Letters

Dear Editor: The Pain Catastrophizing Scale (PCS), which assesses catastrophic thoughts and feelings about pain, is well represented in the empirical literature. For example, the PCS has been studied in relationship to crosscultural validation; various medical conditions, such as low-back pain, whiplash, chronic pain in incarcerated women, vaginismus, cancer, and postoperative pain; and various psychological investigations including family relationships, positive personal attributes, attachment dynamics, anxiety, and major depressive disorder. In addition, the PCS has been used to explore demographic differences in specific types of patient samples (e.g., samples defined by a singular pain syndrome). In these studies, gender, age, and ethnicity have tended to demonstrate demographic variations (i.e., higher in women in 2 of 3 studies; no age differences; higher in African-Americans). However, we were unable to locate a single study using the PCS to determine the demographic profile of pain catastrophizing in a primary care sample—the focus of the present study. Potential participants were men and women, ages 18 years or older, who were being seen at an outpatient internal medicine clinic for nonemergent medical care. The clinic is staffed predominantly by residents in the department of internal medicine, and is located in a midsized mid-western United States city. We excluded individuals with compromising medical (e.g., debilitating pain), intellectual (e.g., mental retardation), cognitive (e.g., dementia), or psychiatric symptoms (e.g., psychotic) of a severity to preclude the candidate’s ability to successfully complete a survey (n=13). This exclusion process was informal and undertaken by the recruiter as patients registered for clinical service. Whereas 349 individuals were approached, 244 agreed to participate, for a participation rate of 70 percent. As for the 105 individuals who did not participate, 68 refused outright, 13 appeared too distressed, 21 appeared too burdened (e.g., struggling with children), and 21 reported not wanting to commit the time. Of the 244 individuals who agreed to participate, 239 completed the Pain Catastrophizing Scale. Of these 239 respondents, 62.3 percent were women and 37.7 percent were men, ranging in age from 21 to 80 years (mean [M]= 45.74, standard deviation [SD] = 15.12). Most participants were White (76.2%); however, 20.5 percent of participants were African-American, 0.8 percent Asian, 1.7 percent Hispanic, and 0.8 percent “Other. ” With regard to educational attainment, all but 2.1 percent had at least graduated high school, whereas 24.3 percent had earned at least a bachelors degree. During clinic hours, one of the authors (D.A.W.) positioned himself in the lobby of the clinic, approached consecutive incoming patients following registration, and informally assessed exclusion criteria. With potential candidates, the recruiter reviewed the focus of the project (i.e., a study examining pain) and then invited each to participate. Each participant was asked to complete a six-page anonymous survey, which took about 10 minutes. Surveys were completed onsite in the lobby, before appointments with providers. Participants were asked to place completed surveys into sealed envelopes and then into a collection box in the lobby of the clinic. Completion of the survey was considered implied consent, which was explained to participants on the cover page to the survey. In addition to demographic variables, we assessed the catastrophizing of pain using the PCS. The PCS is a 13-item self-report measure that assesses catastrophic thoughts and feelings about pain. This measure has a 5-point Likertstyle response scale (0=not at all to 4=all the time) and the scoring range is 0 to 52, with higher scores indicating higher levels of catastrophic thoughts and feelings about pain. The PCS has three underlying factors or dimensions of pain catastrophizing: rumination (items 8, 9, 10 and 11), magnification (items 6, 7 and 13) and helplessness (items 1, 2, 3, 4, 5 and 12). With regard to validity, the PCS has been validated in both clinical and nonclinical populations. In the current study, Cronbach’s alpha was 0.98 for the 13-item measure, 0.97 for the rumination subscale, 0.88 for the magnification subscale, and 0.96 for the helplessness subscale. In the current study, each of the three subscales of the PCS were very highly correlated with each other (all three correlations were 0.93) and with the total score (correlations ranged from 0.97–0.98), so only the total PCS score was considered further. As for the demographic patterns associated with pain catastrophizing, scores on the PCS were statistically significantly correlated with both age (r= -0.30, p<0.001) and level of education (r= -0.22, p<0.98), yet age Letters to the Editor