Development and Validation of a Chronic Pain Mental Well-Being Scale for Filipinos: A Basis for the Assessment and Well-Being Program for People with Chronic Pain

Development and Validation of a Chronic Pain Mental Well-Being Scale for Filipinos: A Basis for the Assessment and Well-Being Program for People with Chronic Pain | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and Validation of a Chronic Pain Mental Well-Being Scale for Filipinos: A Basis for the Assessment and Well-Being Program for People with Chronic Pain Kimberly Joanna C. Dayrit This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7023629/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Chronic pain affects 10.4% of the general population in the Philippines, yet scales used to measure the well-being of patients are derived from Western practice. This study developed and validated the Chronic Pain Mental Well-Being Scale for Filipinos to bridge the gap between culturally appropriate tools and measure the well-being of chronic pain patients. Data was collected from 100 Filipinos who have been experiencing chronic pain for at least six months. After exploratory factor analysis, results showed that three factors namely biological, psychosocial, and cultural domains affect mental well-being of patients related to chronic pain. This scale is divided into three categories namely Biological, Psychosocial, and Cultural Domains. The biological factors focused on the physical aspects of chronic pain including pain intensity, physical functioning, sleep disturbances, fatigue, and medication use. The psychosocial factor which includes the emotional and cognitive aspects of mental well-being to chronic pain. It includes pain catastrophizing, emotional resilience, coping strategies, mental health symptoms, and self-efficacy. Moreover, it also added the social perceptions of chronic pain sufferers to pain. The cultural domain aims to measure the cultural dynamics and relationships of patients that are uniquely Filipino and modeled from Enriquez’ Kapwa framework of hiya and pakikisama . chronic pain Filipinos hiya pakikisama mental well-being INTRODUCTION Background of the Study According to Dydyk & Connerman (2024), chronic pain is a persistent condition that includes a range of discomfort often originating from various sources, such as injury, disease, andsometimes unknown causes. Persistent pain must last at least 3 to 6 months and impair an individual’s quality of life, which can lead to emotional distress, social isolation, and physical impairments. One quarter of the population in the United States is suffering from chronic pain, making it one of the most common issues encountered in outpatient healthcare (Nahin, 2015). It is a significant health issue but is often underreported and left untreated, especially in developing countries such as the Philippines, because of various factors. In the Philippines, studies on the prevalence and treatment of chronic pain did not exist until 2011. A study conducted by Javier and Lu (2012) investigated the prevalence and incidence of chronic pain in the Philippines. The study revealed that 10.4% of the general population had moderate-to-severe chronic pain, with a 3.4% incidence rate, with women and elderly individuals as common patients. Another study that used a systematic reviewand meta-analysis reported that the prevalence of chronic pain is greater in developing countries (Sá et al.,2019). Management of chronic pain extends beyond medical treatments such as physical therapy and pharmacology. It is also dependent on the severity and accessibility of healthcare for each patient. Most professionals recommend a multimodal combination of treatments , ; however, for developing countries such as the Philippines, treatment for patients is often discontinued because of inaccessible healthcare, misdiagnosis, and financial constraints, which often lead to reduced quality of life, affecting all facets of an individual’s daily activities. One important aspect of chronic pain management is the well-being of patients. Furthermore, a sizable portion of patients with chronic pain concurrently suffer from psychological disorders such as generalized anxiety disorder and major depressive disorder (Annagür et al.,2014). There are current standardized tests that measure the well-being of patients with chronic pain, including the McGill Pain Questionnaire, the Warwick-Edinburgh Mental Well-being Scale, and the Pain Catastrophizing Scale. That said, the scales mentioned are developed in the Western context. Studies on chronic pain in the Philippines are often combined with other medical conditions, such as cancer, therefore contributing to inadequacies in effective pain management. Despite the increase in mental health awareness and education in the Philippines, it is still stigmatized, resulting in insufficient emotional support for patients. This study hopes to bridge the gap in the culturally appropriate well-being scale and serves as a basis for assessment and treatment programs to increase the quality of life of patients suffering from chronic pain. Chronic Pain and Mental Well-being Chronic pain affects a large portion of the global population, extending its implications beyond physiological discomfort to