INSTRUMENTOS DE MEDIDA DE DOR E DE COMPORTAMENTOS CORRELATOS

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J Pain.2018 Mar;19(3):317-329. doi: 10.1016/j.jpain.2017.11.006. Epub 2017 Dec Dimensionality and Reliability of in a Pooled Multicountry Sample the Central Sensitization Inventory

Cuesta-Vargas AI1, Neblett R2, Chiarotto A3, Kregel J4, Nijs J5, van Wilgen CP6, Pitance L7,

Knezevic A8, Gatchel RJ9,Mayer TG10,Viti C11, Roldan-Jiménez C12,Testa M13,Caumo W14, Jeremic-Knezevic M15,Luciano JV16.

Centralsensitization(CS) involves the amplification of neural signaling within thecentralnervous system, which evokes pain hypersensitivity The Central SensitizationInventory(CSI) assesses 25 overlapping health-related symptom dimensions that have been reported to be associated with CS-related disorders. Previous studies have reported satisfactory test-retest reliability and internal consistency, but factor analyses have exhibited conflicting results in different language versions. The purpose of this cross-sectional study was to thoroughly examine thedimensionalityandreliabilityof the CSI, withpooleddata from 1,987 individuals, collected in several countries. The principal component analysis suggested that 1 general factor of CS best described the structure. A subsequent confirmatory factor analysis revealed that a bifactor model, which accounted for the covariance among CSI items, with regard to 1 general factor and 4 orthogonal factors, fit the CSI structure better than the unidimensional and the 4-factor models. Additional analyses indicated substantialreliabilityfor the general factor (ie, Cronbach α = .92; ω = .95; and ω hierarchical = .89).Reliabilityresults for the 4 specific factors were considered too low to be used for subscales. The results of this study clearly suggest that only total CSI scores should be used and reported. PERSPECTIVE: As far as we know, this is the first study that has examined the factor structure andreliabilityof the CSI in a largemulticountrysample. The CSI is currently considered the leading self-report measure of CSrelated symptoms worldwide. No: 15 FI: 5.15 Citações: 11

MEMORIAL WOLNEI CAUMO

Cad Saúde Pública.2008 Jun;24(6):1368-76.

Translation and adaptation of the Brazilian version of the Night Eating Questionnaire.

Harb AB1,Caumo W,Hidalgo MP.

The goal of this study was to translate and adapt the Night Eating Questionnaire to Portuguese and assess the reliability of the Portuguese-language version. The study included two phases. The first consisted of: (1) translation into Portuguese; (2) back-translation into English; (3) correction and semantic adaptation; (4) content validation; and (5) assessment of the understanding of the questionnaire by means of 10 cm Visual Analogue Scales with 30 adult users of a nutritional support clinic. In the second phase, the questionnaire`s reliability was assessed in 100 subjects with similar demographic characteristics to the first sample. In the fifth step, understanding of the instrument assessed by the visual analogue scales was 8.20+/-1.55 cm. The instrument showed satisfactory internal consistency, with an overall Cronbach alpha of 0.78. The Portuguese version proved to be easily understandable, with good semantic validation and consistency, suggesting that the questionnaire may be a good instrument for screening the night eating syndrome. However, other psychometric characteristics of this instrument need to be assessed in samples with different social and educational levels No: 2 FI: 0.59 Citações: 0

PainMed.2013 Jan;14(1):52-61. doi: 10.1111/j.1526-4637.2012.01528.x. Epub 2012 Nov 21. Cross-cultural adaptation and validation of the profile of chronic pain: screen for a Brazilian population.

Caumo W1,Ruehlman LS,Karoly P,Sehn F,Vidor LP,Dall-Ágnol L,Chassot M,Torres IL.

OBJECTIVE: To translate the original English version ofthe Profile of Chronic Pain: Screen (PCP:S) into Brazilian Portuguese and examinebasic psychometric properties of the translated version. We investigated ceiling and floor effects, internal consistency, factor structure, convergent validity, and the ability of theBrazilianPCP:S(B-PCP:S) to discriminate persons withpainwho were either employed or not working, or in treatment or not in treatment. METHODS: The Brazilian Portuguese version of the Profile of Chronic Pain: Screen (B-PCP:S) was administered to a sample of 414 adults (men = 67).Paincatastrophizing was also assessed. Subsamples with special conditions (working despitepain[N = 116] vs not working due topain[N = 122], and not receiving treatment forpain[N = 119] vs receiving treatment [N = 119]) were identified to investigate the discriminativepropertiesof B-PCP:S. RESULTS: For the B-PCP:S, Cronbach’sα values were 0.76 (severity), 0.88 (interference), and 0.87 (emotional burden). Confirmatory factor analysis supported the original, English language three-factor structure, with the comparative fit index = 0.93, root mean square error of approximation = 0.075, and normed fit index = 0.93. Significant correlations were found betweenpainintensity,paininterference, and emotional burden, and a criterion measure of catastrophizing (correlation coefficients ranged from 0.48 to 0.66, P < 0.01). B-PCP:Sscores (severity, interference, and emotional burden) were higher in subjects under a doctor’scare forpainand in those not working due topain. CONCLUSION: This B-PCP:Sversionwas found to be a reliable instrument, withbasicevidence of validity

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for the evaluation ofpain severity, interference, and emotional burden in Brazilian Theprofileof B-PCP:Sscores was similar to that observed in theoriginal version. No: 3 FI: 2.78 Citações: 22 Portuguese adults.

