Translation and validation of Simplified Chinese version of the Pain Catastrophizing Scale in chronic pain patients: Education may matter
Open accessAbstract
Objective: Pain catastrophizing is linked to many aspects of pain perception and defines a unique dimension in predicting pain intensity and physical disability. Pain Catastrophizing Scale (PCS) is an effective, validated,self-report measure, commonly used in clinical trials. Here, we present a Simplified Chinese PCS (SC-PCS) version developed in Chinese patients suffering from chronic pain. Methods: The SC-PCS was generated in five steps and tested on an initial patient cohort (N = 30). A convenience sample (N = 200) of in-hospital patients with non-malignant pain lasting for more than 12 weeks were recruited for the study, of which 81 completed 5 additional pain questionnaires. A subset (N = 24) of the patients completed an additional SC-PCS, 10 days after the initial query to assess test–retest validation. Results: Intra-class correlations coefficient indicated high reproducibility and temporal consistency, (0.97), for the total score. Cronbach’s alpha determined high internal consistency across the SC-PCS total score and its three subscales (0.87, 0.85, 0.62, and 0.65). The SC-PCS total score moderately or weakly (R = −0.2 to 0.49), but significantly, correlated with other measurements, such as pain Visual Analog Scale, Beck Depression Inventory, Pain Anxiety Symptoms Scales, Positive and Negative Affect Schedule, and education. We used exploratory factor analysis to examine the dimensionality of the SC-PCS, which indicated instability of the current three-factor model. However, a confirmatory factor analysis indicated that the three-factor model had the best goodness-fitting. Conclusions: We demonstrate the successful translational adaptation from English to Simplified Chinese as well as the reliability and validity of SC-PCS. An important discovery was education level significantly correlated with SC-PCS, identifying a future consideration for other cross-cultural development of self-reported measures.
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All the measures employed have excellent or good internal consistency and test-retest reliability and are widely used as outcome measures in chronic pain services.
“All the measures employed have excellent or good internal consistency and test-retest reliability 9,10,14 -16 and are widely used as outcome measures in chronic pain services.”
From A service evaluation to examine the effectiveness of chronic pain management programmes delivered using video conferencing technology compared to in-person (2023) · cites this paper as [16]
The Abstract (Results; page unavailable) reports good internal consistency for the Simplified Chinese Pain Catastrophizing Scale total score (α = 0.87) and excellent test–retest reproducibility (ICC = 0.97). The paper does not establish these properties for all measures employed: two SC-PCS subscales had lower internal consistency (α = 0.62 and 0.65). It also does not establish that the measures are widely used as outcomes in chronic pain services. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPublished reliable change values were not found for the PSEQ, CPAQ and PCS questionnaires, so Criterion A on the Leeds RCI calculator, which uses Cronbach's alpha as a reliability measure, was used with values from several large studies: PSEQ = 0.94, CPAQ = 0.90 and PCS = 0.87.
“Published reliable change values were not found for the PSEQ, CPAQ and PCS questionnaires. Therefore, we used Criterion A on the Leeds RCI calculator which uses Cronbach ' s alpha as a reliability measure, and were found from several large studies as follows: PSEQ = 0.94, 11 CPAQ = 0.90, 15 and PCS = 0.87. 16”
From A service evaluation to examine the effectiveness of chronic pain management programmes delivered using video conferencing technology compared to in-person (2023) · cites this paper as [16]
Pain catastrophizing will be assessed with the Pain Catastrophizing Scale (PCS).
“Pain catastrophizing will be assessed with the Pain Catastrophizing Scale (PCS). PCS consists of 13 items, and each item will be answered with a numeric value between 0 and 4; 0 corresponded to “not at all,” and 4 corresponded to “all the time.” Higher scores indicate a higher level of pain catastrophizing [30].”
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Whole-brain functional network disruption in chronic pain with disk herniation
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“PCS has good reliability (Cronbach’s α = 0.87) [48].”
InfluentialZhang, C., Chen, X., Yin, Y., Xie, D.-F., Luo, J., Ai, Y., Zhan, W., Kan, H., Zhang, S., Jiang, G., et al. (2023) · Pain Research and Management · doi:10.1155/2023/2028379 · Cited by 4 · see citing works
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“China-based studies (Shen et al., 2018; Yap et al., 2008) have replicated the original PCS structure and reported satisfactory psychometrics.”
BackgroundCheng, M., Liu, H., Pu, C., Chen, G., Zhang, Y., & Yan, L. (2024) · Pain Management Nursing · doi:10.1016/j.pmn.2024.06.006 · Cited by 3 · see citing works
Ou-Yang, Z.-Y., Feng, Y., Yang, Y., Chen, N.-X., Su, X.-L., Zhang, Q., Zhong, M., Hu, J., Ye, Q., Zhao, J., et al. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043244 · Cited by 3 · see citing works
“Pain catastrophizing, according to other research, is a distinct contributor to the subjective experience of pain intensity [21,22].”
BackgroundTian, A., Gao, H., Wang, Z., Li, N., Ma, J., Guo, L., & Ma, X. (2023) · BMC Medical Imaging · doi:10.1186/s12880-023-01057-8 · Cited by 3 · see citing works
“In line with previous studies [10], four questionnaires (Pain Anxiety Symptoms Scale [20], Fear of Pain Questionnaire III [21], Pain Catastrophizing Scale [22] and Pain Vigilance and Awareness Questionnaire [23]) were applied to measure fear of pain (FoP).”