its impact on an individual’s psychological well-being. According to the biopsychosocial model, chronic pain is a multifaceted condition that requires an integrated approach incorporating emotional, cognitive, and interpersonal dimensions. The severity and persistence of chronic pain are commonly associated with mental health issues such as anxiety and depression, often combined with social isolation, which can further decrease patients’ quality of life. Annagur et al. (2014) reported strong associations between chronic pain and mental well-being , and decreased quality of life, emphasizing the reduced quality of sleep in patients with chronic pain. Furthermore, interventions aimed at both physical and mental well-being canimprove the quality of life of patients with chronic pain. Moreover, in collectivist societies, sociocultural perspectives can provide insight into the relationship between chronic pain and mental well-being (Bulisig & Aruta, 2022). Clemente et al. (2008) discussed Enriquez’s Kapwa Model, which supports resilience among chronic pain sufferers and reinforces the importance of social connectedness and community support in relation to pain management. Prevalence and Social Impact of Chronic Pain in Developing Countries The prevalence of chronic pain varies in terms of location and socioeconomic context. A systematic review of chronic pain incidence in developing countries revealed significant differences in the level of treatment in terms of healthcare accessibility, resources, and sociocultural factors (Sa et al., 2019; Zaki & Hari, 2015). Cultural stigma surrounding pain and mental health exists, particularly in Asian countries, and prevents individuals from seeking medical intervention. In the Philippines, underreporting and undertreatment of chronic pain are common due to limited access to healthcare (Lu & Javier, 2012). Measurement of Chronic Pain and Mental Well-being A comprehensive approach to managing chronic pain includes assessing its psychological impact on the patient. Several studies have underscored the importance of culturally adapted tools, especially in diverse populations (Boateng et al., 2018; Lamm et al., 2020). The Framework The development of the Chronic Pain Mental Well-Being Scale for Filipinos is based on Engel's biopsychosocial model (Engel, 1977 as cited by Bolton & Gillett, 2019) and Vygotsky’s sociocultural theory (1978). These two frameworks provide a comprehensive approach to the development and validation of a scale intended to assess the well-being of Filipinos with chronic pain. The biopsychosocial model suggests that medical conditions, such as chronic pain, can be understood through an extensive approach by considering the individual who has the illness, their experience, and, last,their attitudes toward it (Wade & Halligan, 2017). Although Engel’s theory was written 40 years ago, it is still used as a framework for understanding physiological relationships, which include heredity and neurochemical factors; psychological factors, which include emotions and cognitive processes; and social factors in human behavior, which include support systems, cultural beliefs, and social relationships. On the other hand, Vygotsky’s sociocultural theory bridges the gaps of cultural sensitivity and appropriateness in the development of the Chronic Pain Well-Being Scale for Filipinos. According to sociocultural theory, individuals actively participate in their cognitive development, with an emphasis on the interaction of innate abilities, social interaction, and cultural factors. The incorporation of the biopsychosocial model and sociocultural theory helps provide an integrative approach for developing a scale for the well-being of chronic patients. The biopsychosocial framework provides guidance in selecting items that can measure physical symptoms, as well as the psychological and social components of pain and well-being, whereas the sociocultural theory of Vygotsky highlights cultural dimensions that emphasize the importance of the Filipino experience of chronic pain as well as measuring components of mental well-being in the context of the Filipino approach. Additionally, this scale development incorporated Enriquez’s Kapwa Model to create items that measure well-being, specifically hiya (shame/dignity) and pakikisama (companionship/self-esteem). Rationale Mental well-being is a crucial factor in understanding chronic pain management and patient prognosis. However, culturally appropriate scales that measure the well-being of individuals with chronic pain in the Filipino context are lacking. Thus, the development and validation of the Chronic Pain Mental Well-being Scale for Filipinos aims to bridge the gap between the literature and the cultural factors that encompass the Filipino values. In addition to assessment, one aim of this study is to provide a framework for designing a well-being program that will increase the efficiency of chronic pain management. METHODOLOGY Research Design This study utilized a descriptive research design to develop and validate the Chronic Pain Mental Well-being Scale for Filipinos. It is divided into three phases, namely, item development, scale development, and scale evaluation. Scale development process The Chronic Pain Mental