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.
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.2003.09.005.10.1016/j.ejpain.2003.09.005)| false
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.2005.05.003.10.1016/j.pain.2005.05.003)| false
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.
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.S133032)| false
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.2005.06.008.10.1016/j.ejpain.2005.06.00816095936)| false
Asmundson GJG, Bovell CV, Carleton NR, McWilliams LA. The Fear of Pain Questionnaire-Short Form (FPQ-SF): factorial validity and psychometric properties. Pain 2008;134:51–8.1748236110.1016/j.pain.2007.03.033)| false
Lyby PS, Aslaksen PM, Flaten MA. Is fear of pain related to placebo analgesia? J Psychosom Res 2010;68:369–77,http://dx.doi.org/10.1016/j.jpsychores.2009.10.009.2030770410.1016/j.jpsychores.2009.10.009)| false
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.2011.07.010.10.1016/j.pain.2011.07.01021875771)| false
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.2012.02.042.2246469610.1016/j.pain.2012.02.042)| false
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,http://dx.doi.org/10.1007/s00213-011-2233-4.
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,http://dx.doi.org/10.1007/s00213-011-2233-4.2138410610.1007/s00213-011-2233-4)| false
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,http://dx.doi.org/10.2147/JPR.S33559.23049277)| false
Browne MW, Cudeck R. Alternative ways of assessing model fit, vol. 154. Sage Focus Editions; 1993. p. 136.
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.
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:1014884704974.1197743610.1023/A:1014884704974)| false