Cross-Cultural Adaptation and Validation of the Brazilian Portuguese Version of the Pain Catastrophizing Scale

Authors

  • Francisléa Sehn Phisiot,

    1. School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre
    2. Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre
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  • Eduardo Chachamovich MD, PhD,

    1. Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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  • Liliane Pinto Vidor DDS,

    1. School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre
    2. Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre
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  • Letizzia Dall-Agnol Phisiot,

    1. School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre
    2. Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre
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  • Izabel C. Custódio de Souza Biol, PhD,

    1. School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre
    2. Laboratory of Pain & Neuromodulation at HCPA/UFRGS, Porto Alegre
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  • Iraci L. S. Torres PharmaD, PhD,

    1. School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre
    2. Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre
    3. Laboratory of Pain & Neuromodulation at HCPA/UFRGS, Porto Alegre
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  • Felipe Fregni MD, PhD,

    1. Neurology and Physical Medicine & Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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  • Wolnei Caumo MD, PhD

    Corresponding author
    1. School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre
    2. Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre
    3. Laboratory of Pain & Neuromodulation at HCPA/UFRGS, Porto Alegre
    4. Pharmacology Department, Instituto de Ciências Básicas da Saúde, UFRGS, Porto Alegre, Brazil
    5. Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital, Boston, Massachusetts, USA
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  • Declaration of interests: The authors declare that there are no financial or other relationships that might lead to conflicts of interest.

Wolnei Caumo, MD, PhD, Hospital de Clínicas de Porto Alegre, Laboratory of Pain & Neuromodulation, Rua Ramiro Barcelos, 2350, CEP 90035-003, Bairro Rio Branco, Porto Alegre, RS, Brazil. Tel: (51)-3359-8083; Fax: 55-51-3308-5605; E-mail: caumo@cpovo.net.

Abstract

Objective.  Catastrophizing is a maladaptive response to pain and is one of the factors that contribute to the chronicity of some pain syndromes. The Pain Catastrophizing Scale (PCS) assists both treatment planning and outcome assessment. Its use is limited in Portuguese-speaking countries because of the lack of a validated translated version. We conducted the validation of the Brazilian Portuguese (BP)-PCS and explored its psychometric properties. This study reports the internal consistency, factor structure, and its capability to discriminate pain reported by patients with specific chronic pain conditions.

Methods.  Three hundred eighty-four patients, 317 women (82.55%), aged 18–79 years with chronic nonmalignant pain attending an outpatient multidisciplinary pain center participated in this cross-sectional study. The instruments were the BP-PCS, pain intensity, pain interference in functional capacity, and a sociodemographic questionnaire. One subsample with chronic tensional headache (CTH) according to the criteria of the International Headache Society (N = 19), and another with a diagnosis of fibromyalgia according to the American College of Rheumatology criteria (N = 50) were selected to assess the discriminative properties of BP-PCS.

Results.  We observed good internal consistency (Cronbach's α values of 0.91 for the total BP-PCS, and 0.93 [helplessness], 0.88 [magnification], and 0.86 [rumination] for the respective subdomains). The item-total correlation coefficients ranged from 0.91 to 0.94. Confirmatory factor analysis (CFA) supported the three factors structure, with the comparative fit index = 0.98, root mean square error of approximation = 0.09, and normed fit index = 0.98. Significant correlations were found for pain intensity, pain interference, and patient's mood (correlation coefficients ranged from 0.48 to 0.66, P < 0.01). No significant gender difference was observed for BP-PCS scores. When comparing scores of BP-PCS scale and subscales between the selected control group (patients with pain scores on visual analog scale equal or lower than 40 mm in the most part of the day in the last 6 months) and patients with fibromyalgia or CTH, we observed lower scores for the former group.

Conclusion.  Our findings support the validity and reliability of the BP-PCS. The scale showed satisfactory psychometric properties. CFA provides support for the three-factor structure reported in previous studies. This factor structure presented good discriminative properties to identify catastrophizers who present with mild chronic pain, fibromyalgia, and CTH. The BP-PCS is a valuable tool for use in scientific studies and in the clinical setting in patients with chronic pain in Brazilian Portuguese-speaking countries.

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