Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Waltham, Massachusetts 02453, USA.
J Pain. 2011 Jun;12(6):677-86. doi: 10.1016/j.jpain.2010.12.008. Epub 2011 Feb 26.
An important construct in understanding pain-related disability is pain-related fear. Heightened pain-related fear may result in behavioral avoidance leading to disuse, disability, and depression; whereas confrontation of avoided activities may result in a reduction of fear over time and reengagement with activities of daily living. Although there are several measures to assess pain-related fear among adults with chronic pain, none exist for children and adolescents. The aim of the current study was to develop a new tool to assess avoidance and fear of pain with pediatric chronic pain patients: the Fear of Pain Questionnaire, child report (FOPQ-C), and Fear of Pain Questionnaire, parent proxy report (FOPQ-P). After initial pilot testing, the FOPQ-C and FOPQ-P were administered to 299 youth with chronic pain and their parents at an initial multidisciplinary pain treatment evaluation. The FOPQ demonstrated very strong internal consistency of .92 for the child and parent versions. One-month stability estimates were acceptable and suggested responsivity to change. For construct validity, the FOPQ correlated with generalized anxiety, pain catastrophizing, and somatization. Evidence of criterion-related validity was found with significant associations for the FOPQ with pain, healthcare utilization, and functional disability. These results support the FOPQ as a psychometrically sound measure.
Pain-related fear plays an important role in relation to emotional distress and pain-related disability among children and adolescents with chronic pain. Identification of patients with high levels of fear avoidance of pain with the FOPQ will inform how to proceed with psychological and physical therapy interventions for chronic pain.
理解疼痛相关残疾的一个重要结构是与疼痛相关的恐惧。高度的与疼痛相关的恐惧可能导致行为回避，从而导致失用、残疾和抑郁；而面对回避的活动可能会随着时间的推移减少恐惧，并重新参与日常生活活动。尽管有几种评估成年人慢性疼痛相关恐惧的方法，但对于儿童和青少年来说，这些方法并不存在。本研究的目的是为慢性疼痛的儿科患者开发一种新的评估回避和对疼痛恐惧的工具：疼痛恐惧问卷，儿童报告版（FOPQ-C）和疼痛恐惧问卷，家长代理报告版（FOPQ-P）。经过初步试点测试后，FOPQ-C 和 FOPQ-P 被用于 299 名患有慢性疼痛的青少年及其家长在多学科疼痛治疗评估中的初始阶段。FOPQ 的儿童和家长版本的内部一致性非常强，为.92。一个月的稳定性估计值可以接受，并表明对变化的反应能力。在结构有效性方面，FOPQ 与广泛性焦虑、疼痛灾难化和躯体化相关。与 FOPQ 与疼痛、医疗保健利用和功能残疾之间存在显著关联，这表明其具有标准相关的有效性。这些结果支持 FOPQ 作为一种具有良好心理测量学特性的测量工具。
在患有慢性疼痛的儿童和青少年中，与疼痛相关的恐惧在情绪困扰和与疼痛相关的残疾方面起着重要作用。使用 FOPQ 识别出高度恐惧回避疼痛的患者，将为如何进行慢性疼痛的心理和物理治疗干预提供信息。
