment
With the ever increasing number of people living with chronic pain, it still appears that those who have chronic pain aren't always taken seriously by healthcare professionals. This is unfortunate because studies have shown that patients with chronic pain who are understood do much better physically and psychosocially than those who aren't understood. For example, studies have shown that people with rheumatoid arthritis have fewer painful flare-ups, people with lower back pain have a better quality of life, and people with mixed types of pain conditions can participate in more activities if their pain is understood and accepted than those who don't have that acceptance.
Now, physicians use the Chronic Pain Acceptance Questionnaire (CPAQ) as a measurement for how chronic pain affects their patients, but the number of questions used varied according to new ideas about pain surfaced. The author of this study wanted to learn what would be the most useful in the CPAQ to make up a solid assessment for chronic pain.
Researchers recruited patients with chronic pain and divided 333 into Group 1 and 308 into Group 2. All patients completed self-report questionnaires one week before being assessed by physicians. The questionnaires assessed levels of depression, pain anxiety, disability and medications. The medications were classified as strong opioids (controlled medications for pain relief), weak opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants, muscle relaxants, sedatives, anticonvulsants, selective serotonin reuptake inhibitors (SSRIs), which are antidepressants too, and over-the-counter pain relievers. Pain was rated on a scale of zero to 10, with zero being no pain at all and 10 being the worst possible.
The results of the study showed that the CPAQ could be divided into two sections: Activity Engagement and Pain Willingness, which is consistent with the earlier use of the questionnaire.
In Activity agreement, this is related to being involved in everyday activities while having pain and Pain Willingness is related to not participating in a certain behavior in order to prevent pain from occurring.
The patients turned out to fall into one of three clusters, two of which were expected. They were patients who score on either end of the scales, either high or low. The third cluster included patients who were functioning with everyday activities but still had a lot of pain that required pain relief. This group also may be functioning well physically, but reported psychosocial issues.
The authors of the article pointed out that the third group could benefit from treatment that would help them learn how to better cope with the physical pain so it would be more effectively relieved. They also noted that just because patients scored high on the Pain Willingness scale, it was not a given that they would score low on the Activity Engagement scale. This could be because many patients have the mindset that certain activities need to be done regardless of how much pain they're experiencing.
In an earlier study, by Nicholas and Asghari, CPAQ was criticized because it wasn't efficient in discovering issues like pain self-efficacy, pain-related anxiety, and catastrophizing (fearing the worst when it comes to pain). However, five other research groups didn't agree with these thoughts.
The authors conclude that using the CPAQ is useful and reliable in helping assess patients and their levels of pain until more reliable measurements are developed.
Kevin E. Vowles, et al. The Chronic Pain Acceptance Questionnaire: Confirmatory factor analysis and identification of patient subgroups. In Pain. Nov. 30, 2008. Vol. 140. No. 2. Pp. 284-291
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