Objective To develop and begin to evaluate a new measure of the centrality of pain in patients’ lives. Design Cross-sectional survey and cognitive interviews. Setting Academic general internal medicine clinic. Patients 65 adult internal medicine patients with chronic non-malignant pain (CNMP). Outcome measures We assessed content validity and clarity of the 10-item Centrality of Pain Scale (COPS) by soliciting feedback from chronic pain experts and by conducting cognitive interviews with patients with CNMP. We assessed internal consistency reliability using Cronbach’s alpha. We assessed construct validity by comparing the COPS with other measures of chronic pain morbidity including pain severity, depression, anxiety, physical and mental health function, PTSD, quality of life, and provider assessment. Results Healthcare providers felt the COPS had excellent face validity. Cognitive interviews revealed that patients’ understanding of the items matched the intended construct, the scale measured an important concept, and items were easy to understand. The COPS had excellent internal consistency (alpha=0.9). COPS was negatively associated with age (r=−0.29; p=0.02), but not with other demographic characteristics. Higher COPS scores were associated with poorer physical (r=−0.48; p<0.001) and mental (r=−0.39 ; p=0.002 ) health function, quality of life (r=−0.36; P=0.004) and provider assessment of stability (r=−0.38; p=0.004) as well as with greater pain grade (r=0.55; p<0.001) and depression (r=0.63; p<0.001). In multivariate analyses, age, physical and mental health function, and depression were independently associated with COPS. Conclusions The COPS has excellent internal consistency and construct validity. Additional studies are needed to further validate the scale.

Somatization, the presentation of physical symptoms without an identifiable cause, is among the most common problems in primary medical care. Treatment approaches are typically offered within the medical consultation interview once the medical provider distinguishes between physical and emotional etiology. This dualistic strategy is especially troublesome for patients whose physical complaints cannot be validated and who are recommended for only mental health therapy. The aim of this study was to examine how medical practitioners can instead motivate patients to consider both physical and emotional treatment. An analogue intervention consisting of an enhanced consultation interview was compared to a care as usual consultation interview on the key outcome of motivation to engage in mental health treatment. A total of 129 participants with medically unexplained symptoms were randomly assigned to these two conditions. Motivation to engage in mental health treatment was evaluated with the FMP Questionnaire, Credibility and Expectancy Questionnaire, and the newly developed Motivation to Engage in Therapy questionnaire (MET). Results of ANCOVA revealed significant differences between the two analogue consultation interviews on 3 out of 5 outcome measures. The largest effect was found for the MET followed by the credibility and expectancy subscales (1.6, .9, and .8). This finding suggests that a particular type of discourse between medical provider and patient can lead to increased motivation for holistic care treatment for those with somatization.ii Acknowledgments