The Turkish Fear of Pain Questionnaire

Study Overview
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Brief Summary
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Children's chronic pain is a significant condition that affects roughly 25% of children, with approximately 3% of them requiring intense pain therapy. In the adult literature, various scales have been established to assess fear of pain. When these scales are studied, fear of pain has been shown to have a role in adult chronic pain research, but this topic has gotten less attention in pediatric chronic pain research. The Fear of Pain Questionnaire for Children (FOPQ-C) is a questionnaire that addresses this knowledge gap. The purpose of this study is to determine the validity and clinical utility of the Fear of Pain Questionnaire for Children (FOPQ-C) Scale in the Turkish community.

Detailed Description
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Pain is a multidimensional experience that includes sensory, cognitive, emotional, and social factors. The International Association for the Study of Pain defines chronic pain as pain that lasts longer than three months, besides the lack of a clear description. Chronic pain is a critical developmental health issue that can be recurring or persistent, causing significant disruption in everyday life. Children with chronic pain that is continuous or recurrent may be unable to attend school, may withdraw from social activities, and may develop internalizing symptoms as a result of their discomfort. Given these findings, researchers and clinicians must focus on concerns connected to pediatric chronic pain in order to reduce these challenges and develop appropriate methods. Adults are reported to suffer from 19 percent of chronic pain, with two-thirds describing their pain as persistent and 50% describing it as unbearable. Chronic pain has emerged as a significant problem in children, affecting around one out of every four children, while approximately 3% of children require intense pain therapy. Psychosocial factors interact with physiological processes to influence pain outcomes such as pain perception and impairment, according to the biopsychosocial model of chronic pain. Fear of pain is a psychological mechanism that has been shown to be effective in predicting chronic pain and accompanying disability in adults. When pain-related sensations are viewed as dangerous, fear of pain develops. The Fear Avoidance Model of Pain outlines how fear of pain influences the outcomes of people who are in chronic pain. Many elements of the condition, including experimentally generated pain severity, pain during dental treatment, chronic pain behavior, and pain-related disability, have been linked to fear of pain. Simultaneously, in the Fear Avoidance Model of Pain, if pain is seen as threatening, pain-related fear develops, leading to avoidance. Simultaneously, in the Fear Avoidance Model of Pain, if pain is seen as threatening, pain-related fear develops, leading to avoidance behaviors and hypervigilance. After that, there's incapacity and depression. These negative outcomes aggravate the fear and avoidance loop. While assessing fear of pain is critical, assessing fear of re-injury is more difficult because it can entail movement, physical activity, or a mix of these things. Furthermore, patients frequently do not report or subjectively sense pain, but rather have trouble performing the actions or activities that have been required of them. In the adult literature, various scales have been established to assess fear of pain. Fear of pain has been shown to have a role in adult chronic pain research, but it has gotten less attention in pediatric chronic pain research. The Fear of Pain Questionnaire for children and parents (FOPQ-C SF, FOPQ-P) is a questionnaire that addresses this knowledge gap. As a result, the purpose of this study is to see if the Fear of Pain Questionnaire for Children & Parents (FOPQ-C, FOPQ-P) Scale is valid in the Turkish community and how effective it is in therapeutic practice.

Official Title
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The Turkish Adaptation, Validity, and Reliability Study of the Fear of Pain Questionnaire (FOPQ-TR)

Conditions
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Chronic Headache

Participation Criteria
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Eligibility Criteria
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Inclusion criteria of children with chronic pain: (1) Being diagnosed with chronic pain. (2) To have the cognitive ability to answer questions for assessment. (3) Completing the test-retest assessment. (4) To be the native language Turkish. Exclusion criteria for children with chronic pain: Uncontrollable psychological diseases (eg, attention deficit hyperactivity disorder, autism spectrum disorder, schizophrenia, bipolar disorder, major depressive disorder), specific pathologies, will not be included in the study. Patients who started a new treatment during the study or 6 weeks before the study. Study participants will be instructed not to take analgesics for 48 hours prior to assessments. Inclusion criteria for healthy children: between the ages of 5-18. Not having any psychiatric or neurological diagnosis. To be the native language Turkish. Exclusion criteria for healthy children: Families and children who did not agree to participate in the study. To have received medical treatment for any neuropsychiatric disorder.

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Chronic Headache Group<br>Children with chronic headache | |
| Healthy Group<br>Children without pain | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of pain of fear for children | The Fear of Pain Questionnaire-Short Form (FOPQ-C-SF) for Children is a 10-item variant of the 24-item Fear of Pain Questionnaire for Children. It uses children's self-reports to assess pain-related anxieties (4 items) and avoidance behaviors (6 items). When I'm in pain, for example, I cancel my plans. When I'm in pain, I'm worried something bad may happen. A 0-4 Likert scale is used for scoring. A score of 0 indicates significant disagreement, while a score of 5 indicates great agreement. The total score is calculated by aggregating the individual item scores. Higher pain-related fear and avoidance behavior are associated with higher scores. | Baseline | 
| Evaluation of pain of fear for parents | The Fear of Pain Scale for Children-Parent Form (FOPQ-P) is a scale that evaluates children's fear of pain with a parent report. FOPQ-P consists of 23 items. The scale assesses fear of pain in three sub-areas. These are: Fear of Pain (8 items), Avoidance of Activities (10 items), and Avoidance of School (5 items). Scoring is done on a Likert scale of 0-4 points. The parent rates the child's approach to pain that has existed for several hours or throughout the day, from 0 = strongly disagree to 4 = strongly agree. | Baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of pain catastrophing for children | The Pain Catastrophing Scale was developed to assess adults' pain-related catastrophizing thoughts. The Pain Catastrophizing Scale-Child (PCS-C) is an adapted version of the Pain Catastrophizing Scale for children. PCS-C evaluates catastrophizing behavior with 13 items: thinking long about pain (4 items), magnifying pain (3 items), and helplessness (6 items). For example, I can't get the pain out of my mind. I'm afraid my pain will get worse. There is nothing I can do to reduce the pain. Scoring is done on a Likert scale of 0-4 points. 0=not at all; 4=extremely The adult version of the Turkish version of the Pain Catastrophizing Scale for families will be used. | Baseline | 
| Evaluation of pain for children | It is a valid and reliable scale that children and their families prefer to use when determining the level of discomfort. It is made up of six different facial expressions that represent the degree of pain. From a happy face (0 points) to a very sad and crying expression, they show the stages of increasing pain (10 points). Each facial expression's meaning is carefully explained to the child. The severity of pain during facials is rated by children. | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Chronic headache, Pain related fear, Assessment, Children, validity, cultural adaptation