Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter October 1, 2017

Developing a model for measuring fear of pain in Norwegian samples: The Fear of Pain Questionnaire Norway

Sara M. Vambheim, Peter Solvoll Lyby, Per M. Aslaksen, Magne Arve Flaten, Ole Åsli, Espen Bjørkedal and Laila M. Martinussen



Fear of pain is highly correlated with pain report and physiological measures of arousal when pain is inflicted. The Fear of Pain Questionnaire III (FPQ-III) and The Fear of Pain Questionnaire Short Form (FPQ-SF) are self-report inventories developed for assessment of fear of pain (FOP). A previous study assessed the fit of the FPQ-III and the FPQ-SF in a Norwegian non-clinical sample and proved poor fit of both models. This inspired the idea of testing the possibility of a Norwegian FOP-model.

Aims and methods

A Norwegian FOP-model was examined by Exploratory Factor Analysis (EFA) in a sample of 1112 healthy volunteers. Then, the model fit of the FPQ-III, FPQ-SF and the Norwegian FOP-model (FPQ-NOR) were compared by Confirmatory Factor Analysis ( CFA). Sex neutrality was explored by examining model fit, validity and reliability of the 3 models amongst male and female subgroups.


The EFA suggested either a 4-, a 5- or a 6-factor Norwegian FOP model. The eigenvalue criterion supported the suggested 6-factor model, which also explained most of the variance and was most interpretable. A CFA confirmed that the 6-factor model was better than the two 4- and 5-factor models. Furthermore, the CFA used to test the fit of the FPQ-NOR, the FPQ-III and the FPQ-SF showed that the FPQ-NOR had the best fit of the 3 models, both in the whole sample and in sex sub-groups.


A 6-factor model for explaining and measuring FOP in Norwegian samples was identified and termed the FPQ-NOR. This new model constituted six factors and 27 items, conceptualized as Minor, Severe, Injection, Fracture, Dental, and Cut Pain. The FPQ-NOR had the best fit overall and in male- and female subgroups, probably due to cross-cultural differences in FOP.


This study highlights the importance on exploratory analysis of FOP-instruments when applied to different countries or cultures. As the FPQ-III is widely used in both research and clinical settings, it is important to ensure that the models construct validity is high. Country specific validation of FOP in both clinical and non-clinical samples is recommended.

Department of Psychology, University of Tromsø, N-9037 Tromsø, Norway

  1. Ethical issues

    Informed consent for the studies were required and collected. The studies were approved by the Regional Committee for Medical Research Ethics North Norway.

  2. Conflict of interest

    Conflict of interest statement

    The authors declare no conflict of interest.


This study was supported by a grant from the BIAL Foundation (186/10) and the University of Tromsø, UiT, Tromsø, Norway.


[1] Albaret MC, Sastre MTM, Cottencin A, Mullet E. The Fear of Pain questionnaire: factor structure in samples ofyoung, middle-aged and elderly European people. EurJ Pain 2004;8:273–81, http://dx.doi.Org/10.1016/j.ejpain.2003. in Google Scholar PubMed

[2] McNeil DW, Rainwater AJ. Development of the Fear of Pain Questionnaire-III. J Behav Med 1998:21:389–410,http://dx.doi.Org/10.1023/A:1018782831217.10.1023/A:1018782831217Search in Google Scholar

[3] Roelofs J, Peters ML, Deutz J. Spijker C. Vlaeyen JWS. The Fear of Pain Questionnaire (FPQ: further psychometric examination in a non-clinical sample. Pain 2005;116:339–46,http://dx.doi.Org/10.1016/j.pain.2005. in Google Scholar PubMed

[4] Sole E, Castarlenas E, Sanchez-Rodriguez E, Galàn S, de la Vega R, Jensen MP, Mirò J. The reliability and validity of the Spanish version of the Fear of Pain Questionnaire. J Health Psychol 2017:1-11,,1359105316686669.10.1177/1359105316686669Search in Google Scholar PubMed

[5] Vambheim SM, Øien RA. Sex differences in fear of pain: item level analysis of the FPQ-III. J Pain Res 2017;10:825–31.10.2147/JPR.S128850Search in Google Scholar PubMed PubMed Central

[6] Vambheim SM, Lyby PS, Aslaksen PM, Flaten MA, Åsli O, Martinussen LM. The Fear of Pain Questionnaire III and the Fear of Pain Questionnaire Short Form: a confirmatory factor analysis. J Pain Res 2017;10:1871–8.10.2147/JPR.S133032Search in Google Scholar PubMed PubMed Central

[7] Wijk AJ, Hoogstraten J. Dutch translation of the Fear of Pain Questionnaire: factor structure, reliability and validity. Eur J Pain 2006;10:479–86,http://dx.doi.Org/10.1016/j.ejpain.2005. in Google Scholar PubMed

