A 2-Item Short Form of the Pain Self-Efficacy Questionnaire: Development and Psychometric Evaluation of PSEQ-2

Published:November 13, 2014DOI:


      • The total score on the newly derived 2-item PSEQ-2 is highly correlated with that of the original PSEQ and it has comparable, but weaker, psychometric properties.
      • In clinical or research settings where time is limited or there is a need for just an indication of pain self-efficacy beliefs, the PSEQ-2 is robust and should suffice.
      • If time is not so constrained and a more comprehensive and reliable assessment of pain-self-efficacy is sought, the full PSEQ is recommended.


      The Pain Self-Efficacy Questionnaire (PSEQ) is an established 10-item measure of pain self-efficacy that is widely used in clinical and research settings. However, a shorter measure would reduce patient and researcher burden and save valuable time in busy clinical settings. The aim of this study was to develop and confirm the psychometric properties of a valid and reliable 2-item short form of the PSEQ (PSEQ-2). We used a large sample of 1,418 chronic pain patients, which we randomly split into 2 smaller groups. We identified the 2 short-form items in Sample 1 and confirmed their properties in Sample 2. In order to identify the 2 items for the short-form measure, we selected the first item based on the highest item-total correlation. The second item was identified after a series of additional analyses. The 2 items identified from the PSEQ reflected confidence in one's ability to work and lead a normal life despite pain. The PSEQ-2's validity and internal consistency were found to be sound. Test-retest reliability, sensitivity to change, and convergent validity were confirmed in a separate patient sample (n = 140) that had recently completed an intervention designed, in part, to modify self-efficacy beliefs. The PSEQ-2 appears to be a robust measure of pain self-efficacy.


      Pain self-efficacy is a belief in one's ability to carry out activities even when in pain and is important in coping effectively with pain. A short measure of pain self-efficacy was developed and evaluated. It appears to be suitable for use in clinical and research settings.

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        • Adams J.H.
        • Williams ACdeC.
        What affects return to work for graduates of a pain management program with chronic upper limb pain?.
        J Occup Rehabil. 2003; 13: 91-106
        • Asghari A.
        • Nicholas M.K.
        Pain self-efficacy beliefs and pain behaviour: A prospective study.
        Pain. 2001; 94: 85-100
        • Asghari A.
        • Nicholas M.K.
        An investigation of pain self-efficacy beliefs in Iranian chronic pain patients: A preliminary validation of a translated English-language scale.
        Pain Med. 2009; 10: 619-632
        • Ayer M.
        • Tyson G.A.
        The role of self-efficacy and fear-avoidance beliefs in the prediction of disability.
        Austral Psychol. 2001; 36: 250-253
        • Bandura A.
        Self-efficacy: Toward a unifying theory of behavioural change.
        Psychol Rev. 1977; 84: 191-215
        • Barkham M.
        • Bewick B.
        • Mullin T.
        • Gilbody S.
        • Connell J.
        • Cahill J.
        • Mellor-Clark J.
        • David Richards
        • Unsworth G.
        • Evans C.
        The CORE-10: A short measure of psychological distress for routine use in the psychological therapies.
        Couns Psychother Res. 2013; 13: 3-13
        • Cardosa M.
        • Osman Z.J.
        • Nicholas M.K.
        • Tonkin L.
        • Williams A.
        • Aziz K.A.
        • Ali R.M.
        • Dahari N.M.
        Self-management of chronic pain in Malaysian patients: Effectiveness trial with 1-year follow-up.
        Transl Behav Med. 2012; 2: 30-37
        • Cohen J.
        Statistical Power Analysis for the Behavioural Sciences.
        2nd ed. Erlbaum, Hillsdale, NJ1988
        • Cohen M.
        • Nicholas M.K.
        • Blanch A.
        Medical assessment and management of work-related low back or neck-arm pain: More questions than answers.
        J Occup Health Saf. 2000; 16: 307-317
        • Coughlan G.M.
        • Ridout K.L.
        • Williams ACdeC.
        • Richardson P.H.
        Attrition from a pain management program.
        Br J Clin Psychol. 1995; l34: 471-479
        • Dehghani M.
        • Sharpe L.
        • Nicholas M.K.
        Modification of attentional biases in chronic pain patients: A preliminary study.
        Eur J Pain. 2004; 8: 585-594
        • Dworkin R.H.
        • Turk D.C.
        • Farrar J.T.