PainMed.2012 Nov;13(11):1425-35. doi: 10.1111/j.1526-4637.2012.01492.x. Epub 2012 Oct 4. Cross-cultural adaptation and validation of the Brazilian Portuguese version of the pain catastrophizing scale.

Sehn F1,Chachamovich E,Vidor LP,Dall-Agnol L,de Souza IC,Torres IL,Fregni F,Caumo W.

OBJECTIVE: Catastrophizingis amaladaptiveresponsetopainand isoneof thefactorsthatcontributeto thechronicityof somepain syndromes. ThePain Catastrophizing Scale (PCS) assists both treatment planning and outcome assessment. Its use is limited in Portuguese-speakingcountries because of the lackof a validated translated version. Weconductedthevalidationof the Brazilian Portuguese (BP)-PCSand explored its psychometric properties. This study reports the internal consistency,factorstructure, and its capability to discriminatepainreported by patients with specific chronicpainconditions. METHODS: Three hundred eighty-four patients, 317 women (82.55%), aged 18-79 years with chronic nonmalignantpainattending an outpatient multidisciplinarypaincenter participated in this cross-sectional study. The instruments were the BP-PCS, pain intensity, pain interference in functional capacity, and a socio demographic questionnaire.Onesubsample with chronic tension headache (CTH) according to the criteria of the International Headache Society (N = 19), and another with a diagnosis of fibromyalgia according to the American College of Rheumatology criteria (N = 50) were selected to assess the discriminative properties of BP-PCS. RESULTS: We observed good internal consistency (Cronbach’s α values of 0.91 for the total BP-PCS, and 0.93 [helplessness], 0.88 [magnification], and 0.86 [rumination] for the respective subdomains). The item-total correlation coefficients ranged from 0.91 to 0.94. Confirmatory factor analysis (CFA) supported the threefactorsstructure, with the comparative fit index = 0.98, root mean square error of approximation = 0.09, and normed fit index = 0.98. Significant correlations were found for pain intensity, pain interference, and patient’s mood (correlation coefficients ranged from 0.48 to 0.66, P < 0.01). No significant gender difference was observed for BP-PCSscores. When comparing scores of BP-PCSscaleand subscales between the selected control group (patients withpainscores on visual analogscaleequal or lower than 40 mm in the most part of the day in the last 6 months) and patients with fibromyalgia or CTH, we observed lower scores for the former group. CONCLUSION: Our findings support the validity and reliability of the BP-PCS. Thescaleshowed satisfactory psychometric properties. CFA provides support for the three-factorstructure reported in previous studies. Thisfactorstructure presented good discriminative properties to identifycatastrophizeswho present with mild chronicpain, fibromyalgia, and CTH. The BP-PCSis a valuable tool for use in scientific studies and in the clinical setting in patients with chronicpainin BrazilianPortuguese-speakingcountries. No: 4 FI: 3.1 Citações: 75

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J Psychosom Res.2010 Mar;68(3):223-33. doi: 10.1016/j.jpsychores. 2009. 09.013. Epub 2009 Dec 9. Evaluation of the structure of Brazilian State-Trait Anxiety Inventory using a Rasch psychometric approach.

Kaipper MB1,Chachamovich E,Hidalgo MP,Torres IL,Caumo W.

OBJECTIVE: This study evaluates the State-Trait Anxiety Inventory (STAI) structure using a Rasch psychometric approach, and a refined and shorter STAI version is proposed. METHODS: A cross-sectional study was performed with 900 inpatients scheduled for elective surgery. Age varied from 18 to 60 years (American Society of Anesthesiologists physical status I-III). Demographic information was collected using a structured questionnaire. The measuring instrument (the STAI) was applied to all patients in the afternoon before the surgery and prior to the patients receiving preoperative sedatives. RESULTS: Rasch analysis of the state and trait anxiety scales was performed separately. This analysis demonstrated that the original format of state and trait scales fails to show invariance across the trait-state anxiety level, which results in the unstable performance of items. The refined scale was retested in two subsequent random samples of 300 subjects each, and the results were confirmed. The performance was adequate regardless of gender. In the analysis, some items of the state scale (items 3,4,9,10,12,15, and 20) were deleted due to poor fit statistics. The remaining 13 items showed unidimensionality, local independence, and adequate index of internal consistency. Also, the original trait scale displayed several weaknesses. First, the four-point Likert response scale proved to be inadequate, and threshold disorders were found in all 20 items. Also, the original trait scale showed insufficient item-trait interaction and several individual item misfits. Following the rescoring process, and retesting in a second random sample, items were excluded (namely Items 3, 4, 11, 13, 14, 15, 18, and 19). The refined version showed local independence, unidimensionality, and adequate fit statistics. DISCUSSION: The results indicate that the application of the Rasch model led to the refinement of the classic STAI state and trait scales. In addition, they suggest that these shorter versions have a more suitable psychometric performance and are free of threshold disorders and differential item functioning problems. No: 5 FI: 3.2 Citações: 70

