Shorter Pain Medication Attitudes Questionnaire Validated

An abbreviated version of the Pain Medication Attitudes Questionnaire (PMAQ-14) has been developed and tested by a research team led by James Elander, PhD, head of the Centre for Psychological Research at the University of Derby, United Kingdom.¹ Results were reported March 2017 in PAIN.

First described in The Journal of Pain in 2006, the original 47-item Pain Medication Attitudes Questionnaire (PMAQ) is composed of 7 scales that measure attitudes and beliefs in patients who use pain medications:  Addiction, Need, Scrutiny, Side Effects, Tolerance, Mistrust of Doctors, and Withdrawal.² Those 7 domains were selected based on focus groups, expert opinions and a review of the relevant literature on patient concerns and other potential barriers to the appropriate use of analgesics. Specific questions in each scale were developed using input from 220 patients with chronic pain, including their beliefs and concerns about pain medication, and analyzed to determine how their answers correlated with medication use, depression, and disability.

PMAQ-14 was created with input from 3 groups of patients with chronic pain. The first group comprised 295 patients who completed the full 47-item PMAQ. In order to identify the 2 items in each of the 7 scales that best represented their content, the researchers performed correlation and regression analyses. The second two groups (n=241 and n=147) completed the resultant 14-item version. The research team then tested the factor structure and criterion-related validity of the short form in accordance with methodological recommendations for the development of valid abbreviated forms of clinical assessment procedures.³ Upon analysis, the original and abbreviated scales were found to generate similar scores.

“To conclude, this short form of the PMAQ allows attitudes to pain medications to be measured in a valid and more efficient way, which could allow attitudes to pain medication to be measured in more future studies, for example, studies of analgesic users not in contact with specialist pain clinics; studies focusing on how PMAQ data could inform treatment and prescribing decisions; and longitudinal research to identify influences on changes in analgesic use and dependence,” the researchers wrote. “Such longitudinal studies could inform better early identification of problems and health education initiatives to help people avoid analgesic use disorders,” they added.

Summary and Clinical Applicability

Dr Elander told Clinical Pain Advisor that the main impetus for development of the PMAQ-14 was to produce a brief version of the PMAQ for use in research. However, he noted that the questionnaire could also be useful in clinical practice. “Doctors and healthcare professionals who work with people taking analgesics might ask them routinely to complete the PMAQ-14, or give the questionnaire in a more targeted way to selected patients, such as long-term users, patients whose doses have risen, or patients concerned or worried about their own use of analgesics. The PMAQ-14 can be scored very quickly and easily and will give the health professional a quick indicator of what types of concerns are most important to the person, and this could inform their discussion with them. They could be especially alert to high ‘Need’ scores, which might indicate risk of analgesic dependence.”

Limitations

• Most survey participants were women (86.4% in group 1, 81.7% in group 2, and 81.0%, in group 3).
• All information about participants’ pain experiences and analgesic use was self-reported.

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References

1. Elander J, Said O, Maratos FA, Dys A, Collins H, Schofield MB. Development and validation of a short-form Pain Medication Attitudes Questionnaire (PMAQ-14). PAIN. 2017;158(3):400-407. doi:10.1097/j.pain.0000000000000773
2. McCracken LM, Hoskins J, Eccleston C. Concerns about medication and medication use in chronic pain. J Pain. 2006;7(10):726-734. doi:10.1016/j.jpain.2006.02.014.
3.  Smith GT, McCarthy DM, Anderson KG. On the sins of short-form development. Psychol Assess. 2000;12(1):102-111.