Psychological Inflexibility in Pain Scale: Turkish Adaptation, Validity, and Reliability Study

Chronic pain is a major contributor to disability. Research has highlighted psychological inflexibility as a significant factor linked to chronic pain. The Psychological Inflexibility in Pain Scale (PIPS) is a useful tool created to assess this construct in individuals suffering from chronic pain. This study aimed to evaluate the psychometric properties and factor structure of the Turkish version of the PIPS in a population experiencing chronic pain.

The sample comprised 278 participants with chronic pain. Participants completed several measures, including the sociodemographic information form, the PIPS, the Acceptance and Action Questionnaire II, the Cognitive Fusion Questionnaire, the Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale.

Exploratory factor analyses compared 16-item and 12-item versions using two- and three-factor solutions. The 12-item two-factor model was the best option (root-mean-square error of approximation = .084, Tucker-Lewis Index = .928), matching the original avoidance and cognitive fusion subscales. Following exploratory factor, confirmatory factor, and reliability analyses, item 8 was removed owing to consistently poor psychometric performance, resulting in a final 11-item two-factor structure. Internal consistency of the 11-item two-factor structure was good for the total scale (α = .883) and both subscales (avoidance α = .875, fusion α = .702). Test-retest reliability over 2 weeks was strong for the total scale and the avoidance subscale (r = .904 and .907, respectively) but lower for the cognitive fusion subscale (r = .678). Confirmatory factor analysis confirmed the two-factor structure after minor adjustments, with acceptable fit indices (χ²/df = 2.52, Comparative Fit Index = .967, root-mean-square error of approximation = 0.0740). Criterion validity showed significant positive correlations between the avoidance subscale and experiential avoidance (r = .535) and the cognitive fusion subscale and cognitive fusion (r = .385) as well as significant links with depression, anxiety, and pain catastrophizing (r = .291, .361, and .645, respectively).

The PIPS is a valid and reliable scale for assessing the psychological inflexibility model in the context of chronic pain in the Turkish-speaking population. Reevaluating this scale in specific groups and analyzing samples based on factors such as pain intensity and duration will enhance the literature on this topic.

© 20XX by the American Society for Pain Management Nursing.