Tool Evaluates Feelings of Pain Invalidation for Patients With Chronic Pain

A novel tool, the Pain-Invalidation Scale (Pain-IS), has been developed to measure different aspects of pain invalidation experienced by individuals with chronic pain. Creation of the tool and assessment of its reliability were discussed in a study published in the Journal of Pain.

Investigators from Murdoch University in Australia performed a literature review to define major themes about pain invalidation. Using the themes, the investigators created a pilot survey in 2018 and recruited 302 individuals with pain lasting at least 3 months to respond to 79 questions about pain invalidation using a 7-point Likert-style response scale. A second cohort of 308 individuals was recruited to respond to a subset of the most robust 36 pain-invalidation items. Feedback from these surveys was used to formulate the Pain-IS. A third cohort of 300 individuals was recruited in 2021 to respond to the Pain-IS tool.

The age of the study participants ranged from 31.3 to 37.4 years. The first 2 surveys included more women, and the third survey was more evenly split between genders. Duration of pain of less than 36 months was reported in 49% to 63% of participants. Approximately three-quarters had pain on most days, and the most common pain location was the back or neck.

The investigators sought to make the Pain-IS short to avoid fatigue during assessment by removing items with poor discriminatory value and redundant measures.

In the first pilot survey, 4 major domains emerged that identified the source of invalidation from self, others, caregivers, and healthcare professionals.

In the second pilot survey, responses were normally distributed without outliers. Responses to a subset of 24 items was better fit compared with 30 or 26 items (χ², 508.39; P <.001). The final Pain-IS had 6 items, each with 4 subscales: invalidation of self, invalidation by immediate others, invalidation by healthcare professional, and invalidation by over-attentive others.

The Pain-IS had high internal consistency (α, 0.91) and test-retest reliability, in which all subscales had high correlation coefficients (r range, 0.69-0.84).

This study may have been biased by recruiting individuals online; therefore, additional validation in the clinical setting is likely needed.

The Pain-IS instrument was found to be reliable for evaluating feelings of invalidation among patients with chronic pain. Patient responses to the Pain-IS will likely highlight areas of concern and could serve as a starting point for clinicians to discuss therapy with patients. The authors concluded, “The detection of invalidating attitudes, by the self or others, may be a valuable first step in the design of pain management programs, such that training in self-compassion, emotional processing techniques, effective partner support, and active listening, can be incorporated as indicated by test outcomes.”