Construct Validation Of The Pain Coping Strategies Questionnaire In Chinese Chronic Pain Samples And Assessment Of Its Impact On Modulation Of Conditioned Laboratory Pain

Conditioned pain modulation(CPM)is believed to be one of the well-studied endogenous pain inhibitions,occurring when pain from one noxious test stimulus(TS)at one location can be inhibited by a second painful conditioning stimulus(CS)applied at a different location(Youssef et al.,2016).The degree of pain inhibition caused by CS on TS reflects individuals’ CPM effect,that is,the more powerful pain inhibition,the higher CPM effect.Based on previous clinical and experiment research,individuals with different pain sensitivity levels would show different CPM effect,while,the specific coping strategy of catastrophizing,cognitive coping as well as appraisals(i.e.,self-efficacy)may play an important role in individuals’ CPM effect.Examining CPM effect while considering the influences of coping and pain self-efficacy in higher pain sensitive or lower pain sensitive population will help to expand our understanding of the relationship between sensitivity to pain,CPM effect cognitive factors,and pain appraisal.It is hypothesized that compared with lower pain sensitive individuals(LPS),higher pain sensitive individuals(HPS)would show less CPM effect,while use more passive coping strategies such as catastrophizing as well as less positive coping strategies such as cognitive coping with less pain self-efficacy.In addition,pain coping strategies and self-efficacy may have some impact on CPM effect.Reviewing previous studies,Coping Strategies Questionnaire(CSQ),developed by Rosenstiel and Keefe(1983),provides a comprehensive assessment to pain coping strategies used by chronic pain patients in research and clinical settings.Corresponding CSQ versions have also been applied extensively among American and European pain population,while few of studies have worked on CSQ Chinese version adapted and analyzed in Chinese-cultural chronic pain subjects,still less its reliability or validity.To explore relationship between sensitivity to pain,CPM effect,cognitive factors,and pain appraisal in Chinese chronic pain patients,it is indispensable firstly to access CSQ’s factor structure as well as reliability,validity in Chinese chronic pain samples.From this perspective,exploratory factor analysis(EFA)was used in Study 1 to explore factor structure solutions in Chinese adult chronic patients(N=480).Meanwhile,gender equivalence was also tested between male and female groups.Results showed that 17-item model met the criteria of EFA,with the same meaning in male and female groups,including four components:catastrophizing,diversion,reinterpretation and cognitive coping.Study 2 selected new subjects with similar demographics and pain conditions(N=320)on the basis of Study 1 for confirmatory factor analysis(CFA).Compared with other competitive models,only CSQ-17 model obtained from Study 1 satisfied the corresponding fitting index.The result of gender equivalence test showed that the model was also consistent in the Chinese male and female groups in those new samples.For convergent validity,factors catastrophizing and cognitive coping in CSQ-17 were related to pain outcomes that should be theoretically related(for example,pain disability,pain negative emotions,pain self-efficacy,depression);while for discriminant validity,all four factors were not associated or weakly associated with theoretically irrelevant demographic variables(for example,gender,age,body mass index).Some pain outcome indicators could also be predicted after pain appraisals(for example,pain self-efficacy)being controlled.In conclusion,Study 2indicated that 17-item,four-factor CSQ model derived from Study 1 had acceptable internal consistency reliability and construct validity,incremental validity in Chinese women and men samples,providing a reliable tool for subsequent research to measure pain coping strategies.In Study 3,to verify above hypotheses between sensitivity to pain,CPM effect cognitive factors,and pain appraisal,by using CSQ from Study 1 and 2,two(pain sensitivity conditions: HPS vs.LPS)by two(CPM conditions: CPM group vs.control group)between-subjects experiment design was manipulated to evaluate their relationship.Independent variables were pain sensitivity conditions and CPM conditions.Dependent variables were CPM effect,pain coping strategies,pain self-efficacy as well as pain outcomes(i.e.,pain threshold,pain tolerance and intensity).180 participants(N=180),90 with higher pain sensitive scores and 90 with lower pain sensitive scores,were randomly assigned to participant in electrical stimulus test and/or cold pressor test,with a series of questionnaires being filled.Results from Study 3 suggested that compared with lower pain sensitive participants,higher pain sensitive participants tended to report less CPM effect,using more catastrophizing but less cognitive coping pain coping strategies.The experiment also indicated that CPM effect was not related to any pain coping strategies or pain self-efficacy,which provided a kind of consequence possibility for further related studies.Above all,as a reliable tool for measuring pain coping strategies,17-item,four-factor CSQ had a stable factor structure with good internal consistency reliability,structural validity and incremental validity in both Chinese male and female pain samples.Compared with lower pain sensitive population,higher pain sensitive population would like to show less CPM effect,using more catastrophizing while less cognitive coping strategies.While pain coping strategies or pain self-efficacy were not specifically associated with CPM effect.