        • Haythornthwaite J.A.
        • Jensen M.P.
        • Katz N.P.
        • Kerns R.D.
        • Stucki G.
        • Allen R.R.
        • Bellamy N.
        • Carr D.B.
        • Chandler J.
        • Cowan P.
        • Dionne R.
        • Galer B.S.
        • Hertz S.
        • Jadad A.R.
        • Kramer L.D.
        • Manning D.C.
        • Martin S.
        • McCormick C.G.
        • McDermott M.P.
        • McGrath P.
        • Quessy S.
        • Rappaport B.A.
        • Robbins W.
        • Robinson J.P.
        • Rothman M.
        • Royal M.A.
        • Simon L.
        • Stauffer J.W.
        • Stein W.
        • Tollett J.
        • Wernicke J.
        • Witter J.
        • IMMPACT
        Core outcome domains for chronic pain clinical trials: IMMPACT recommendations.
        Pain. 2005; 113: 9-19
        • Edwards R.R.
        • Smith M.T.
        • Stonerock G.
        • Haythornthwaite J.A.
        Pain-related catastrophizing in healthy women is associated with greater temporal summation of and reduced habituation to thermal pain.
        Clin J Pain. 2006; 22: 730-737
        • Fish R.A.
        • McGuire B.E.
        • Hogan M.J.
        • Stewart I.
        • Morrison T.G.
        Validation of the Chronic Pain Acceptance Questionnaire (CPAQ) in an internet sample and development and preliminary validation of the CPAQ-8.
        Pain. 2010; 149: 435-443
        • Flor H.
        • Behle D.J.
        • Birbaumer N.
        Assessment of pain-related cognitions in chronic pain patients.
        Behav Res Ther. 1993; 31: 63-73
        • Foster N.E.
        • Thomas E.
        • Bishop A.
        • Dunn K.M.
        • Main C.J.
        Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care.
        Pain. 2010; 148: 398-406
        • Frost H.
        • Klaber Moffett J.
        • Moser J.
        • Fairbank J.
        Evaluation of a fitness programme for patients with chronic low back pain.
        BMJ. 1993; 310: 151-154
        • Gibson L.
        • Strong J.
        The reliability and validity of a measure of perceived functional capacity for work in chronic back pain.
        J Occup Rehabil. 1996; 6: 159-175
        • Jacob M.C.
        • Kerns R.D.
        Assessment of the Psychosocial Context of the Experience of Chronic Pain.
        in: Turk D.C. Melzack R. Handbook of pain assessment. 2nd ed. Guilford Press, New York2001: 362-384
        • Jacobson N.S.
        • Revensdorf D.
        Statistics for assessing clinical significance of psychotherapy techniques: Issues, problems, and new developments.
        Behav Assess. 1988; 19: 133-145
        • Jacobson N.S.
        • Roberts L.J.
        • Berns S.B.
        • McGlinchey J.B.
        Methods for defining and determining the clinical significance of treatment effects: Description, application, and alternatives.
        J Consult Clin Psychol. 1999; 67: 300-307
        • Jensen M.
        • Keefe F.J.
        • Lefevre J.C.
        • Romano J.M.
        • Turner J.A.
        One- and two-item measures of pain beliefs and coping strategies.
        Pain. 2003; 104: 453-469
        • Jensen M.P.
        • Karoly P.
        Self-report scales and procedures for assessing pain in adults.
        in: Turk D.C. Melzack R. Handbook of Pain Assessment. 2nd ed. Guilford Press, New York2001: 15-34
        • Jensen M.P.
        • Strom S.E.
        • Turner J.A.
        • Romano J.M.
        Validity of the sickness impact profile Roland scale as a measure of dysfunction in chronic pain patients.
        Pain. 1992; 50: 157-162
        • Kendal P.C.
        • Marrs-Garcia A.
        • Nath S.R.
        • Sheldrick R.C.
        Normative comparison for the evaluation of clinical significance.
        J Consult Clin Psychol. 1999; 67: 285-299
        • Kerns R.D.
        • Turk D.C.
        • Rudy T.E.
        The West Haven–Yale Multidimensional Pain Inventory (WHYMPI).
        Pain. 1985; 23: 345-356
        • Kori S.H.
        • Miller R.P.
        • Todd D.D.
        Kinesiophobia: A new view of chronic pain behaviour.
        Pain Manag. 1990; 3: 35-43
        • Kroenke K.
        • Spitzer R.L.
