Two months ago, we discussed persistent pelvic pain and how it can significantly impact an individual’s quality of life affecting their physical, emotional, and social well-being. (Click here to get access to the full article)
Since pelvic pain is such a complex condition, a multidimensional approach is essential to diagnose and treat it. However, traditional objective measures have their limitations when it comes to understanding the patient’s experience and the impact of their symptoms on daily life.
This is where using the SAD CLLIFSS acronym coined by Carolyn Vandyken and Antony Lo in 2019 comes into play and it is widely used in Carolyn’s courses at REFRAME REHAB.
The acronym stands for Stress, Anxiety/Depression, Castrophization, Low Self Efficacy, Low Positive Effect, Injustice, Fear, Shame/Self Compassion and Sensory-Motor Dysregulation. It represents a comprehensive set of self-reported measures designed specifically for psychosocial constructs that are part of a phenotypic understanding of nocioplastic pain.
We took a deep dive into the Central Sensitivity Index (CSI), one of the 8 questionnaires part of the SAD CLLIFSS framework, in our article two months ago. Last month’s article featured the DASS, Insomnia Severity Index, and the Fremantle.
This month we’ll take a closer look at the Pain Catastrophizing Scale (PCS), Positive and Negative Affect Schedule (PANAS), Pain Self-Efficacy Questionnaire (PSEQ), and the Tampa Scale for Kinesiophobia (TSK-11).
- Pain Catastrophizing Scale (PCS):
This questionnaire is designed to measure the degree to which patients engage in catastrophic thinking related to pain. Catastrophizing is a maladaptive coping strategy that can amplify the perception of pain and hinder recovery.
The PCS is a 13-item self-report measure divided into three subscales: rumination, magnification, and helplessness. Knowing a patient’s tendency toward catastrophic thinking can guide interventions such as cognitive-behavioral therapy or mindfulness-based strategies to improve pain management.
- Positive and Negative Affect Schedule (PANAS):
The PANAS measures two core dimensions of mood: Positive Affect and Negative Affect. It consists of 20 items: 10 for Positive Affect (PA) and 10 for Negative Affect (NA).
While not specific to pain, PANAS can provide insights into the emotional context in which pain is experienced. Monitoring affective states could be useful to identify emotional triggers or coping mechanisms, and can influence the treatment plan.
- Pain Self-Efficacy Questionnaire (PSEQ):
This is a 10-item questionnaire that assesses a person’s belief in their ability to accomplish various activities despite their pain. A low score could indicate that the patient feels helpless against their pain or is victimized in their pain experience. This low score signals the need for interventions that bolster self-efficacy, like graded exposure to activity, patient education, or cognitive-behavioral approaches.
- Tampa Scale for Kinesiophobia(TSK-11):
This tool is used to measure fear of movement or injury. The TKS-11 is a shorter version of the original Tampa Scale and consists of 11 items. High scores on this scale could suggest that fear-avoidance behaviors are exacerbating or maintaining the patient’s pain condition. This could indicate the need for interventions like exposure therapy or graded motor imagery to address fear of movement.
Here are two examples of how these questionnaires can help broaden the assessment of your clients.
Example 1: A 35-year-old female patient presents with a history of interstitial cystitis, causing chronic pelvic pain. She reports that her pain is impacting her work and personal life, causing her significant distress.
As part of the initial assessment:
- Pain Catastrophizing Scale (PCS): Her score is high, indicating that she frequently engages in catastrophic thinking related to her pain.
- PANAS: She scores low on Positive Affect and high on Negative Affect, suggesting that she is currently struggling emotionally.
- Pain Self-Efficacy Questionnaire (PSEQ): She scores low, indicating low confidence in her ability to manage pain.
- TKS-11: Her score indicates a moderate fear of movement, suggesting some level of kinesiophobia.
Treatment Plan: Given her high PCS and low PSEQ scores, a multimodal approach including cognitive-behavioral therapy to address catastrophic thinking and improve self-efficacy is recommended.
The PANAS results might prompt a discussion about potential co-treatment with a mental health provider. Physical therapy interventions would also consider her fear of movement as revealed by the TKS-11, perhaps incorporating graded exposure techniques.
Example 2: A 50-year-old male has been experiencing chronic pelvic pain due to chronic prostatitis for several years. Despite trying various treatments, the pain persists and has started to interfere with his work.
As part of the Initial Assessment:
- Pain Catastrophizing Scale (PCS): His score is moderate, indicating some level of catastrophic thinking.
- PANAS: His Positive Affect is average but his Negative Affect is elevated, suggesting that while not depressed, he is experiencing emotional distress.
- Pain Self-Efficacy Questionnaire (PSEQ): His score is moderately low, which shows he has limited confidence in his ability to manage his pain.
- TKS-11: The patient scores high, indicating a strong fear of movement or re-injury.
Treatment Plan: The elevated TKS-11 scores suggest that addressing fear of movement should be a priority, perhaps through graded motor imagery or exposure therapy. His moderate PCS score and elevated Negative Affect might benefit from cognitive-behavioral approaches or mindfulness-based stress reduction techniques.
Given the low PSEQ score, interventions aimed at boosting self-efficacy, such as structured exercise regimens that allow him to experience success, could be valuable.
In both cases, these questionnaires provide a multi-dimensional view of the patients’ experiences, which allows for a more targeted and effective treatment strategy for their chronic pelvic pain.