Well-Being Scale for Filipinos was developed in this study. The initial phase of this study was item development. It involves writing items on the basis of Engel's biopsychosocial model, Vygotsky’s sociocultural theory, and Enriquez’s Kapwa Model. This scale has 3 domains: physiological factors, psychological factors, and sociocultural factors. Initially, each of the factors will have a 20-item pool (total of 60 items) to be validated by subject matter experts and conceptually defined. This scale uses a Likert scale to measure each item. Furthermore, the items generated used inductive and deductive approaches that reflected a comprehensive view of the theoretical frameworks and practical applications. After one week, the subject matter experts returned the validated items whether they were accepted, needed revisions, or rejected. The initial number of items remained after expert validation with revisions, as noted by the experts. After pretesting validation and reliability testing, the researcher proceeded with the data collection. The data were collected via Google Forms and were shared online with different targeted communities. Moreover, the researcher also asked for assistance from physical therapists and occupational therapists' colleagues to tap into patients who may meet the inclusion criteria. Social media sharing also helped reach participants across the country. A sample size of 100 participants was given the instrument. All participants met the inclusion and exclusion criteria. After 100 participants were reached, statistical analysis via Pearson’s correlation, exploratory factor analysis and Cronbach’s alpha was performed to establish the reliability and validity of the developed scale (Samuels & Gilchrist, 2014). The last phase of the scale development process was the finalization of the administration, scoring, and instructions. Sample and Sampling Technique Purposive sampling was used to select participants for this study since the scale to be developed is purposely aimed at patients with chronic pain (Campbell et al.,2020). In addition to being diagnosed with chronic pain, participants were Filipino citizens who were at least 18 years old. Individuals with cognitive impairment or who were receiving psychiatric treatment were excluded. A total of 100 participants across the Philippines were used in the pilot test of this study to ensure adequate statistical analysis via exploratory factor analysis. Eleven percent of the participants belong to the 18–24 years age group, 34% belong to the 25–31 years age group, 14% belong to the 32–38 years age group, 16% belong to the 39–45 years age group, 10% belong to the 46–53 years age group, 9% belong to the 53–59/> age group, and 2% each of the remaining ages are 66–75 years old. The majority of the participants were female (n=67), whereas 33 were male. The most common chronic pain experienced by the participants was back pain, neck pain, headache, migraine, and joint pain. Fifty-five percent of the participants were currently experiencing more than one pain, whereas 45% reported only one type of pain. Moreover, 45 of the participants had been suffering from chronic pain for more than 12 months, 29 had been suffering for more than 6 months, and 26 had been suffering for at least 3 months. Data collection procedure Data collection was performed through online platforms, specifically through Google Forms. Participants were recruited through posts on social media and in diverse groups of our targeted sample. In addition, the researcher connected with hospital practitioners to cater to chronic pain patients. The participants are then sent a secure link with the form, including the informed consent, purpose of the study, confidentiality, and opt-out options. The participants then completed the survey online. The survey took approximately 15 minutes to complete. Finally, the data will be collected for 2 weeks. Ethical considerations Informed consent was given to the participants prior to answering the survey while ensuring that opting out of the survey at any given point was an option for the participants if they felt uncomfortable proceeding. No identifying data were collected to ensure the anonymity of the participants. Finally, the participants’ answers are stored in a secure folder with passcode that the researcher can access only. Data analysis The data yielded from the survey were analyzed through descriptive statistics. The demographics of the participants were analyzed via means and standard deviations to provide an overview of the sample population. Moreover, validity was determined through content validity, where three subject matter experts thoroughly reviewed the initial scale items and feedback was given to the researcher for further consideration before the pilot study. After univariate statistical analysis, exploratory factor analysis and Cronbach’s alpha were used to determine the reliability of the items. Finally, Pearson’s r was used to investigate the relationships between mental well-being and the three factors. RESULTS Exploratory Factor Analysis Exploratory factor analysis was used to explore the factor structure of the mental well-being scale in relation to chronic pain. The principal component analysis procedure extracted three