        The PHQ-9: A new depression and diagnostic severity measure.
        Psychiatr Ann. 2002; 32: 509-521
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.W.
        • Monahan P.O.
        • Lowe B.
        Anxiety disorders in primary care: Prevalence, impairment, comorbidity and detection.
        Ann Intern Med. 2007; 146: 317-325
        • Lim H.S.
        • Chen P.P.
        • Wong T.C.M.
        • Gin T.
        • Wong E.
        • Chan I.S.F.
        • Chu J.
        Validation of the Chinese Version of Pain. Self-Efficacy Questionnaire.
        Anesth Analg. 2007; 104: 918-923
        • Linton S.J.
        • Nicholas M.
        • MacDonald S.
        Development of a Short Form of the Örebro Musculoskeletal Pain Screening Questionnaire.
        Spine. 2011; 36: 1891-1895
        • Lovibond P.F.
        • Lovibond S.H.
        The structure of negative emotional states: Comparison of the Depression, Anxiety and Stress Scales (DASS) with the Beck Depression and Anxiety Inventories.
        Behav Res Ther. 1995; 33: 335-343
        • Man A.K.Y.
        • Chu M.C.
        • Chen P.P.
        • Ma M.
        • Gin T.
        Clinical experience with a chronic pain management programme in Hong Kong Chinese patients.
        Hong Kong Med J. 2007; 13: 372-378
        • McCracken L.M.
        • MacKichan F.
        • Eccleston C.
        Contextual cognitive-behavioral therapy for severely disabled chronic pain sufferers: Effectiveness and clinically significant change.
        Eur J Pain. 2007; 11: 314-322
        • McGuire B.E.
        • Morrison T.
        • Hermanns N.
        • Skovlund S.
        • Eldrup E.
        • Gagliardino J.
        • Kokoszka A.
        • Matthews D.
        • Pibernik-Okanović M.
        • Rodríguez-Saldaña J.
        • de Wit M.
        • Snoek F.J.
        Short-form measures of diabetes-related emotional distress: The PAID-5 and PAID-1.
        Diabetologia. 2010; 53: 66-69
        • Morley S.
        • Williams A.C.
        Conducting and evaluating treatment outcome studies.
        in: Gatchel R.J. Turk D.C. Psychosocial Factors in Pain. Guilford Press, New York2002: 52-68
        • Nicholas M.K.
        Self-efficacy and chronic pain.
        in: Paper presented at the annual conference of the British Psychological Society, St. Andrews, Scotland. 1989
        • Nicholas M.K.
        The pain self-efficacy questionnaire: Taking pain into account.
        Eur J Pain. 2007; 11: 153-163
        • Nicholas M.K.
        • Asghari A.
        • Blyth F.M.
        What do the numbers mean? Normative data in chronic pain measures.
        Pain. 2008; 134: 158-173
        • Nicholas M.K.
        • Asghari A.
        • Corbett M.
        • Smeets R.J.
        • Wood B.M.
        • Overton S.
        • Perry C.
        • Tonkin L.E.
        • Beeston L.
        Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic pain?.
        Eur J Pain. 2012; 16: 93-104
        • Nicholas M.K.
        • Asghari A.
        • Sharpe L.
        • Brnabic A.
        • Wood B.M.
        • Overton S.
        • Tonkin L.
        • de Sousa M.
        • Finniss D.
        • Beeston L.
        • Sutherland A.
        • Corbett M.
        • Brooker C.
        Cognitive exposure versus avoidance in patients with chronic pain: Adherence matters.
        Eur J Pain. 2014; 18: 424-437
        • Nicholas M.K.
        • Wilson P.H.
        • Goyen J.
        Comparison of cognitive behavioural group treatment and an alternative non-psychological treatment for chronic low back pain.
        Pain. 1992; 48: 339-347
        • Nicholson Perry K.
        • Nicholas M.K.
        • Middleton J.W.
        Spinal cord injury-related pain in rehabilitation: A cross-sectional study of relationships with cognitions, mood and physical function.
        Eur J Pain. 2009; 13: 511-517
        • Nunnally J.C.
        • Bernstein I.H.
        Psychometric Theory.
        3rd ed. McGraw-Hill, New York, NY1994
        • Ralphs J.R.
        • Williams ACdeC.
        • Richardson P.H.
        • Pither C.E.
        • Nicholas M.K.
        Opiate reduction in chronic pain patients: A comparison of patient-controlled reduction and staff controlled cocktail methods.
