Skip to main content
SpringerLink
Log in

Empirical Evidence of the Validity of the Spanish Version of the Pain Vigilance Awareness Questionnaire

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

The Spanish version of the Pain Vigilance and Awareness Questionnaire has not been validated.

Purpose

The aims of this study were to examine the factor structure of the Spanish version of the Pain Vigilance and Awareness Questionnaire and present empirical evidence regarding its validity.

Method

A sample of 468 chronic back pain patients completed a battery of instruments to assess fear-avoidance beliefs, pain anxiety, pain catastrophizing, pain vigilance and awareness, pain acceptance, depression, anxiety, disability, and pain intensity.

Results

Confirmatory factor analysis supported the validity of a nine-item version with two subscales: Active Vigilance and Passive Awareness. Both subscales and the total score were positively and significantly correlated with other fear-related constructs: fear-avoidance beliefs, pain anxiety, and pain catastrophizing. Regression analyses showed that Active Vigilance and the two subscales of the Fear-Avoidance Beliefs Questionnaire were significantly associated with higher anxiety and that the Acceptance Activity Engagement subscale was significantly associated with lower anxiety. The Fear-Avoidance Beliefs Questionnaire–Physical subscale was associated with higher disability and the Acceptance Pain Willingness subscale was associated with lower disability. The Fear-Avoidance Beliefs Questionnaire–Work subscale was significantly associated with higher pain intensity and depression; the Acceptance Activity Engagement and Pain Willingness subscales were significantly associated with lower pain intensity and depression.

Conclusion

The Spanish version of the Pain Vigilance and Awareness Questionnaire is a reliable and valid instrument. Pain Acceptance and Fear Avoidance beliefs are better predictors of adjustment to pain than pain hypervigilance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. When the total score of the CPAQ-SV was introduced into the regression analysis rather than the subscales of the PVAQ-SV and the FABQ-SV, acceptance was significantly associated with all the criterion variables (Pain Intensity, γ = −0.31, t = −5.54, p < 0.05; Depression, γ = −0.51, t = −10.95, p < 0.05; Anxiety, γ = −0.19, t = −3.66, p < 0.05; Disability, γ = −0.36, t = −6.47, p < 0.05).

References

  1. Crombez G, Van Damme S, Eccleston C. Hypervigilance to pain: an experimental and clinical analysis. Pain. 2005;116:4–7.

    Article  PubMed  Google Scholar 

  2. Van Damme SJ, Crombez G, Eccleston C, Roelofs J. The role of hypervigilance in the experience of pain. In: Asmundson GJG, Vlaeyen JWS, Crombez G, editors. Understanding and treating fear of pain. Oxford: Oxford University Press; 2004. p. 71–90.

    Google Scholar 

  3. McCracken LM. Attention to pain in persons with chronic pain: a behavioral approach. Behav Ther. 1997;28:271–84.

    Article  Google Scholar 

  4. Miller LC, Murphy R, Buss AH. Consciousness of body: private and public. J Pers Soc Psychol. 1981;41:397–406.

    Article  Google Scholar 

  5. Rosenstiel AK, Keefe EJ. The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain. 1983;17:33–44.

    Article  PubMed  CAS  Google Scholar 

  6. McWilliams LA, Asmundson GJG. Assessing individual differences in attention to pain: psychometric properties of the pain vigilance and awareness questionnaire modified for a non-clinical pain sample. Pers Indiv Differ. 2001;31:239–46.

    Article  Google Scholar 

  7. Roelofs J, Peters M, Muris P, Vlaeyen JWS. Dutch version of the pain vigilance and awareness questionnaire: validity and reliability in a pain-free population. Behav Res Ther. 2002;40:1081–90.

    Article  PubMed  CAS  Google Scholar 

  8. Roelofs J, Peters ML, McCracken LM, Vlaeyen JWS. The pain vigilance and awareness questionnaire (PVAQ): further psychometric evaluation in fibromyalgia and other chronic pain syndromes. Pain. 2003;101:299–306.

    Article  PubMed  Google Scholar 

  9. McCracken LM. A contextual analysis of attention to chronic pain: what the patient does with their pain might be more important than their awareness or vigilance alone. J Pain. 2007;8:230–6.

    Article  PubMed  Google Scholar 

  10. Esteve R, Muñoz M. Fear of pain and anxiety sensitivity: related or redundant constructs? In: Columbus P, editor. Fear of pain. New York: Nova; 2010. p. 25–42.

    Google Scholar 

  11. Asmundson GJG, Norton PJ, Vlaeyen JWS. Fear-avoidance models of chronic pain: an overview. In: Asmundson GJG, Vlaeyen JWS, Crombez G, editors. Understanding and treating fear of pain. Oxford: Oxford University Press; 2004. p. 3–24.

