Highlights
- •Patients with chronic pain were clustered in 4 subgroups according to their pain acceptance levels.
- •Each pain acceptance cluster was significantly associated with patterns of functioning.
- •Both versions of the Chronic Pain Acceptance Questionnaire (CPAQ-20 and CPAQ-8) are useful instruments to identify cluster membership.
Abstract
A substantial literature indicates that pain acceptance is a useful behavioral process
in chronic pain rehabilitation. Pain acceptance consists of willingness to experience
pain and to engage in important activities even in the presence of pain and is often
measured using the Chronic Pain Acceptance Questionnaire (CPAQ). Previous traditional
cluster analyses of the 20-item CPAQ identified 3 patient clusters that differed across
measures of patient functioning in meaningful ways. The aims of this study were to
replicate the previous study in a new sample, using the more robust method of latent
class analysis (LCA), and to compare the cluster structure of the CPAQ and the shorter
CPAQ-8. In total, 914 patients with chronic pain completed the CPAQ and a range of
measures of psychological and physical function. Patient clusters identified via LCA
were then used to compare patients across functional measures. Contrary to previous
research, LCA demonstrated that a 4-cluster structure was superior to a 3-cluster
structure. Consistent with previous research, cluster membership based on patterns
of pain willingness and activity engagement was significantly associated with specific
patterns of psychological and physical function, in line with theoretical predictions.
These cluster structures were similar for both CPAQ-20 and CPAQ-8 items. These results
provide further evidence of the relevance of chronic pain acceptance, and a more nuanced
understanding of how the components of acceptance are related to function.
Perspective
Pain acceptance is important in chronic pain. The findings of the present study, which
included 914 individuals with chronic pain, provide support for 4 discrete groups
of patients based on levels of acceptance (low, medium, and high), as well as a group
with a high level of activity engagement and low willingness to have pain. These groups
appear statistically robust and differed in predictable ways across measures of functioning.
Key words
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Article info
Publication history
Published online: August 19, 2015
Accepted:
July 29,
2015
Received in revised form:
July 8,
2015
Received:
January 19,
2015
Footnotes
The present study was partly supported by grants from the Swedish Association of Local Authorities and Regions (SALAR) and from the Vårdal Foundation.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
