The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain
Abstract
Fear of pain has been implicated in the development and maintenance of chronic pain behavior. Consistent with conceptualizations of anxiety as occurring within three response modes, this paper introduces an instrument to measure fear of pain across cognitive, overt behavioral, and physiological domains. The Pain Anxiety Symptoms Scale (PASS) was administered to 104 consecutive referrals to a multidisciplinary pain clinic. The alpha coefficients were 0.94 for the total scale and ranged from 0.81 to 0.89 for the subscales. Validity was supported by significant correlations with measures of anxiety and disability. Regression analyses controlling for measures of emotional distress and pain showed that the PASS made a significant and unique contribution to the prediction of disability and interference due to pain. Evidence presented here supports the potential utility of the PASS in the continued study of fear of pain and its contribution to the development and maintenance of pain behaviors. Factor analysis and behavioral validation studies are in progress.
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The PASS has demonstrated a stable factor structure and good psychometric properties, as well as strong correlations with the original 40-item PASS.
“The PASS has demonstrated a stable factor structure and good psychometric properties (McCracken & Dhingra, 2002; Roelofs et al., 2004), as well as strong correlations with the original 40-item PASS (McCracken, Zayfert, & Gross, 1992).”
From Acceptance and values-based action in chronic pain: A three-year follow-up analysis of treatment effectiveness and process (2011) · cites this paper as McCracken, Zayfert, & Gross, 1992
Patients scoring high on pain-related anxiety and fear score higher on self-report measures of disability and depression.
“They also score higher on self-report measures of disability and depression,76”
From Psychological aspects of persistent pain: Current state of the science (2004) · cites this paper as [76]
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References 33 · Cited by 950
- Authors
- McCracken, L. M., Zayfert, C., & Gross, R. T.
- Affiliations
- West Virginia University (US)
- Corresponding author
- Gross, Richard T.
- ORCID
- McCracken, Lance M.
- Venue
- Pain
- Published
- 1992-07
- Volume
- 50
- Issue
- 1
- Pages
- 67-73
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W2091211206
- Cited by
- 950
- References
- 33
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 35 · 2023: 47 · 2022: 19 · 2021: 39 · 2020: 43 · 2019: 30 · 2018: 29 · 2017: 30 · 2016: 34 · 2015: 39 · 2014: 38 · 2013: 43 · 2012: 40
- FWCI
- 4.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- fear of pain, chronic pain, anxiety, disability, pain interference, multidisciplinary pain clinic, scale development, psychometric validation
- MeSH terms
- Adult, Anxiety, Evaluation Studies as Topic, Female, Humans, Male, Middle Aged, Pain, Phobic Disorders, Psychiatric Status Rating Scales, Psychometrics, Regression Analysis
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