Psychometric Evaluation of the Turkish PICES in Chronic Pain Patients

This study was conducted to examine the validity and reliability of the Turkish version of the Pain-induced Comfort Eating Scale (PICES), which was developed to assess pain-related comfort eating behavior in individuals with chronic pain.

This cross-sectional study was conducted between June and October 2025 at an internal medicine outpatient clinic of a university hospital in Elazığ with 161 community-dwelling adults experiencing chronic pain. To ensure a representative sample of stable outpatients, acutely hospitalized inpatients were excluded. Data were collected using a Personal Information Form, PICES, Three-factor Eating Questionnaire, and Brief Pain Inventory. The scale's content and language validity were assessed by expert opinion; its construct validity was examined using Confirmatory Factor Analysis. Reliability analyses included Cronbach's alpha, McDonald's omega, and intraclass correlation coefficient (ICC) for test-retest reliability.

The content validity indices were found to be the item-level content validity index = 0.90-1.00 and the scale-level content validity index = 0.94. The Kaiser-Meyer-Olkin value was 0.739, and Bartlett's sphericity test was significant (p < .001). As a result of confirmatory factor analysis, a single-factor structure consisting of three items was confirmed, and factor loadings ranging from 0.850 to 0.970 were determined. The internal consistency of the scale was found to be high (Cronbach's alpha = 0.860; McDonald's omega = 0.902), and the test-retest reliability conducted with 30 participants was determined to be excellent (ICC = 0.924). Positive and significant correlations were found between PICES scores and the pain intensity and pain interference subscales of the Brief Pain Inventory (p < .01). Furthermore, PICES scores showed weak and negative correlations with the cognitive restraint and uncontrolled eating subscales of the TFEQ-18, providing evidence for discriminant validity.

The Turkish version of the PICES is a valid and reliable tool for assessing pain-related comfort eating in outpatient clinical settings. Its brevity allows for quick use in research and clinical practice to identify maladaptive eating responses to chronic pain.