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Psychosocial stressors in the pain experience: The development of a pain-validation scale

Nicola, Melinda (2020) Psychosocial stressors in the pain experience: The development of a pain-validation scale. PhD thesis, Murdoch University.

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Many people with chronic pain report distress at being disbelieved, judged, or criticized with regards to their pain. Pain-invalidation may be inflicted by the self, by immediate others in one’s social network, or come from healthcare professionals. At the other extreme, over-validation may also be problematic, with excessive interference by well-meaning others potentially limiting functional rehabilitation. Given the potential for psychological and physiological detriment of pain-invalidation or over-validation, this research was designed to operationalize the construct of pain-validation and enable its measurement. Study 1 involved a thematic analysis of pain narratives, to identify pain-validation themes, and to facilitate the creation of an item pool best representing the construct. Terms related to pain-validation, invalidation and over-validation were employed in a systematic search strategy used to extract relevant articles from 5 databases. Examination of 431 peer-reviewed articles, followed by a thematic analysis, gave rise to five major themes including: Not Being Believed, Lack of Compassion, Lack of Understanding / Awareness, Critical Judgement, and Feeling Stigmatized. The outcomes from themes identified in Study 1 informed the generation of items for Study 2: Development of a Pain-Validation Scale. Six subject matter experts and 10 adults from the general community provided feedback on a broad pool of items, regarding construct relevance, item wording, and suitability of the response scale. A pain-validation survey was then distributed to 302 participants aged between 18-65 years having chronic pain, recruited via the online crowdsourcing platform, Prolific. Exploratory factor analysis was performed on the data collected, and guided decisions on reduction of the item list to 36 items. The resulting proposed Pain-Validation Scale (P-VS) consisted of 4 subscales: Invalidation by the Self, Invalidation by Immediate Others, Invalidation by Healthcare Professionals, and Over-validation. Study 3 involved the distribution of a second survey, again using Prolific to recruit 308 participants aged between 18 – 65 years with chronic pain. Confirmatory factor analysis was performed on the resulting data, and structural equation modelling was used to determine a model of best fit for the measure. Through the consideration of construct representation, internal consistency, and statistical ‘best fit’, the 24-item model was deemed the most appropriate model of pain-validation. The 4 subscales were retained, each represented by 6 items. Part 2 of Study 3 involved analyses designed to demonstrate validity and reliability of the Pain-Validation Scale. High internal consistencies were found for all subscales, and test-retest outcomes at 1 month showed acceptable stability of subscale scores of the P-VS instrument. To further support the validity of the P-VS, regression analyses were conducted examining the relationship of each pain-validation domain with related theoretical constructs including self-compassion, perfectionism, fear of negative evaluation, self-efficacy, illness cognitions, and pain-catastrophization. Additionally, hierarchical linear regressions allowed for examination of covariates Age, Gender, and Pain Frequency, and showed that Pain Frequency was an important variable contributing to pain-validation outcomes. Having demonstrated evidence of validity and reliability, the P-VS may be appropriate for use by clinicians and therapists for clients with chronic pain. The P-VS may serve as a useful tool with the capacity to detect adverse levels of pain-invalidation or over-validation in specific domains, such that these issues can be addressed in the early stages of pain-management interventions.

Item Type: Thesis (PhD)
Murdoch Affiliation(s): Psychology, Counselling, Exercise Science and Chiropractic
United Nations SDGs: Goal 3: Good Health and Well-Being
Supervisor(s): Correia, Helen, Drummond, Peter and Ditchburn, Graeme
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