    Google Scholar 

  12. McNeil DW, Rainwater AJ. Development of the Fear of Pain Questionnaire—III. J Behav Med. 1998;21:389–410.

    Article  PubMed  CAS  Google Scholar 

  13. Kori SH, Miller RP, Todd DD. Kinesiophobia: a new view of chronic pain behavior. Pain Manage 1990; Jan/Feb: 35–43.

  14. Arntz A, De Jong P. Anxiety, attention and pain. J Psychosom Res. 1993;37:423–31.

    Article  PubMed  CAS  Google Scholar 

  15. Arntz A, Dressen L, De Jong P. The influence of anxiety on pain: attentional and attributional mediators. Pain. 1994;56:307–14.

    Article  PubMed  CAS  Google Scholar 

  16. Jassen SA, Arntz A. Anxiety and pain: attentional and endorphinergic influences. Pain. 1996;66:145–50.

    Article  Google Scholar 

  17. Goubert L, Crombez G, Van Damme S. The role of neuroticism, pain catastrophizing and pain-related fear in fear vigilance to pain: a structural equations approach. Pain. 2004;107:234–24.

    Article  PubMed  Google Scholar 

  18. Roelofs J, Peters ML, Patijn J, Schouten EGW, Vlaeyen JWS. Electronic dairy assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients. Pain. 2004;112:335–42.

    Article  PubMed  Google Scholar 

  19. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44:1–25.

    Article  PubMed  Google Scholar 

  20. McCracken LM, Velleman SC. Psychological flexibility in adults with chronic pain: a study of acceptance, mindfulness, and values-based action in primary care. Pain. 2010;148:141–7.

    Article  PubMed  Google Scholar 

  21. McCracken LM. Toward understanding acceptance and psychological flexibility in chronic pain. Pain. 2010;149:420–1.

    Article  PubMed  Google Scholar 

  22. Esteve R, Ramírez-Maestre C, López-Martinez AE. Adjustment to chronic pain: the role of pain acceptance, coping strategies, and pain-related cognitions. Ann Behav Med. 2007;33:79–88.

    Article  Google Scholar 

  23. McCracken LM. Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain. 1998;74:21–7.

    Article  PubMed  CAS  Google Scholar 

  24. McCracken LM, Samuel VM. The role of avoidance, pacing, and other activity patterns in chronic pain. Pain. 2007;130:119–25.

    Article  PubMed  Google Scholar 

  25. McCracken LM, Spertus IL, Janeck AS, Sinclair D, Wetzel FT. Behavioral dimensions of adjustment in persons with chronic pain: pain-related anxiety and acceptance. Pain. 1999;80:283–9.

    Article  PubMed  CAS  Google Scholar 

  26. McCracken LM, Vowles KE, Eccleston C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain. 2004;107:159–66.

    Article  PubMed  Google Scholar 

  27. McCracken LM, Vowles KE, Eccleston C. Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. Behav Res Ther. 2005;43:1335–46.

    Article  PubMed  Google Scholar 

  28. Viane I, Crombez G, Eccleston C, Devulder J, De Corte W. Acceptance of the unpleasant reality of chronic pain: effects upon attention to pain and engagement with daily activities. Pain. 2004;112:282–8.

    Article  PubMed  Google Scholar 

  29. Viane I, Crombez G, Eccleston C, Poppe C, Devulder J, Van Houdenhove B, De Corte W. Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal. Pain. 2003;106:65–72.

    Article  PubMed  Google Scholar 

  30. Vowles KE, McCracken LM. Acceptance and values-based action in chronic pain: a study of treatment effectiveness and process. J Consult Clin Psychol. 2008;76:397–407.

    Article  PubMed  Google Scholar 

  31. Vowles KE, McCracken LM. Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes. Behav Res Ther. 2010;48:141–6.

    Article  PubMed  Google Scholar 

  32. Vowles KE, McCracken LM, McLeod C, Eccleston C. The Chronic Pain Acceptance Questionnaire: confirmatory factor analysis and identification of patient subgroups. Pain. 2008;140:284–91.

    Article  PubMed  Google Scholar 

  33. Vowles KE, McNeil DW, Gross RT, McDaniel ML, Mouse A, Bates M, Gallimore P, McCall C. Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain. Behav Ther. 2007;38:412–25.

    Article  PubMed  Google Scholar 

  34. Wicksell RK, Olsson GL, Melin L. The Chronic Pain Acceptance Questionnaire (CPAQ)—further validation including a confirmatory factor analysis and a comparison with the Tampa Scale of Kinesiophobia. Eur J Pain. 2009;13:760–8.

    Article  PubMed  Google Scholar 

  35. Jensen MP, Turner P, Romano JM, Fisher LD. Comparative reliability and validity of chronic pain intensity measures. Pain. 1999;83:157–62.

    Article  PubMed  CAS  Google Scholar 

  36. Kline RB. Principles and practice of structural equation modeling. 3rd ed. New York: Guilford; 2005.

    Google Scholar 

  37. Waddell G, Newton M, Henderson J, Somerville D, Main CJ. A Fear-avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52:157–68.

