The measurement of subjective pain intensity continues to be important to both researchers and clinicians. Although several scales are currently used to assess the intensity construct, it remains unclear which of these provides the most precise, replicable, and predictively valid measure. Five criteria for judging intensity scales have been considered in previous research: ease of administration of scoring; relative rates of incorrect responding; sensitivity as defined by the number of available response categories; sensitivity as defined by statistical power; and the magnitude of the relationship between each scale and a linear combination of pain intensity indices. In order to judge commonly used pain intensity measures, 75 chronic pain patients were asked to rate 4 kinds of pain (present, least, most, and average) using 6 scales. The utility and validity of the scales was judged using the criteria listed above. The results indicate that, for the present sample, the scales yield similar results in terms of the number of subjects who respond correctly to them and their predictive validity. However, when considering the remaining 3 criteria, the 101-point numerical rating scale appears to be the most practical index.

Objective: The fear-avoidance (FA) model of chronic pain describes how individuals experiencing acute pain may become trapped into a vicious circle of chronic disability and suffering. We propose to extend the FA model by adopting a motivational perspective on chronic pain and disability. Methods: A narrative reviewResults: There is ample evidence to support the validity of the FA model as originally formulated. There are, however, some key challenges that call for a next generation of the FA model. First, the FA model has its roots in psychopathology, and investigators will have to find a way to account for findings that do not easily fit within such framework. Second, the FA model needs to address the dynamics and complexities of disability and functional recovery. Third, the FA model should incorporate the idea that pain-related fear and avoidance occurs in a context of multiple and often competing personal goals. Discussion:To address these three key challenges, we argue that the next generation of the FA model needs to more explicitly adopt a motivational perspective, one that is built around the organizing powers of goals and self-regulatory processes.Using this framework, the FA model is recast as capturing the persistent but futile attempts to solve pain-related problems in order to protect and restore life goals.

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A growing number of investigators have used models of stress and coping to help explain the differences in adjustment found among persons who experience chronic pain. This article reviews the empirical research which has examined the relationships among beliefs, coping, and adjustment to chronic pain. Although preliminary, some consistent findings are beginning to emerge. For example, patients who believe they can control their pain, who avoid catastrophizing about their condition, and who believe they are not severely disabled appear to function better than those who do not. Such beliefs may mediate some of the relationships between pain severity and adjustment. Although coping strategies appear to be associated with adjustment in chronic pain patients, methodological problems limit conclusions regarding the strength and nature of this association. Our recommendations for future research include the development of coping and belief measures which: (1) do not confound different dimensions (e.g., coping, beliefs, and adjustment) in the same measure; (2) assess specific (rather than composite) constructs; (3) are psychometrically sound; and (4) assess behavioral coping strategies more objectively. We also recommend a greater use of experimental research designs to examine causal relationships among appraisals, coping, and adjustment.

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L’autorégulation peut être définie comme un processus d’orientation vers un objectif visant l’atteinte et le suivi de buts personnels. Dans cet article, on distingue trois phases dans ce processus: 1) le choix d’un objectif, l’organisation et la représentation/interprétation; 2) la poursuite active du but; 3) l’atteinte et le suivi ou, au moment opportun, l’abandon du but. Ces trois phases servent de fil conducteur à ce texte. On présente pour chaque phase des outils d’évaluation et des interventions. L’article se termine par la description d’orientations pour de futures recherches concernant l’évaluation de l’autorégulation et les interventions, en retenant quinze principes d’intervention qui peuvent être exploités comme régles générales pour la mise en œuvre d’interventions dans la prise en charge des maladies chroniques et le développement d’une politique de santé. Self‐regulation can be defined as a goal‐guidance process aimed at the attainment and maintenance of personal goals. In this article three phases are distinguished in this process: (a) goal selection, setting and construal/representation; (b) active goal pursuit; and (c) goal attainment and maintenance or, when appropriate, goal disengagement. These phases are used as a structure for the present review. For each phase, assessment instruments and interventions are described. The article concludes with directions for future research concerning self‐regulation assessment and interventions, including 15 intervention principles which can be used as rules of thumb for the development of interventions in chronic illness management and in health promotion.

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