449: Responsiveness of Pain Concept Instruments in Patients with Chronic Low Back Pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Assessment and Measurement of Pain/Nociception, Physiotherapy, Treatment/management

Background and Aims: Pain Science Education (PSE) aims to align individuals’ understanding of pain with current science, improving pain and wellbeing [1]. PSE focuses on conceptual change by restructuring existing knowledge and addressing misconceptions [2]. The Concept of Pain Inventory (COPI-Adult) [3] and Pain Concepts Questionnaire (PCQ) [4] are patient-reported measures that assess beliefs about pain, but their responsiveness, ability to detect changes over time in the construct being measured, has not been studied [5]. This study investigates the responsiveness of COPI-Adult and PCQ in patients with chronic low back pain (CLBP) following a PSE program.

Methods: Study followed the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. Patient-Reported Outcome Measures (PROMs) administered before and after a PSE intervention included: the Revised Neurophysiology of Pain Questionnaire (r-NPQ, 0-12), Numeric Pain Rating Scale (NPRS, 0-10), COPI-Adult (0-65), and PCQ (biopsychosocial/biomedical 1-6). Within-group differences were analyzed via paired t-test (p < 0.05). Receiver Operating Characteristic (ROC) curves assessed responsiveness, with Area Under the Curve (AUC) > 0.70 indicating good quality [6]. A Global Perceived Effect (GPE) scale for belief change (range -5 to 5) served as the anchor; a cutoff of 2 distinguished those who changed beliefs from those who did not.

Results: This study included 84 participants with CLBP (53 female, mean age=37.7 years [SD=12.3], mean pain intensity=5.3 [SD=1.6]. Only 4 participants showed a score less than 2 on the GPE of change of beliefs scale. The results showed significant within group differences before and after PSE for pain intensity (baseline: 5.3, post: 3.3, t=8, p<0.001), pain beliefs (COPI-Adult, baseline: 33.2, post: 44.3, t=-11, p<0.001; PCQ-biopsychosocial, baseline: 4.6, post: 5.1, t=-6.4, p<0.001; PCQ-Biomedical, baseline: 3.2, post: 2.3, t=11.4, p<0.001) and pain neurophysiology knowledge (baseline: 4.6, post: 7.3, t=-9.8, p<0.001). The AUC for the change scores of the r-NPQ, COPI-Adult, PCQ–Biopsychosocial and PCQ–Biomedical were respectively: 0.89 (p=0.007), 0.85 (p=0.02), 0.83 (p=0.03), and 0.28 (p=0.15).

Conclusions: All the PROMs included in this study met the COSMIN criterion for good quality of responsiveness, except for the PCQ-Biomedical scale. Patients experienced reduced both pain intensity and biomedical scores on the PCQ, along with notable improvements in their beliefs about pain (especially around biopsychosocial concepts) and their knowledge after a PSE program. These findings suggest that a PSE program can foster changes in how patients understand pain neurophysiology and misconceptions, as well as decrease pain intensity. The COPI-Adult, r-NPQ and PCQ (Biopsychosocial) are recommended for evaluating conceptual change following a PSE program.

References: 1. Moseley GL, Leake HB, Beetsma AJ, Watson JA, Butler DS, van der Mee A, Stinson JN, Harvie D, Palermo TM, Meeus M, Ryan CG. Teaching Patients About Pain: The Emergence of Pain Science Education, its Learning Frameworks and Delivery Strategies. J Pain. 2024 May;25(5):104425. doi: 10.1016/j.jpain.2023.11.008. Epub 2023 Nov 19. PMID: 37984510.
2. Reezigt RR, Beetsma AJ, Catley MJ, Palermo TM, Pate JW, Leake HB, Reneman MF, Watson JA, Ryan CG, Lorimer Moseley G. Assessing pain science education; the measurement properties of assessment instruments of conceptual change: A narrative and rapid review. J Pain. 2026 Mar;40:106195. doi: 10.1016/j.jpain.2026.106195. Epub 2026 Jan 21. PMID: 41577212.
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5. Newman AK, Morais CA, Van Dyke BP, Thorn BE. An Initial Psychometric Evaluation of the Pain Concepts Questionnaire in a Low-SES Setting. J Pain. 2021 Jan;22(1):57-67. doi: 10.1016/j.jpain.2020.05.002. Epub 2020 Jun 27. PMID: 32603873.
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Presenting Author: Thamiris Costa de Lima
Submitting Author: Thamiris Costa de Lima

Senior Author: Thais Cristina Chaves

IASP 2026 Global Year theme of Neuropathic Pain: No

• Thamiris Costa de Lima: PhD candidate in Physiotherapy - Federal University of Sao Carlos
• Joshua W. Pate: PhD in Paediatric Pain - University of Technology Sydney
• Roger Berg: Master in Physiotherapy - Federal University of Sao Carlos
• Thais Cristina Chaves: PhD in Rehabilitation - Federal University of Sao Carlos