factors. Using the varimax raw rotation, 56 of the 60 items were considered acceptable items, with 1 item loaded to two factors. However, the researcher made the decision to load the 1 item, whichever was the highest factor. The highest loaded item is .85. The total mean score for all participants (N=100) along with the 55 remaining items was M = .30. The consistency of the chronic pain mental well-being scale according to Cronbach’s alpha was .93, which was statistically high, indicating good interitem consistency. As a result, 55 items remained, and three factors were labeled after careful analysis of the remaining items: biological/physiological, psychosocial, and cultural factors. Originally, psychological and social factors were two different dimensions, but after an in-depth analysis, they were combined, and a cultural dimension was added. Table 1 Accepted Items with Their Factor Loading Item Factor 1 Factor 2 Factor 3 1: I feel physically exhausted due to my pain. 0.68835 2: I have difficulty falling or staying asleep because of my pain. 0.68562 3: My pain significantly interferes with my daily activities. 0.60375 6: I take pain medication to lessen the severity of my pain. 0.62897 10: I do not engage in physical activities due to pain (e.g. running, exercise). 0.65884 12: Chronic pain has reduced my strength. 0.73087 13. My pain worsens with physical exertion. 0.66791 14: I have trouble getting rest because of pain discomfort. 0.77355 15: I feel exhausted even with minimal effort because of pain 0.78112 16: I avoid lifting heavy objects 0.61256 17: I feel stiff upon waking up in the morning. 0.68659 18: I find it hard to concentrate because of my pain 0.64063 19: The pain intensifies most days of the week. 0.77509 10: I regularly take medications for pain discomfort. 0.76387 24: I find it hard to concentrate when my pain flares up. 0.58210 25: I often feel stressed. 0.71533 26. I am irritable, especially when in pain. 0.74637 28: I feel drained because of constant pain. 0.67960 31: I feel like my pain is not manageable. 0.63978 32: I feel anxious thinking about my chronic/persistent pain. 0.62536 41: I feel disconnected from people because of my pain. 0.56314 42: I find it difficult to spend time with other people due to my pain. 0.56963 48: I feel I am a burden to my family and friends because of pain. 0.53328 60. I talk to my family and friends about my journey experiencing chronic/persistent pain 0.53426 4: I feel energized to complete physical tasks despite my pain 0.65768 5: I know how to effectively manage my pain. 0.52275 7: I am able to perform everyday tasks despite my pain. 0.81196 8: I maintain independence despite my pain. 0.68783 9: I feel productive even with chronic/persistent pain. 0.67426 21: I enjoy things that make me happy. 0.69111 22: I manage to have a positive outlook in life despite my pain. 0.68356 23: I can accomplish tasks without losing focus, even with pain. 0.69726 33: I feel confident to manage my pain symptoms. 0.61911 0.79960 35: I can do my normal routine despite my pain. 0.77706 36: I look forward to the future despite my pain. 0.68602 37: I feel capable of finding ways to enjoy life, despite chronic/persistent pain. 0.79026 38: I can easily adapt to different situations despite the pain 0.85378 39: I can overcome setbacks caused by pain. 0.84350 40: I find different ways to cope with my pain. 0.78456 44: I feel supported and encouraged. 0.68952 46: My pain feels manageable when I’m around my family and friends. 0.50711 30: I feel helpless, especially when in pain. 0.515277 43: I often avoid talking about my pain with other people. 0.719411 45: I feel isolated due to chronic/persistent pain 0.552947 49: I worry others will think less of me. 0.680178 50: I feel ashamed and guilty when I cannot function well due to pain 0.596395 51: I am not comfortable showing my pain discomfort in public 0.754638 52: I downplay the severity of my pain to avoid judgment 0.696003 53. I avoid complaining about my pain. 0.720971 54. I avoid being an inconvenience to others because of my pain. 0.558107 55. I tolerate pain in silence. 0.678879 56: I do not cancel plans, even when experiencing severe pain. 0.514479 58: I hide my pain to avoid negativity and being labeled as lazy 0.716447 59: I avoid seeking help to manage my pain. 0.717760 Table 1 shows the accepted items with their factor loadings. The factor means obtained using the sample ( N =100 ) are shown in Table 2. The Cronbach’s Alpha values of the three factors were .95, .94, and .92, while the overall consistency of the 55 items was .937 which indicates high reliability. Table 2 Means and Standard Deviations for the Factors of the Chronic Pain Mental Well-Being Scale (N=100) N Mean SD Biological Domain 100 3.3 0.66 Psychosocial Domain 100 3.55 0.52 Cultural Domain 100 3.22 0.75 Table 2 shows the means and standard deviations across all the factors. The biological domain had a mean score of 3.3, the psychosocial domain had a mean score of 3.55, and the cultural domain had a mean score of 3.22. The standard deviations for all factors are .66, .52, and .75, respectively. Table 3 Correlation Matrix of the Mental Well-Being Scale among Chronic Pain Sufferers Factors Biological Domain Psychosocial Domain Cultural Domain Biological