Arq Neuropsiquiatr.2011 Dec;69(6):943-8.

Validation of a Brazilian quantitative sensory testing (QST) device for the diagnosis of small fiber neuropathies.

Schestatsky P1,Stefani LC,Sanches PR,Silva Júnior DP,Torres IL,Dall-Agnol L,Balbinot LF,Caumo W.

Quantitativesensorytesting(QST) isdefinedas the determination of thresholds forsensory perception undercontrolledstimulus. Ouraimwas to validate anewQSTdeviceforBraziliansample. In 20 healthy adults, thermoalgesic thresholds were assessed using a QST prototype (Heat Pain Stimulator-1.1.10; Brazil). A 30 × 30 mm(2) thermode with a 1°C/sstimuluschange rate were applied.Thresholdsof three consecutivestimuliwere averaged in two different sessions separated by at least two weeks. Additionally long thermal heat painstimulus was performed. To evaluate the consistency of our method we also analyzed 11 patients with small fiber neuropathy. Results showed good reproducibility of thermalperceptionthresholdsin

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normal individuals and plausible abnormalthresholdsin patients. We conclude that ourQSTdeviceis reliable when analyzing the nociceptive pathway in controls and patients. No: 6 FI: 1.04 Citações: 34

Br J Anaesth. 2016 Nov;117(5):642-649.

Development, psychometric evaluation and validation of a brief measure of emotional preoperative stress (B-MEPS) to predict moderate to intense postoperative acute pain.

Caumo W, Nazare Furtado da Cunha M, Camey S, Maris de Jezus Castro S, Torres IL, Cadore Stefani L.

BACKGROUND: Preoperative stress might influence postoperative pain, thereby, it is desirable to assess it more precisely. Thus, we developed and evaluated the psychometric properties of a brief measure of emotional preoperative stress (B-MEPS) index using Item Response Category Characteristic Curves. We validated and assessed whether the B-MEPS can predict moderate to intense acute postoperative pain (MIAPP). METHODS: We included 863 adult patients who underwent elective surgeries (ASA I-III physical status). The B-MEPS was constructed based on items selected from instruments to assess anxiety, depression, future self-perception and minor psychiatric disorders. We identified 24 items with greatest discriminant power to identify patients who should undergo surgery to treat cancer with MIAPP. The reliability was maximized using the Cronbach’s alpha indices. Fifteen items remained, which were adjusted by the Generalized Partial Credit Model. The convergent validity was assessed correlating the B-MEPS index with the pain catastrophizing (n = 100). Finally, the B-MEPS was applied in a prospective cohort of patients who underwent an abdominal hysterectomy (n = 150). RESULTS: The Cronbach’s alpha for selected items was 0.83. The correlation coefficient between B-MEPS index and catastrophizing was r = 0.37 (P < 0.01). A hierarchical regression model evidenced that the B-MEPS index was a factor independent to predict MIAPP after an abdominal hysterectomy [odds ratio (OR)=1.20, confidence interval (CI) 95% 1.05-1.43). CONCLUSIONS: The B-MEPS index presents satisfactory psychometric evaluations based on its internal consistency, convergent, and discriminant validity. The B-MEPS is a propensity index to MIAPP, which might help the clinician to decide on the best therapeutic approaches for acute postoperative pain No: 7 FI: 6.49 Citações: 5

Reply: allostatic load as an approach to support the theoretical assumptions of the Brief Measure of Emotional Preoperative Stress (B-MEPS).

W. Caumo1,2,3,4,Email the author W. Caumo, J.D. Segabinazi1,2, L.P.C. Stefani1,4. DOI: org/10.1093/bja/aex064 https://doi.

