Acceptance: What's in a Name? A Content Analysis of Acceptance Instruments in Individuals With Chronic Pain

Abstract

and PerspectiveInstruments to assess chronic pain acceptance have been developed and used.Uninvestigated is whether and to what extent the content of the items reflects acceptance. A content analysis of thirteen instruments that aim to measure acceptance of chronic pain was performed. A coding scheme was used that consisted of three categories that represent key components of acceptance, i.e. "disengagement from pain control", "pain willingness", and "engagement in activities other than pain control". The coding scheme consisted of five additional categories in order to code items that do not to represent acceptance, i.e., "controlling pain", "pain costs", "pain benefits", "unclear", and "no fit". Two coders rated to what extent the items of acceptance instruments belonged to one or more of these categories.Results indicated that acceptance categories were not equally represented in the acceptance instruments. Of note, some instruments had many items in the category "controlling pain". Further analyses revealed that the meaning of acceptance differs between different instruments, and between different versions of the same instrument. This study illustrates the importance of content validity when developing and evaluating self-report instruments.Perspective. This article investigated the content validity of questionnaires designed to measure acceptance in individuals with chronic pain. Knowledge about the content of the instruments will provide further insight into the features of acceptance and how to measure these.

Do Flexible Goal Adjustment and Acceptance Help Preserve Quality of Life in Patients with Multiple Sclerosis?

“…Furthermore, given the broad range of processes covered by the acceptance construct [27] one may wonder what precisely is it that underlies its positive effect, and what are facilitating or hindering factors in attaining acceptance. Flexible goal adjustment may be an important factor in both ways.…”

“…Acceptance may be defined as recognizing the need to adapt to a chronic illness while being willing to tolerate the unpredictable, uncontrollable nature of the disease [26]. In addition, acceptance has been specifically framed within the dual-process model of coping as a specific instantiation of flexible adjustment of goals that are blocked as a result of chronic illness [22,27]. Acceptance has been identified as a potentially adaptive way to cope with chronic illness.…”

The role of pain acceptance on function in individuals with disabilities

“…36 The CPAQ scoring instructions require that all of the items be reverse scored before summing. Thus, the CPAQ Pain Willingness scale score represents "not believing that pain control is necessary" more than "willingness to experience pain."…”

“…41 Pain acceptance can be defined as (1) a willingness to experience pain while also (2) engaging in behaviors consistent with one's values despite pain. 36,39,42 Greater pain acceptance, as operationalized by measures of these 2 domains, has been shown to be associated with less pain intensity, pain-related anxiety, avoidant behavior, depression, and physical disability in crosssectional studies. 38,55 Acceptance has also been shown to buffer the effect of pain intensity on daily function 25 and to buffer the effects of catastrophic thinking on anxiety, depression, and disability.…”

“…Moreover, the items usually used to assess the pain acceptance domain of willingness to engage in activities despite pain have conceptual and item overlap with measures assessing outcome domains reflecting disability and pain interference. 36 This confound can inflate the associations found in cross-sectional studies and therefore limit the conclusions that can be drawn. To address these issues, we sought to determine whether pain acceptance at one time predicts a variety of key pain-related domains assessed 3.5 years later using an approach that statistically controls for the potential confound because of item overlap.…”