Domain -- -0.579** 0.417** Psychosocial Domain -0.579** -- 0.089 Cultural Domain 0.417** 0.089 -- **p<.05 Table 3 shows the correlation matrix using Pearson’s r between factors of mental well-being in relation to chronic pain sufferers. The biological, psychosocial, and cultural domains are significantly related to each other. Meints & Edwards (2018) examined how psychosocial and cultural factors affect pain perception, which highlights the multifaceted nature of pain. DISCUSSION AND CONCLUSION In the present study, three factors of mental well-being in relation to chronic pain were identified, namely, the biological, psychosocial, and cultural domains. The constructed and validated items underwent exploratory factor analysis to determine the acceptable items per factor. As a result, 55 items remained, and interitem consistency was analyzed via Cronbach’s alpha, which yielded high reliability for each factor and its overall consistency. According to Meints & Edwards (2019), the biopsychosocial approach to pain emphasizes the multidimensionality of pain in terms of management, diagnosis, and perception. Additionally, Enriquez’s Kapwa Model (1992) provides a culturally unique approach to Filipino’s social interaction, therefore providing a cultural dimension to the developed scale. The present study focused on the development and validation of the Chronic Pain Mental Well-being Scale for Filipinos. The Chronic Pain Mental Well-being Scale for Filipinos aims to measure the mental well-being scale of Filipino individuals suffering from chronic pain. This scale is divided into three categories, namely, the biological domain, psychosocial domain, and cultural domain. The physiological factors (biological domain) focused on the physical aspects of chronic pain to the patient’s mental well-being, including subdomains of pain intensity, physical functioning, sleep disturbances, fatigue, and medication use. The second domain is the psychosocial factor, which includes the emotional and cognitive aspects of mental well-being in relation to chronic pain. It includes subdomains such as pain catastrophizing, emotional resilience, coping strategies, mental health symptoms, and self-efficacy. Moreover, it also added the social perceptions of chronic pain sufferers in relation to pain. The cultural domain aims to measure the cultural dynamics and interpersonal relationships of patients, incorporating factors that are uniquely Filipino, such as hiya and pakikisama . Additionally, Garay et al. (2020) , highlighted that Filipinos are survivors of circumstances; thus, resilience is one of the themes of this domain. This also includes items on support systems, hiya, pakikisama , and social stigma. Additionally, this scale is intended to be administered to Filipinos aged 18-75 years who are experiencing any type of chronic pain for at least 3 months. The scores and scale interpretations are as follows: a score of 240 or higher indicates critical low mental well-being, suggesting that an individual may find it difficult to adjust and cope with pain, as well as increasing the risk of developing mental health problems secondary to pain. A score of 181–239 indicates low mental well-being, with individuals having difficulties coping with pain, which raises significant concerns about their well-being. A strong need for support and intervention is suggested, whereas a score of 121--180 suggests moderate mental well-being and that the individual may have slight difficulty adapting and coping with pain; support may be beneficial. A score of 120 indicates generally positive mental well-being, indicating that the individual is able to cope positively and adapt to changes caused by pain. Compared with existing mental well-being scales, the present study focused on a scale made for Filipinos and their experiences in relation to chronic pain, which aims to bridge the gap toward a culturally appropriate assessment. Implications and limitations of the study The development of the Chronic Pain Mental Well-being Scale for Filipinos aims to understand pain and the factors affecting mental well-being. It aims to be utilized as a culturally relevant scale to measure chronic pain and mental well-being for Filipinos to address culturally unique experiences influencing pain perception and management (Sá et al., 2019). This study aims to increase awareness of Filipino’s experiences of pain since it is often understudied in Filipino communities. In addition, we hope to promote effective treatment strategies that improve the pain management and quality of life of Filipino chronic pain sufferers. However, this study has several limitations that can be further improved by future researchers. First, this study included only 100 participants, which may not represent most of the population in the Philippines that is suffering from chronic pain. Moreover, communication with other allied health professionals may also be beneficial in ensuring that the study can be used in hospital settings. Declarations Ethics approval and consent to participate The researcher adheres to the WHO Declaration of Helsinki 1964, ensuring ethical standards and procedures for research with human beings. Informed consent form was given to the participants to ensure that their