        Pain. 1994; 56: 279-288
        • Riddle D.L.
        • Jensen M.P.
        Construct and criterion-related validity of brief pain coping scales in persons with chronic knee osteoarthritis pain.
        Pain Med. 2013; 14: 265-275
        • Revicki D.
        • Cella D.
        • Hays R.
        • Sloan J.A.
        • Lenderking R.
        • Aaronson N.K.
        Responsiveness and minimal important differences for patient reported outcomes.
        Health Qual Life Outcomes. 2006; 4: 70
        • Roland M.
        • Morris R.
        A study of a natural history of the back pain, part 1: Development of a reliable and sensitive measure of disability in low back pain.
        Spine. 1983; 8: 141-144
        • Ruehlman L.S.
        • Karoly P.
        • Newton C.
        • Aiken L.S.
        The development and preliminary validation of a brief measure of chronic pain impact for use in the general population.
        Pain. 2005; 113: 82-90
        • Sardá Jr., J.
        • Nicholas M.K.
        • Pimenta C.A.
        • Asghari A.
        Pain related self-efficacy beliefs in a Brazilian chronic pain patient sample: A psychometric analysis.
        Stress Health. 2007; 23: 185-190
        • Strong J.
        • Westbury K.
        • Smith G.
        • McKenzie I.
        • Ryan W.
        Treatment outcome in individuals with chronic pain: Is the Pain Stages of Change Questionnaire (PSOCQ) a useful tool?.
        Pain. 2002; 97: 65-73
        • Tabachnick B.G.
        • Fidell L.S.
        Using Multivariate Statistics.
        Allyn & Bacon, New York2001
        • Tan G.
        • Nguyen Q.
        • Cardin S.A.
        • Jensen M.F.
        Validating the use of two-item measures of pain beliefs and coping strategies for a veteran population.
        J Pain. 2006; 7: 252-260
        • Taylor R.
        • Lovibond P.F.
        • Nicholas M.K.
        • Cayley C.
        • Wilson P.H.
        The utility of somatic items in the assessment of depression in chronic pain patients: A comparison of the Zung Self-rating Depression Scale (SDS) and the Depression Anxiety Stress Scales (DASS) in chronic pain, clinical and community samples.
        Clin J Pain. 2005; 21: 91-100
        • Uebersax J.S.
        • Wyman J.F.
        Short forms to assess life quality and symptom distress for urinary incontinence in women: The incontinence impact questionnaire and the urogenital distress inventory.
        Neurourol Urodyn. 1995; 4: 131-139
        • Vlaeyen J.W.S.
        • de Jong J.
        • Geilen M.
        • Heuts P.H.T.G.
        • van Breukelen G.
        The treatment of fear of movement/(re)injury in chronic low back pain: Further evidence on the effectiveness of exposure in vivo.
        Clin J Pain. 2002; 18: 251-261
        • Vodermaier A.
        • Linden W.
        • Siu C.
        Screening for emotional distress in cancer patients: A systematic review of assessment instruments.
        J Natl Cancer Inst. 2009; 101: 1464-1488
        • Watson P.J.
        • Booker C.K.
        • Main C.J.
        Evidence for the role of psychological factors in abnormal paraspinal activity in patients with chronic low back pain.
        J Musculoskel Pain. 1997; 5: 41-56
        • Williams ACdeC.
        • Nicholas M.K.
        • Richardson P.H.
        • Pither C.E.
        • Fernandes J.
        Does randomisation affect the generality of findings from a controlled trial? The effects of patient preference versus randomisation on inpatient versus outpatient chronic pain management.
        Pain. 1999; 83: 57-65
        • Williams ACdeC.
        • Nicholas M.K.
        • Richardson P.H.
        • Pither C.E.
        • Justins D.M.
        • Chamberlain J.H.
        Evaluation of a cognitive behavioural programme for rehabilitating patients with chronic pain.
        Br J Gen Pract. 1993; 43: 513-518
        • Wood B.M.
        • Nicholas M.K.
        • Blyth F.
        • Asghari A.
        • Gibson S.
        Catastrophizing mediates the relationship between pain intensity and depressed mood in older adults with persistent pain.
        J Pain. 2013; 14: 149-157
        • Yost K.J.
        • Eton D.T.
        Combining distribution- and anchor-based approaches to determine minimally important differences: The FACIT experience.
        Eval Health Prof. 2005; 28: 172