Pain Acceptance
One of the ways to help patients manage their pain is to assess for their acceptance of pain. Chronic pain acceptance involves experiencing the ongoing pain without psychological or physical attempts to avoid, reduce, or control it.1 2 The Chronic Pain Acceptance Questionnaire (CPAQ) was developed by Geisser and revised to a 20-item version with two subscales: the degree to which one engages in life activities regardless of pain [this is very OT!] and (2) their willingness to experience pain. Among the pain acceptance assessments, the CPAQ has relatively good reliability and validity. A CPAQ-8 has also been developed and been shown to also have psychometric soundness compared to the CPAQ-20.3 The CPAQ has also been translated for other languages include Spanish, Cantonese, Swedish, and Finnish.
The 20-item CPAQ-revised has been designed to measure acceptance of pain. The acceptance of chronic pain is thought to reduce unsuccessful attempts to avoid or control pain and thus focus on engaging in valued activities and pursuing meaningful goals.
There have been 2 factors identified in the CPAQ-Revised: (1) Activity engagement (pursuit of life activities regardless of pain).
Items – 1, 2, 3, 5, 6, 8, 9, 10, 12, 15, 19. (2) Pain willingness (recognition that avoidance and control are often unworkable methods of adapting to chronic pain).
Items – 4, 7, 11, 13, 14, 16, 17, 18, 20.
CPAQ-R
October 2006 revision
Below you will find a list of statements. Please rate the truth of each statement as it
applies to you. Use the following rating scale to make your choices. For instance, if you believe a statement is ‘Always True,’ you would write a 6 in the blank next to that statement.
0 – Never true
1 – Very rarely true
2 – Seldom true
3 – Sometimes true
4 – Often true
5 – Almost always true
6 – Always true
_____ 1. I am getting on with the business of living no matter what my level of pain is.
_____ 2. My life is going well, even though I have chronic pain.
_____ 3. It’s OK to experience pain.
_____ 4. I would gladly sacrifice important things in my life to control this pain better.
_____ 5. It’s not necessary for me to control my pain in order to handle my life well.
_____ 6. Although things have changed, I am living a normal life despite my chronic pain.
_____ 7. I need to concentrate on getting ride of my pain.
_____ 8. There are many activities I do when I feel pain.
_____ 9. I lead a full life even though I have chronic pain.
_____ 10. Controlling my pain is less important than any other goals in my life.
_____ 11. My thoughts and feelings about pain must change before I can take important steps in my life.
_____ 12. Despite the pain, I am now sticking to a certain course in my life.
_____ 13. Keeping my pain level under control takes first priority whenever I’m doing something.
_____ 14. Before I can make any serious plans, I have to get some control over my pain.
_____ 15. When my pain increases, I can still take care of my responsibilities.
_____ 16. I will have better control over my life if I can control my negative thoughts about pain.
_____ 17. I avoid putting myself in situations where my pain might increase.
_____ 18. My worries and fears about what pain will do to me are true.
_____ 19. It’s a great relief to realize that I don’t have to change my pain to get on with life.
_____ 20. I have to struggle to do things when I have pain.
Scoring
Activities engagement: Sum items 1, 2, 3, 5, 6, 8, 9, 10, 12, 15, 19.
Pain willingness: Reverse score items 4, 7, 11, 13, 14, 16, 17, 18, 20 and sum.
Total: activity engagement + pain willingness.
Higher score = more acceptance,
CPAQ for Occupational Therapy
The CPAQ can be a useful assessment that occupational therapists use for their patients with chronic pain. I believe that this assessment, although not specifically an OT one, has factors that are very much occupationally-centered. The first factor which looks at activity engagement despite pain aligns with one’s occupational participation and deprivation. Due to it’s high reliability and validity, this first factor of the CPAQ can be used to determine if pain specifically may be limiting activities based on one’s acceptance of it. The pain willingness factor can also be insightful as it provides insight into the client’s thoughts and perception of pain and their willingness through their “recognition that avoidance and control are often unworkable methods of adapting to chronic pain”.
Combined with other interventions such as CBT, mindfulness, Acceptance and Commitment Therapy, occupational therapy participation, PAMs, and other relaxation methods that are client-centered with consideration for one’s client contexts, I believe the CPAQ can be a sensitive way to measure and determine the effectiveness of occupational therapy services for pain. For example, as part of ACT, OTs can use the CPAQ as a tool to measure changes with respective to the biopsychosocial complexity of pain.
While the pain score from 1-10 is nice, I believe it is only looking at one particular snapshot of pain. It also is not very holistic and can depend on so many factors. For example, a patient could be improving overall, but could be experiencing a pain flare up. Their pain could be an 8/10 before taking medications, and a 3/10 after. The time in which you ask someone could change drastically, e.g., from 8 to 3 in an hour or less such as with opioids.
The more important consideration for pain interventions is the long-term and lasting effects of an intervention. Therefore, the CPAQ-20 is much more sensitive to not only pain (which is subjective), but the person’s actual thought processes and perception of how pain may interfere with their life.
Sources
- McCracken LM, Carson JW, Eccleston C, Keefe FJ. Acceptance and change in the context of chronic pain. Pain 2004;109:4–7.↑
- McCracken LM, Vowles KE, Eccleston C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain 2004;107:159–66.↑
- Fish, R. A., McGuire, B., Hogan, M., Morrison, T. G., & Stewart, I. (2010). Validation of the Chronic Pain Acceptance Questionnaire (CPAQ) in an Internet sample and development and preliminary validation of the CPAQ-8. Pain, 149(3), 435-443.↑