Pain-Induced Anxiety in Older Adults: Validation of The Pass-20p (Pain Anxiety Symptoms Scale-20) For Use in Brazil And Development of A Shortened Version

Introduction: Chronic pain is associated with biological and behavioral responses that are often linked to neuropsychiatric disorders such as anxiety. In pain-related conditions, anxiety may be assessed using the Pain Anxiety Symptoms Scale (PASS- 20P), an instrument already translated and cross-culturally adapted for use in Brazil. This study aimed to evaluate the psychometric properties of the Brazilian version of the PASS-20P in older adults with chronic pain. Methods: This was a methodological study focused on instrument validation, involving older adults experiencing chronic pain. Sociodemographic and pain-related data (nature, etiology, intensity) were collected. The Hospital Anxiety and Depression Scale (HADS) and the PASS-20P were administered—the latter on three separate occasions: first, by two different researchers independently, and then, 7 to 14 days later, by only one of them. Statistical analyses included Cronbach’s alpha, intraclass correlation coefficient (ICC), and Pearson’s correlation coefficient. Results: The sample consisted of 60 participants with a mean age of 78.4 years. Most were women (91.7%), white (63.3%), widowed (48.7%), and presented pain of primarily osteodegenerative etiology (51.7%). The PASS-20P demonstrated excellent internal consistency (Cronbach’s alpha = 0.899) and satisfactory intra- and inter-rater reproducibility (ICC = 0.938 and 0.948, respectively; p < 0.001). Convergent construct validity was adequate (Pearson’s correlation coefficient = 0.586). A shortened version of the instrument, the PASS-6P, was developed. ROC curve analysis indicated that scores of 9.5 or higher suggest the presence of pain-induced anxiety. Conclusion: The PASS-20P demonstrated adequate psychometric properties for assessing pain-induced anxiety in older adults. Its shortened version may facilitate assessment and contribute to improved management of chronic pain in this population