COSMIN database

Pain-related fear: a critical review of the related measures

Lundberg, M., Grimby-Ekman, A., Verbunt, J., and Simmonds, M. J.
OBJECTIVES: In regards to pain-related fear, this study aimed to: (1) identify existing measures and review their measurement properties, and (2) identify the optimum measure for specific constructs of fear-avoidance, pain-related fear, fear of movement, and kinesiophobia.

DESIGN: Systematic literature search for instruments designed to measure fear of pain in patients with persistent musculoskeletal pain. Psychometric properties were evaluated by adjusted Wind criteria.

RESULTS: Five questionnaires (Fear-Avoidance Beliefs Questionnaire (FABQ), Fear-Avoidance of Pain Scale (FAPS), Fear of Pain Questionnaire (FPQ), Pain and Anxiety Symptoms Scale (PASS), and the Tampa Scale for Kinesiophobia (TSK)) were included in the review. The main findings were that for most questionnaires, there was no underlying conceptual model to support the questionnaire's construct. Psychometric properties were evaluated by diverse methods, which complicated comparisons of different versions of the same questionnaires. Construct validity and responsiveness was generally not supported and/or untested.

CONCLUSION: The weak construct validity implies that no measure can currently identify who is fearful. The lack of evidence for responsiveness restricts the current use of the instruments to identify clinically relevant change from treatment. Finally, more theoretically driven research is needed to support the construct and thus the measurement of pain-related fear.
Pain Res Treat
2090-1550 (Electronic)
Publication year:
Symptom status:
Cognitive/mental state
Emotional state
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
Mental and behavioural disorders and related symptoms
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
FABQ - Fear-Avoidance Beliefs Questionnaire   
FAPS - Fear-Avoidance of Pain Scale
FPQ - Fear of Pain Questionnaire
PASS - Pain Anxiety Symptoms Scale   
TSK - Tampa Scale for Kinesiophobia