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Children’s and adolescents’ relationship to pain during cancer treatment: a preliminary validation of the Pain Flexibility Scale for Children

Authors Thorsell Cederberg J, Weineland Strandskov S, Dahl J, Ljungman G

Received 24 March 2017

Accepted for publication 21 April 2017

Published 16 May 2017 Volume 2017:10 Pages 1171—1178


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Katherine Hanlon

Jenny Thorsell Cederberg,1 Sandra Weineland Strandskov,2 JoAnne Dahl,3 Gustaf Ljungman1

1Department of Women’s and Children’s Health, Pediatric Oncology, Uppsala University, Uppsala, Sweden; 2Närhälsan, Research and Development Center, Primary Health Care, Södra Älvsborg, Borås, Sweden; 3Department of Psychology, Uppsala University, Uppsala, Sweden

Objectives: Children with cancer often suffer from pain. Pain is associated with psychological distress, which may amplify the pain experience. In chronic pain, it has been shown that psychological acceptance is helpful for both adults and children. For experimentally induced pain, interventions fostering psychological acceptance have been shown to predict increases in pain tolerance and reductions in pain intensity and discomfort of pain. A single subject study aiming to nurture psychological acceptance for children with cancer experiencing pain has shown promising results. No instruments measuring psychological acceptance in acute pain are yet available. The aim of the current study was to develop and preliminarily evaluate an instrument to measure psychological acceptance in children experiencing pain during cancer treatment.
Methods: A test version of the Pain Flexibility Scale for Children was sent to all children aged 7–18 years undergoing cancer treatment in Sweden at the time of the study. Exploratory factor analysis was used. Internal consistency, test–retest reliability, and convergent validity were examined.
Results: Sixty-one children participated in the study. A two-factor solution with Promax rotation was found to best represent the data. Internal consistency was good to excellent (a =0.87–0.91). The total scale and the subscales demonstrated temporal stability (Intraclass correlation coefficient =0.56–0.61) and satisfactory convergent validity (r=−0.27 to −0.68).
Discussion: The Pain Flexibility Scale for Children measuring psychological acceptance in children with cancer experiencing pain is now available for use. This enables the evaluation of acceptance as a mediator for treatment change in the context of acute pain in children with cancer, which in turn is a step forward in the development of psychological treatments to help children cope with the pain during these difficult circumstances. The scale shows good psychometric properties but needs further validation, particularly considering the small sample size.

Keywords: acute pain, children, acceptance, psychological flexibility, factor analysis

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