participation is voluntary. I acknowledge that my initial submission did not include documentation from an institutional ethics review committee approval. I confirm that while my research was conducted with the utmost respect for ethical principles, formal approval from Mapúa University’s Institutional Review Board was obtained with approval # ETH-RS-006. Consent for publication Not applicable Availability of data and materials The data set is available upon request Competing interests The author has declared no competing interests. Funding This research received no external funding. Author's contributions Kimberly Joanna C. Dayrit significantly contributed to the research and preparation of this manuscript from topic conceptualization to journal submission. Acknowledgements The researcher would like to acknowledge the participants and mentors who helped complete this study. Author’s information (optional) Kimberly Joanna C. Dayrit [email protected] References Annagür, B. B., Uguz, F., Apiliogullari, S., Kara, İ., & Gunduz, S. (2014). Psychiatric Disorders and Association with Quality of Sleep and Quality of Life in Patients with Chronic Pain: A SCID-Based Study. Pain Medicine , 15 (5), 772–781.https://doi.org/10.1111/pme.12390 Boateng, G. O., Neilands, T. B., Frongillo, E. A., Melgar-Quiñonez, H. R., & Young, S. L. (2018). Best practices for developing and validating scales for health, social, and behavioral research: A primer. Frontiers in Public Health, 6(149).https://doi.org/10.3389/fpubh.2018.00149 Bolton, D., & Gillett, G. (2019). The Biopsychosocial Model 40 Years On. The Biopsychosocial Model of Health and Disease , 1 (1), 1–43.https://doi.org/10.1007/978-3-030-11899-0_1 Bulisig, J. A. C., & Aruta, J. J. B. R. (2022). Measurement and predictors of mental well-being in community samples in the Philippines during the COVID-19 crisis: does religious coping matter? Mental Health, Religion & Culture , 1–16.https://doi.org/10.1080/13674676.2022.2031939 Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., Bywaters, D., & Walker, K. (2020). Purposive sampling: Complex or simple? Research case examples. Journal of Research in Nursing , 25 (8), 652–661.https://doi.org/10.1177/1744987120927206 Clemente, Jose Antonio & Belleza, Delia & Yu, Angela & Catibog, Diane & Solis, Goyena & Laguerta, Jason. (2008). Revisiting the Kapwa Theory: Applying Alternative Methodologies and Gaining New Insights. Garay, G., Garay, M. C., & Martinez, H. (2020). Resilience Amidst Adversity: The Many Faces of Resilience in Filipinos. 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PAIN Reports , 4 (6), e779.https://doi.org/10.1097/PR9.0000000000000779 Samuels, Peter & Gilchrist, Mollie. (2014). Pearson Correlation. Simply Psychology. (2024, August 9). Vygotsky's Sociocultural Theory Of Cognitive Development . https://www.simplypsychology.org/vygotsky.html Wade, D. T., & Halligan, P. W. (2017). The Biopsychosocial Model of Illness: a Model Whose Time Has Come. Clinical Rehabilitation , 31 (8), 995–1004.https://doi.org/10.1177/0269215517709890 Mohamed Zaki, L. R., & Hairi, N. N. (2015). A Systematic Review of the Prevalence and Measurement of Chronic Pain in Asian Adults. Pain Management Nursing , 16 (3), 440–452.https://doi.org/10.1016/j.pmn.2014.08.012 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7023629","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":508086428,"identity":"c8588828-b587-49cb-8357-759d5567c613","order_by":0,"name":"Kimberly Joanna C. 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Persistent pain must last at least 3 to 6 months and impair an individual’s quality of life, which can lead to emotional distress, social isolation, and physical impairments.\u003c/p\u003e\n\u003cp\u003eOne quarter of the population in the United States is suffering from chronic pain, making it one of the most common issues encountered in outpatient healthcare (Nahin, 2015). It is a significant health issue but is often underreported and left untreated, especially in developing countries such as the Philippines, because of various factors. In the Philippines, studies on the prevalence and treatment of chronic pain did not exist until 2011. A study conducted by Javier and Lu (2012) investigated the prevalence and incidence of chronic pain in the Philippines. The study revealed that 10.4% of the general population had moderate-to-severe chronic pain, with a 3.4% incidence rate, with women and elderly individuals as common patients. Another study that used a systematic reviewand meta-analysis reported that the prevalence of chronic pain is greater in developing countries (Sá et al.,2019).\u003c/p\u003e\n\u003cp\u003eManagement of chronic pain extends beyond medical treatments such as physical therapy and pharmacology. It \u003cs\u003eis\u003c/s\u003e also dependent on the severity and accessibility of healthcare for each patient. Most professionals recommend a multimodal combination of treatments\u003cs\u003e,\u003c/s\u003e; however, for developing countries such as the Philippines, treatment for patients is often discontinued because of inaccessible healthcare, misdiagnosis, and financial constraints, which often lead to reduced quality of life, affecting all facets of an individual’s daily activities.