Editor—We are grateful to Scott and McCracken1for their analysis and comments on our paper. The authors underscored the absence of a clear conceptual definition of the construct measured by the Brief Measure of Emotional Preoperative Stress (B-MEPS). We aimed to explain the theoretical assumptions considered to define the domain of interest in the development of B-MEPS as well as the psychometric foundations

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investigated thus far. We would like to highlight that the development of the measure agrees with the latest assumptions on test design published in the Standards for Educational and Psychological Testing.2Regarding test specifications, the standards state that the nature of the test development (the way in which the test is created) may vary widely as a function of the nature of the test and its intended uses. As recommended by the Standards (2014), in the process of developing the B-MEPS we stated the purpose(s) of the test, the intended users and uses, the content domain to be measured, and the expected examinee population. The greater challenge in the process to develop the B-MEPS was to identify a set of items that more precisely assessed preoperative stress. In fact, the B-MEPS scale was developed from several different tools currently used to measure depression symptoms, anxiety, minor psychiatric problems, and future self-perceptions.3 Thus the B-MEPS content items are related to stress since they were extracted from tools previously used to identify emotional aspects, including the surgical setting, to determine individual propensity for severe postoperative pain.45 We understand that in evaluations using the B-MEPS, it could be emphasized that the examinee population answers should be related to their thoughts and feelings associated specifically with the surgery. In the B-MEPS development to discriminate preoperative stress, we analysed the relationship between each item and two stress conditions (surgery to treat cancer and the presence of moderate to intense pain (>4 cm) on a visual analogue scale (VAS; 0–10 cm). Also, the Item Response Theory (IRT)6was used to identify items that evaluate preoperative stress with more specificity. These approaches were used because there is scarce evidence about terms and items to assess physiological, behavioural, and emotional domains specifically related to preoperative emotion. The Standards propose a method that partially shapes the conceptual framework of a measure in which test scores will be used. For instance, B-MEPS scores can help the medical team plan specific interventions to improve postoperative outcomes and to optimize the cost utility of different treatments applied (i.e. preoperative preparation programme through the use of distraction, relaxation, sedation, music therapy, biofeedback, etc.). Each of these uses implies a somewhat different interpretation of preoperative stress and shapes the specified framework and the proposed interpretation of B-MEPS scores. Understood in this way, validation can be viewed as a process of constructing and evaluating arguments for and against the intended interpretation of the test scores and their relevance to the proposed use. In this sense, several sources of validity evidence were searched in our paper to illuminate different aspects of validity of B-MEPS, for example, the test content, the internal structure, the consequences of testing, and the response processes. Therefore, B-MEPS can provide evidence concerning the fit between the construct and the detailed nature of the performance or response engaged in by B-MEPS takers. In the foundation of this psychometric framework, further publications of our research group will address the stress definition related to surgery in a theoretical model based on the allostasis theory (Fig. 1). We considered that the brain processes external sensory inputs from the environment and internal inputs from the body, which comprise an allostatic load. Allostasis is a term used to explain a cascade of physiological reactions for a protective, coordinated, and adaptive response to maintain homeostasis. Stress is the resourceintensive process of mounting allostatic responses to challenges that occur in the external or internal environment.7 Three interdependent systems contribute to the preservation of homeostasis when an injury occurs: neural, endocrine, and immune.8According to this model, stress occurs when environmental stressors exceed and dysregulate adaptive capacity (allostasis). Thus stress is a result of psychological and physiological changes that induce dysfunction and disease. The allostasis load to select the B-MEPS was associated with two stress conditions (surgery to treat cancer and the presence of moderate to intense pain on a VAS), because it has been demonstrated that surgeries to treat cancer are associated with such

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mutilation that the prevalence of psychological distress in patients with cancer is 30–70%.9Also, a cancer diagnosis itself creates unique psychological distress that can affect how a patient relates to pain and how a patient recovers from treatment. No: 8 FI: 6.49 Citações: 0

Model of allostatic load involved in preoperative emotional stress as a potential risk factor for postoperative pain.

JPainSymptom Manage.2018 Oct;56(4):594-601. doi: 10.1016/j.jpainsymman. 2018.06.014. Validation of Two Pain Assessment Tools Usinga Standardized Nociceptive

StimulationinCriticallyIllAdults.

Klein C1,Caumo W2,Gélinas C3,Patines V4,Pilger T4,Lopes A4,Backes FN5,Villas-Boas DF6,Vieira SRR5. RESULTS: Inter-rater reliability of nurses’ CPOT and BPS scores was supported by high weighted kappa >0.7. Discriminativevalidationwas supported with higher CPOT and BPS scores during SNSPA or turning in comparison to baseline (P<0.001). The Glasgow Coma Scale score was the only variable that predicted CPOT and BPS scores with explained variance of 44.5% and 55.2%, respectively. CONCLUSION: The use of the Brazilian CPOT and BPS versions showed good reliability and validity incriticallyilladultsunable to self-report. Astandardizedprocedure, the SNSPA, was used for the first time in thevalidationprocess of thesetoolsand helped us improve thevalidationprocess. No: 10 FI: 3.37 Citações: 0