Original article
Cross-cultural adaptation, reliability, and validity of the German version of the Pain Catastrophizing Scale

https://doi.org/10.1016/j.jpsychores.2007.12.004Get rights and content

Abstract

Objective

In patients with chronic pain, catastrophizing is a significant determinant of self-rated pain intensity and disability. The Pain Catastrophizing Scale (PCS) was developed to assist with both treatment planning and outcome assessment; to date, no German version has been validated.

Methods

A cross-cultural adaptation of the PCS into German was carried out, strictly according to recommended methods. A questionnaire booklet containing the PCS, visual analogue scales (numeric rating scale) for pain intensity and general health, the ZUNG self-rating depression scale, the Modified Somatic Perception Questionnaire (MSPQ), the Fear Avoidance Beliefs Questionnaire (FABQ), and the Roland–Morris (RM) disability questionnaire was completed by 111 patients with chronic low back pain (mean age, 49 years), 100 of which also completed it again 7 days later.

Results

Cronbach's α (internal reliability) for the three subsections of the PCS—helplessness, magnification, rumination—and for the whole questionnaire (PCSwhole) were .89, .67, .88, and .92, respectively. The intraclass correlation coefficients of agreement for the reproducibility were .81, .67, .78, and .80, respectively. The PCSwhole scores correlated with the other scores as follows: pain intensity r=.26, general health r=−.29, ZUNG r=.52, MSPQ r=.53, FABQactivityr=.51, FABQworkr=.61 and RM r=.57. Factor analysis revealed three factors, with an almost identical factor structure to that reported in previous studies.

Conclusion

The psychometric properties of our German version of the PCS were comparable to those reported in previous studies for the original English version. It represents a valuable tool in the assessment of German-speaking chronic low back pain patients.

Introduction

Chronic nonspecific musculoskeletal pain is a burden for patients and is associated with high socioeconomic costs [1], [2], [3]. The underlying construct of chronic pain is complex, and biopsychosocial factors influence both its development and its maintenance: psychological components, such as unhelpful pain cognitions [4], depression, and fearful or catastrophizing thoughts, can influence perceived pain, quality of life [5], physical performance [4], [6], and subjective disability [6]. Catastrophizing is defined as a maladaptive response to pain and is characterized by an experience of heightened pain intensity and difficulty in disengaging from pain [6]; it is an important predictor of pain severity, and of how people cope with pain [7], [8], [9], and appears to predict future disability better than do other variables [6]. Some studies have indicated that pain catastrophizing predicts depression or even mediates the reduction in depression, the perception of pain and the behavior in response to cognitive-behavioral or graded-exercise therapy [10], [11], [12]. Diminishing catastrophizing thoughts can positively influence coping with pain, and behavioral and cognitive traits [13], [14], [15]. In psychological research, it has been shown that pain catastrophizing behavior can influence those involved with the catastrophizer, leading to overcautious treatment decisions [16], [17].

For all these reasons, diminishing catastrophizing thoughts should constitute an important ingredient of therapy for chronic low back pain (LBP) [11]. The Pain Catastrophizing Scale (PCS) was developed in the English language by Sullivan et al. [18] to screen patients with catastrophizing thoughts and to improve treatment planning, implementation, and outcome assessment. The English version of the PCS has been well investigated and its psychometric properties are good [18], [19], [20], [21]. A systematic search of the literature revealed that, to date, no validated German version exists.

The aim of this study was to cross-culturally adapt the English version of the PCS into German and to evaluate its psychometric properties (internal consistency, construct validity, factor structure, reproducibility) in a large group of patients with LBP.

Section snippets

The Pain Catastrophizing Scale (PCS)

The PCS is a self-administered questionnaire that consists of 13 items to assess the extent of the patient's catastrophizing thoughts and behaviors. It comprises three subscales: helplessness, magnification, and rumination. The questionnaire is completed in relation to the patient's thoughts and feelings when they are in pain. It contains questions concerning, for example, the degree to which the person worries all the time about whether the pain will end, thinks how awful and overwhelming it

Cross-cultural adaptation of the PCS

The final version of the German PCS is shown in Appendix A. A few noteworthy difficulties arose during the development of the German version of the PCS, as follows:

Translation and cross-cultural adaptation of the PCS

The aim of the present study was to cross-culturally adapt the PCS, for use with German-speaking patients, and to examine the psychometric properties of the German version produced. Overall, the German version of the PCS showed good psychometric properties. In the following, the translation process and the results concerning validity and reliability will be discussed.