\u003c/p\u003e\n\u003cp\u003eOne important aspect of chronic pain management is the well-being of patients. Furthermore, a sizable portion of patients with chronic pain concurrently suffer from psychological disorders such as generalized anxiety disorder and major depressive disorder (Annagür et al.,2014). There are current standardized tests that measure the well-being of patients with chronic pain, including the McGill Pain Questionnaire, the Warwick-Edinburgh Mental Well-being Scale, and the Pain Catastrophizing Scale. That said, the scales mentioned are developed in the Western context.\u003c/p\u003e\n\u003cp\u003eStudies on chronic pain in the Philippines are often combined with other medical conditions, such as cancer, therefore contributing to inadequacies in effective pain management. Despite the increase in mental health awareness and education in the Philippines, it is still stigmatized, resulting in insufficient emotional support for patients.\u003c/p\u003e\n\u003cp\u003eThis study hopes to bridge the gap in the culturally appropriate well-being scale and serves as a basis for assessment and treatment programs to increase the quality of life of patients suffering from chronic pain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eChronic Pain and Mental Well-being\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChronic pain affects a large portion of the global population, extending its implications beyond physiological discomfort to its impact on an individual’s psychological well-being. According to the biopsychosocial model, chronic pain is a multifaceted condition that requires an integrated approach incorporating emotional, cognitive, and interpersonal dimensions.\u003c/p\u003e\n\u003cp\u003eThe severity and persistence of chronic pain are commonly associated with mental health issues such as anxiety and depression, often combined with social isolation, which can further decrease patients’ quality of life. Annagur et al. (2014) reported strong associations between chronic pain and mental well-being\u003cs\u003e,\u003c/s\u003e and decreased quality of life, emphasizing the reduced quality of sleep in patients with chronic pain. Furthermore, interventions aimed at both physical and mental well-being canimprove the quality of life of patients with chronic pain.\u003c/p\u003e\n\u003cp\u003eMoreover, in collectivist societies, sociocultural perspectives can provide insight into the relationship between chronic pain and mental well-being (Bulisig \u0026amp; Aruta, 2022). Clemente et al. (2008) discussed Enriquez’s Kapwa Model, which supports resilience among chronic pain sufferers and reinforces the importance of social connectedness and community support in relation to pain management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePrevalence and Social Impact of Chronic Pain in Developing Countries\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of chronic pain varies in terms of location and socioeconomic context. A systematic review of chronic pain incidence in developing countries revealed significant differences in the level of treatment in terms of healthcare accessibility, resources, and sociocultural factors (Sa et al., 2019; Zaki \u0026amp; Hari, 2015). Cultural stigma surrounding pain and mental health exists, particularly in Asian countries, and prevents individuals from seeking medical intervention. In the Philippines, underreporting and undertreatment of chronic pain are common due to limited access to healthcare (Lu \u0026amp; Javier, 2012).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMeasurement of Chronic Pain and Mental Well-being\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive approach to managing chronic pain includes assessing its psychological impact on the patient. Several studies have underscored the importance of culturally adapted tools, especially in diverse populations (Boateng et al., 2018; Lamm et al., 2020).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eThe Framework\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe development of the Chronic Pain Mental Well-Being Scale for Filipinos is based on Engel's biopsychosocial model (Engel, 1977 as cited by Bolton \u0026amp; Gillett, 2019) and Vygotsky’s sociocultural theory (1978). These two frameworks provide a comprehensive approach to the development and validation of a scale intended to assess the well-being of Filipinos with chronic pain.\u003c/p\u003e\n\u003cp\u003eThe biopsychosocial model suggests that medical conditions, such as chronic pain, can be understood through an extensive approach by considering the individual who has the illness, their experience, and, last,their attitudes toward it (Wade \u0026amp; Halligan, 2017). Although Engel’s theory was written 40 years ago, it is still used as a framework for understanding physiological relationships, which include heredity and neurochemical factors; psychological factors, which include emotions and cognitive processes; and social factors in human behavior, which include support systems, cultural beliefs, and social relationships.