[8] Asmundson GJG, Bovell CV, Carleton NR, McWilliams LA. The Fear of Pain Questionnaire-Short Form (FPQ-SF): factorial validity and psychometric properties. Pain 2008;134:51–8.10.1016/j.pain.2007.03.033Search in Google Scholar PubMed

[9] Lyby PS, Aslaksen PM, Flaten MA. Is fear of pain related to placebo analgesia? J Psychosom Res 2010;68:369–77, in Google Scholar PubMed

[10] Hovi SL, Lauri S. Patients’ and nurses’ assessment of cancer pain. Eur J Cancer Care 1999;8:213–9.10.1046/j.1365-2354.1999.00171.xSearch in Google Scholar PubMed

[11] Aslaksen PM, Bystad M, Vambheim SM, Flaten MA. Gender differences in placebo analgesia: event-related potentials and emotional modulation. Psycho-som Med 2011;73:193–9, in Google Scholar PubMed

[12] Lyby PS, Aslaksen PM, Flaten MA. Variability in placebo analgesia and the role of fear of pain-an ERP study. Pain 2011;152:2405–12,http://dx.doi.Org/10.1016/j.pain.2011. in Google Scholar PubMed

[13] Lyby PS, Forsberg JT, Åsli O, Flaten MA. Induced fear reduces the effectiveness of a placebo intervention on pain. Pain 2012;153:1114–21,http://dx.doi.Org/10.1016/j.pain.2012. in Google Scholar PubMed

[14] Aslaksen PM, Lyby PS. Fear of pain potentiates nocebo hyperalgesia. J Pain Res 2015;8:703–10, in Google Scholar PubMed PubMed Central

[15] Bjorkedal E, Flaten MA. Interaction between expectancies and drug effects: an experimental investigation of placebo analgesia with caffeine as an active placebo. Psychopharmacology 2011;215:537–48, in Google Scholar PubMed PubMed Central

[16] Bjorkedal E, Flaten MA. Expectation of increased and decreased pain explain the effect of conditioned pain modulation in females. J Pain Res 2012;5:289–300, in Google Scholar PubMed PubMed Central

[17] Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Eq Model 2009;6:1–55, in Google Scholar

[18] Russell DW. In search of underlying dimensions: the use (and abuse) of factor analysis. PerSoc Psychol Bull 2002;28:1629–46.10.1177/014616702237645Search in Google Scholar

[19] Cortina JM. What is coefficient alpha? An examination of theory and applications. J Applied Psych 1993;78:98–104, in Google Scholar

[20] Browne MW, Cudeck R. Alternative ways of assessing model fit, vol. 154. Sage Focus Editions; 1993. p. 136.10.1177/0049124192021002005Search in Google Scholar

[21] Osman A, Breitenstein JL, Barrios FX, Gutierrez PM, Kopper BA. The Fear of Pain Questionnaire-Ill: further reliability and validity with nonclinical samples. J Behav Med 2002;25:155–73,http://dx.doi.Org/10.1023/A:1014884704974.10.1023/A:1014884704974Search in Google Scholar

[22] Carr TD, Lemanek KL, Armstrong FD. Pain and fear ratings: clinical implications of age and gender differences. J Pain Symptom Manage 1998;15: 305-13.10.1016/S0885-3924(97)00370-9Search in Google Scholar

[23] Costello AB, Osborn JB. Best practices in exploratory factor analysis: four recommendations for getting the most out of your analysis. PARE 2005;10.Search in Google Scholar

[24] Field A. Discovering statistics using SPSS. 3rd ed. London: SAGE Publications Ltd; 2009.Search in Google Scholar

[25] Kline P. An easy guide to factor analysis. London: Routledge; 1994.Search in Google Scholar

[26] Reise SP, Waller NG, Comrey AL Factor analysis and scale revision. Psych Assessment 2000;12:287–97.10.1037/1040-3590.12.3.287Search in Google Scholar

[27] Widaman KF. Common factor analysis versus principal component analysis: differential bias in representing model parameters? Multivar Behav Res 1993;28:263–311.10.1207/s15327906mbr2803_1Search in Google Scholar PubMed

[28] Robinson ME, Riley JL, Myers CD, Papas RK, Wise EA, Waxenberg LB, Fillingim RB. Gender role expectations of pain relationship to sex differences in pain. J Pain 2001;5:251–7.10.1054/jpai.2001.24551Search in Google Scholar PubMed

[29] Horn ME, Alappattu MJ, Gay CW, Bishop M. Fear of severe pain mediates sex differences in pain sensitivity responses to thermal stimuli. Pain Res Treat 2014:7, in Google Scholar PubMed PubMed Central

Received: 2017-08-09
Revised: 2017-10-09
Accepted: 2017-10-10
Published Online: 2017-10-01
Published in Print: 2017-10-01

© 2017 Scandinavian Association for the Study of Pain

Scroll Up Arrow