Adaptation of a German version of the PCS

The process of translating and back-translating the English PCS was carried out strictly in accordance with established

Concerns about floor effects

Using the traditional approach, we detected a floor effect of 12% and no ceiling effect for the PCS total score. However, with the more sensible scale width approach, using the minimal detectable change at the two ends of the scale, we detected a noticeable floor effect of 33.7% for the total scale and even greater floor effects for the subscales. This may indicate a scaling problem of the PCS, and it suggests that the PCS would not be able to identify/detect changes in catastrophizing thoughts

Conclusion

The psychometric properties of our German version of the PCS were comparable to those reported by Osman et al. and Van Damme et al. [19], [20], [21] and exceeded those of the original English version [18]. The PCS showed good internal consistency, and the three-factor structure, reported in previous studies, could be replicated. It also showed acceptable to good reproducibility, with a minimal detectable change score of approximately 13 points. Tests of concurrent validity showed that it

Acknowledgments

This project was funded by the National Research Programme NRP53 “Musculoskeletal Health—Chronic Pain” of the Swiss National Science Foundation (Project 405340-104787/2). We thank Gabi Umbricht, Astrid Junge, Marco Saltzmann, Sue Huber, and Vivien Robinson for their exact and unremitting work in performing the forward- and back-translations and Daniel Uebelhart for providing the infrastructure within our Research Unit to carry out this study. Further thanks go to Sven Hoffman and Alex Tschopp

References (55)

  • MJ Sullivan et al.

    Catastrophic thinking and heightened perception of pain in others

    Pain

    (2006)
  • S Van Damme et al.

    A confirmatory factor analysis of the Pain Catastrophizing Scale: invariant factor structure across clinical and non-clinical populations

    Pain

    (2002)
  • F Guillemin et al.

    Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines

    J Clin Epidemiol

    (1993)
  • J Roelofs et al.

    The Tampa Scale for Kinesiophobia: further examination of psychometric properties in patients with chronic low back pain and fibromyalgia

    Eur J Pain

    (2004)
  • CJ Main

    The Modified Somatic Perception Questionnaire (MSPQ)

    J Psychosom Res

    (1983)
  • G Waddell et al.

    A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability

    Pain

    (1993)
  • CB Terwee et al.

    Quality criteria were proposed for measurement properties of health status questionnaires

    J Clin Epidemiol

    (2007)
  • HC De Vet et al.

    When to use agreement versus reliability measures

    J Clin Epidemiol

    (2006)
  • CB Terwee et al.

    Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patients

    J Clin Epidemiol

    (2006)
  • Klaber Moffett J, Richardson G, Sheldon TA, Maynard A. Back pain: its management and cost to society. Center for Health...
  • JW Frymoyer et al.

    The economics of spinal disorders

    The adult spine: principles and practice

    (1997)
  • A Nachemson et al.

    Epidemiology of neck and low back pain

  • MJ Sullivan et al.

    Theoretical perspectives on the relation between catastrophizing and pain

    Clin J Pain

    (2001)
  • DC Turk et al.

    Cognitive factors and persistent pain: a glimpse into pandora's box

    Cogn Ther Res

    (1992)
  • CJ Main et al.

    The Distress and Risk Assessment Method. A simple patient classification to identify distress and evaluate the risk of poor outcome

    Spine

    (1992)
  • MJL Sullivan et al.

    The Pain Catastrophizing Scale: development and validation

    Psychol Assess

    (1995)
  • A Osman et al.

    The Pain Catastrophizing Scale: further psychometric evaluation with adult samples

    J Behav Med

    (2000)
  • Cited by (196)

    View all citing articles on Scopus
    View full text