    Article  PubMed  CAS  Google Scholar 

  38. Kovacs FM, Muriel A, Medina JM, Abraira V, Castillo-Sánchez MD, Olabe-Jaúregui J. Psychometric characteristics of the Spanish version of the FABQ Questionnaire. Spine. 2006;31:104–10.

    Article  PubMed  Google Scholar 

  39. McCracken LM, Zayfert C, Gross RT. The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain. Pain. 1992;50:67–73.

    Article  PubMed  CAS  Google Scholar 

  40. McCracken LM, Gross RT. Does anxiety affect coping with chronic pain? Clin J Pain. 1993;9:253–9.

    Article  PubMed  CAS  Google Scholar 

  41. Roelofs J, McCracken L, Peters ML, Crombez G, van Breukelen G, Vlaeyen JWS. Psychometric evaluation of the Pain Anxiety Symptoms Scale (PASS) in chronic pain patients. J Behav Med. 2004;27:167–83.

    Article  PubMed  Google Scholar 

  42. Sullivan MJL, Bishop SC, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess. 1995;7:524–32.

    Article  Google Scholar 

  43. Muñoz M, Esteve R. Reports of memory functioning by chronic pain patients. Clin J Pain. 2005;21:287–91.

    Article  PubMed  Google Scholar 

  44. Esteve R, López-Martínez AE, Ramírez-Maestre C, Masedo AI, Camacho L, Muñoz M. Evaluación de la aceptación del dolor crónico. VII European Conference on Psychological Assessment. Málaga: EAPA; 2004.

  45. Bendayan R, Esteve R, Blanca MJ. Empirical evidence of the validity of the Spanish version of the chronic pain acceptance questionnaire: the differential influence of activity engagement and pain willingness on adjustment to chronic pain. Br J Health Psychol. 2011. doi:10.1111/j.2044-8287.2011.02039.x.

  46. Rodero B, García-Campayo J, Casanueva B, Lopez Y, Serrano-Blanco A, Luciano JV. Validation of the Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ) for the assessment of acceptance in fibromyalgia. Health Qual Life Outcomes. 2010;8:37.

    Article  PubMed  Google Scholar 

  47. Zigmong AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scan. 1983;67:361–70.

    Article  Google Scholar 

  48. Quintana JM, Padierna A, Esteban C, Arostegui I, Bilbao A, Ruiz I. Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale. Acta Psych Scand. 2003;107:216–21.

    Article  CAS  Google Scholar 

  49. Tejero A, Guimerá EM, Farré JM. Uso clínico del HAD en población psiquiátrica: Un estudio de su sensibilidad, fiabilidad y validez. Rev Esp Dep Psiquiatr Bar. 1985;13:233–8.

    Google Scholar 

  50. Roland M, Morris R. A study of the natural history of back pain. Part I. Spine. 1983;8:141–4.

    Article  PubMed  CAS  Google Scholar 

  51. Kovacs FM, Llobera J, Gil del Real MT, Abraira V, Gestoso M, Fernández G, Grupo Kovacs de Atención Primaria. Validation of the Spanish version of the Roland Morris Questionnaire. Spine. 2002;27:538–42.

    Article  PubMed  Google Scholar 

  52. Jöreskog KG, Sörbom D. Lisrel 8: Structural Equation Modeling with the SIMPLIS Command Language. Hillsdale: Scientific Software International; 1993.

    Google Scholar 

  53. Bentler PM. EQS 6 structural equations program manual. Encino: Multivariate Software, Inc.; 2006.

    Google Scholar 

  54. Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990;107:238–46.

    Article  PubMed  CAS  Google Scholar 

  55. Bentler PM, Bonnet DG. Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull. 1980;88(3):588–606.

    Article  Google Scholar 

  56. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modelling. 1999;6:1–55.

    Article  Google Scholar 

  57. Hu L, Bentler PM. Fit indices in covariance structure modelling: sensitivity to underparameterized model misspecification. Psychol Meth. 1998;3:424–53.

    Article  Google Scholar 

  58. Comrey AL, Lee HB. A first course in factor analysis. Hillsdale: Erlbaum; 1992.

    Google Scholar 

  59. Cohen JW. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Erlbaum; 1988.

    Google Scholar 

  60. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy. New York: Guildford; 1999.

    Google Scholar 

Download references

Acknowledgments

This study was supported by grants from the Spanish Ministry of Science and Innovation (PSI2008-01803/PSIC), and the Regional Government of Andalusia (HUM-566; P07-SEJ-3067).

Author information

Authors and Affiliations

  1. Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain

    R. Esteve, C. Ramírez-Maestre & A. E. López-Martínez

Authors
  1. R. Esteve
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Ramírez-Maestre
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. E. López-Martínez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Esteve.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Esteve, R., Ramírez-Maestre, C. & López-Martínez, A.E. Empirical Evidence of the Validity of the Spanish Version of the Pain Vigilance Awareness Questionnaire. Int.J. Behav. Med. 20, 59–68 (2013). https://doi.org/10.1007/s12529-011-9216-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-011-9216-z

Keywords

Search

Navigation