Let’s talk about pain catastrophizing measures: an item content analysis

Background. Concerns have been raised about whether self-report measures of pain
catastrophizing reflect the construct as defined in the cognitive-behavioral literature.
We investigated the content of these self-report measures; that is, whether items assess
the construct ‘pain catastrophizing’ and not other theoretical constructs (i.e., related
constructs or pain outcomes) using the discriminant content validity method.
Method. Items (n = 58) of six pain catastrophizing measures were complemented with
items (n = 34) from questionnaires measuring pain-related worrying, vigilance, pain
severity, distress, and disability. Via an online survey, 94 participants rated to what
extent each item was relevant for assessing pain catastrophizing, defined as ‘‘to view
or present pain or pain-related problems as considerably worse than they actually are’’
and other relevant constructs (pain-related worrying, vigilance, pain severity, distress,
and disability).
Results. Data were analyzed using Bayesian hierarchical models. The results revealed
that the items from pain-related worrying, vigilance, pain severity, distress, and
disability questionnaires were distinctively related to their respective constructs. This
was not observed for the items from the pain catastrophizing questionnaires. The
content of the pain catastrophizing measures was equally well, or even better, captured
by pain-related worrying or pain-related distress.
Conclusion. Based upon current findings, a recommendation may be to develop a
novel pain catastrophizing questionnaire. However, we argue that pain catastrophizing
cannot be assessed by self-report questionnaires. Pain catastrophizing requires contextual information, and expert judgment, which cannot be provided by self-report
questionnaires. We argue for a person-centered approach, and propose to rename ‘pain
catastrophizing’ measures in line with what is better measured: ‘pain-related worrying’