MethodJoy, D., & Caddle, A. (2023) · British Journal of Pain · doi:10.1177/20494637221135125 · Cited by 2 · see citing works
Yuan, F., Jia, C., Liu, H., Bao, T., Wang, C., Wang, Z., Huang, J., Jiang, Y., Wang, X., Zhang, R., et al. (2025) · Journal of Pain Research · doi:10.2147/jpr.s518072 · Cited by 2 · see citing works
Latent profile analysis of kinesiophobia in patients after lumbar spine surgery
Huang, Q. M., Zhang, X., & Ren, Y. (2025) · European Spine Journal · doi:10.1007/s00586-025-09297-8 · Cited by 2 · see citing works
“This study utilized the Chinese version of PCS, translated and validated by Chinese scholar Shen [38].”
Li, J., Zhao, R., Wang, C., Guo, X., Song, J., & Chu, X. (2023) · The Spine Journal · doi:10.1016/j.spinee.2023.09.003 · Cited by 2 · see citing works
Li, Z., Shi, Y., Chen, X., Wu, Q., Xi, H., & Tian, M. (2024) · Anaesthesia Critical Care & Pain Medicine · doi:10.1016/j.accpm.2024.101361 · Cited by 2 · see citing works
Tu, Z., Miao, J., Zhang, Y., Yang, Z., Xu, R., & Neblett, R. (2024) · Pain Research and Management · doi:10.1155/prm/7966689 · Cited by 1 · see citing works
Variability in Pain Traits Among Young Individuals with High and Low Pain Sensitivity
Zhi, Y., Mao, Z., Zhang, M., & Kong, Y.-Z. (2025) · Journal of Pain Research · doi:10.2147/jpr.s529198 · Cited by 1 · see citing works
Zhang, Y., Long, W., Wang, H., Wang, J., Tang, C., Ma, J., & Zhong, J. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-076362 · Cited by 1 · see citing works
Momentary pain assessments reveal benefits of endoscopic discectomy: a prospective cohort study
Wakaizumi, K., Wu, B., Huang, S., Fan, L., Shen, B., Wu, B., Zhang, J., Baliki, M. N., Apkarian, A. V., & Huang, L. (2021) · PAIN Reports · doi:10.1097/pr9.0000000000000906 · Cited by 1 · see citing works
Self-citationChen, K., Yu, J., Nie, C., Zhu, Y., Jiang, J., Lei, W., Xia, X., & Zheng, C. (2022) · Figshare · doi:10.6084/m9.figshare.19695995
Research Progress in Efficacy Evaluation after Total Knee Arthroplasty
范, 磊. (2024) · Advances in Clinical Medicine · doi:10.12677/acm.2024.14102620
Çankaya, Ö., Akın, E., Kabul, E. G., Tatar, Z., Kılbaş, G., Saraçoğlu, İ., Çalık, B. B., & Yüksel, S. (2025) · Children s Health Care · doi:10.1080/02739615.2025.2476072
“The child version of the PCS (PCS-C) was translated into different languages with many diagnoses of children with chronic pain (Cederberg et al., 2019; Kröner-Herwig & Maas, 2013; Parkerson et al., 2013; Schneider et al., 2022; Shen et al., 2018; Solé et al., 2016).”
InfluentialFeng, Y., Wu, Y., Liu, H., Bao, T., Wang, C., Wang, Z., Huang, J., Jiang, Y., He, C., & Zhu, S. (2023) · Figshare · doi:10.6084/m9.figshare.24564203
Feng, Y., Wu, Y., Liu, H., Bao, T., Wang, C., Wang, Z., Huang, J., Jiang, Y., He, C., & Zhu, S. (2024) · Figshare · doi:10.6084/m9.figshare.24564276
Ibrahim, A. A., Akindele, M. O., Kaka, B., & Mukhtar, N. B. (2021) · Figshare · doi:10.6084/m9.figshare.13725302
Yang, M., Xian, Q., Yang, H.-F., Xu, X., & Al-Goshae, H. (2026) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-026-09541-2
“Pain Catastrophizing Scale (PCS): Patients were assessed preoperatively using the validated Chinese version of the PCS [24].”
Chen, K., Chen, Y., Li, H., Zhan, X., Zhao, X., Zhou, J., Yang, J., Fu, S., Niu, Z., Liu, H., et al. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-113227
Pain Catastrophizing Scale (PCS) in Brazilian patients with chronic cancer pain: A validation study
de Sousa, K. F., Bassi-Dibai, D., Guedes, C. L. R., Mendes, L. P., Coutinho, S. M., Pinheiro, J. S., Leal, P. D. C., de-Paula-Gomes, C. A. F., & Dibai-Filho, A. V. (2026) · Rehabilitación · doi:10.1016/j.rh.2026.101004
- Authors
- Shen, B., Wu, B., Abdullah, T. B., Zhan, G., Lian, Q., Vania Apkarian, A., & Huang, L.
- Affiliations
- Wenzhou Medical University (CN)
- Northwestern University (US)
- China-USA Neuroimaging Research Institute, the Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Corresponding author
- Huang, Lejian
- Venue
- Molecular Pain
- Publisher
- SAGE Publications
- Published
- 2018-01
- Volume
- 14
- Pages
- 1744806918755283-1744806918755283
- ISSN
- 1744-8069 (ISSN-L)
- PMC
- PMC5788090
- OpenAlex
- W2784690968
- Cited by
- 44
- References
- 52
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 10 · 2023: 11 · 2022: 5 · 2021: 4 · 2020: 2 · 2019: 2 · 2018: 1
- FWCI
- 1.45
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Molecular Pain (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Wenzhou Medical University
- Wenzhou University
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- pain catastrophizing, Pain Catastrophizing Scale, cross-cultural adaptation, chronic pain, test-retest reliability, factor structure, educational attainment, self-report measures, psychometric validation
- MeSH terms
- Demography, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Pain Measurement, Socioeconomic Factors, Reproducibility of Results, Catastrophization, Chronic Pain
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