The pain catastrophising scale.
The Pain Catastrophising Scale (PCS) (Sullivan et al 1995) consists of 13 items related to thoughts and feelings about pain. Patients are instructed to rate the degree to which they experience each item when they are in pain on a five-point scale. Responses range from 0 ('Not at all') to 4 ('All the time'). Items are summed to give a total PCS score. Subscale scores of rumination, magnification, and helplessness can also be calculated. It is readily available from websites (eg, www.tac.gov.au).
Validity: Factor analysis of the PCS consistently reveals a solution of three related but independent factors representing the subscales of the PCS in both healthy participants and patients with fibromyalgia (FM) and chronic low back pain (CLBP) (D'Eon et al 2004, Osman et al 2000, Osman et al 1997, Sullivan et al 1995, Van Damme et al 2002).
Asymptomatic volunteers scoring highly on the PCS (> 24) report significantly higher pain during the cold pressor test and painful medical procedures than patients with lower scores (Sullivan et al 1995). Total PCS scores have been reported to be able to discriminate between randomly selected healthy volunteers and patients recruited from pain and rehabilitation centres in 77.1% of cases (Osman et al 2000).
Reliability: Cronbach's alpha in healthy volunteers for PCS total scores and subscale scores range from 0.60 to 0.90 in two large sample studies (D'Eon et al 2004, Sullivan et al 1995). Data for internal consistency in symptomatic studies have varied from acceptable (ICC = 0.63-0.71) (Lame et al 2008) to excellent (alpha = 0.91-0.94) (Papaioannou et al 2009).
The test-retest reliability of the PCS has not been investigated widely. Sullivan et al (1995) reported moderate to good test retest reliability (r = 0.70-0.75) in healthy controls over a 6-12 week interval. However these data refer to the total score only and not to subscale scores.
Gender effect: Females score higher than males on PCS total scores and subscale scores for rumination and helplessness (Osman et al 2000, Osman et al 1997). Despite this, factor analysis has shown that the three-factor solution is consistent across genders (Van Damme et al 2002).
Predictive capacity: PCS total scores and gender have been reported to explain 81% of the variance in resting pain in patients scheduled for lumbar fusion surgery. PCS was a significant predictor of post-operative pain on activity and total analgesic use (Papaioannou et al 2009). Total PCS scores have also been found to significantly predict physical functioning in patients with FM (Karsdorp and Vlaeyen 2009) and ongoing pain following total knee arthroplasty at two year follow up (Forsythe et al 2008). Contrasting results were reported by Meyer et al (2009) who found that PCS scores did not significantly predict average intensity of pain in patients with CLBP.
Catastrophisation is defined as an elevated negative cognitive response to painful stimuli (Sullivan et al 1995). There is a growing body of evidence suggesting that catastrophisation contributes significantly to the development of ongoing pain and disability, particularly in musculoskeletal pain patients (Smeets et al 2006). Active treatment programs including cognitive behavioural therapy (CBT) and general physical activity have been found to have a beneficial effect in patients with CLBP and appear at least in part to work through reducing levels of catastrophisation (Smeets et al 2006). The identification of patients with high levels of catastrophisation may thus be important in directing patients with musculoskeletal pain to appropriate rehabilitation strategies.
This tool provides a means through which to assess those patients who may be at risk of ongoing pain and who may benefit from management strategies which challenge negative cognitive responses to pain. However there are currently little data available regarding the test-retest reliability, sensitivity to change, and clinically meaningful change of the PCS. Further research investigating these dimensions of the PCS would significantly increase the clinical utility of this tool.
D'Eon et al (2004) J Behav Med 27: 361-372.
Forsythe et al (2008) Pain Res Manage 13: 335-341.
Karsdorp & Vlaeyen (2009) Pain 147: 29-35.
Lame et al (2008) J Health Psychol 13: 820-826.
Meyer et al (2009; J Rehab Med41: 620-625.
Osman et al (2000) J Behav Med 23: 351-365.
Osman et al (1997) J Behav Med 20: 589-605.
Papaioannou et al (2009) Pain Med 10: 1452-1459.
Smeets et al (2006) J Pain 7: 261-271.
Sullivan et al (1995) Psychol Assess 7: 524-532.
Van Damme et al (2002) Pain 96: 319-324.
The University of Queensland, Australia