\u003c/p\u003e\n\u003cp\u003eOn the other hand, Vygotsky’s sociocultural theory bridges the gaps of cultural sensitivity and appropriateness in the development of the Chronic Pain Well-Being Scale for Filipinos. According to sociocultural theory, individuals actively participate in their cognitive development, with an emphasis on the interaction of innate abilities, social interaction, and cultural factors.\u003c/p\u003e\n\u003cp\u003eThe incorporation of the biopsychosocial model and sociocultural theory helps provide an integrative approach for developing a scale for the well-being of chronic patients. The biopsychosocial framework provides guidance in selecting items that can measure physical symptoms, as well as the psychological and social components of pain and well-being, whereas the sociocultural theory of Vygotsky highlights cultural dimensions that emphasize the importance of the Filipino experience of chronic pain as well as measuring components of mental well-being in the context of the Filipino approach.\u003c/p\u003e\n\u003cp\u003eAdditionally, this scale development incorporated Enriquez’s Kapwa Model to create items that measure well-being, specifically \u003cem\u003ehiya\u003c/em\u003e (shame/dignity) and \u003cem\u003epakikisama\u003c/em\u003e (companionship/self-esteem).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRationale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMental well-being is a crucial factor in understanding chronic pain management and patient prognosis. However, culturally appropriate scales that measure the well-being of individuals with chronic pain in the Filipino context are lacking. Thus, the development and validation of the Chronic Pain Mental Well-being Scale for Filipinos aims to bridge the gap between the literature and the cultural factors that encompass the Filipino values.\u003c/p\u003e\n\u003cp\u003eIn addition to assessment, one aim of this study is to provide a framework for designing a well-being program that will increase the efficiency of chronic pain management.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003e\u003cstrong\u003eResearch Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study utilized a descriptive research design to develop and validate the Chronic Pain Mental Well-being Scale for Filipinos. It is divided into three phases, namely, item development, scale development, and scale evaluation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eScale development process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Chronic Pain Mental Well-Being Scale for Filipinos was developed in this study.\u003c/p\u003e\n\u003cp\u003eThe initial phase of this study was item development. It involves writing items on the basis of Engel's biopsychosocial model, Vygotsky’s sociocultural theory, and Enriquez’s Kapwa Model. This scale has 3 domains: physiological factors, psychological factors, and sociocultural factors. Initially, each of the factors will have a 20-item pool (total of 60 items) to be validated by subject matter experts and conceptually defined. This scale uses a Likert scale to measure each item.\u003c/p\u003e\n\u003cp\u003eFurthermore, the items generated used inductive and deductive approaches that reflected a comprehensive view of the theoretical frameworks and practical applications. After one week, the subject matter experts returned the validated items whether they were accepted, needed revisions, or rejected. The initial number of items remained after expert validation with revisions, as noted by the experts.\u003c/p\u003e\n\u003cp\u003eAfter pretesting validation and reliability testing, the researcher proceeded with the data collection. The data were collected via Google Forms and were shared online with different targeted communities. Moreover, the researcher also asked for assistance from physical therapists and occupational therapists' colleagues to tap into patients who may meet the inclusion criteria. Social media sharing also helped reach participants across the country.\u003c/p\u003e\n\u003cp\u003eA sample size of 100 participants was given the instrument. All participants met the inclusion and exclusion criteria. After 100 participants were reached, statistical analysis via Pearson’s correlation, exploratory factor analysis and Cronbach’s alpha was performed to establish the reliability and validity of the developed scale (Samuels \u0026amp; Gilchrist, 2014). The last phase of the scale development process was the finalization of the administration, scoring, and instructions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Sample and Sampling Technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePurposive sampling was used to select participants for this study since the scale to be developed is purposely aimed at patients with chronic pain (Campbell et al.,2020). In addition to being diagnosed with chronic pain, participants were Filipino citizens who were at least 18 years old. Individuals with cognitive impairment or who were receiving psychiatric treatment were excluded.\u003c/p\u003e\n\u003cp\u003eA total of 100 participants across the Philippines were used in the pilot test of this study to ensure adequate statistical analysis via exploratory factor analysis. Eleven percent of the participants belong to the 18–24 years age group, 34% belong to the 25–31 years age group, 14% belong to the 32–38 years age group, 16% belong to the 39–45 years age group, 10% belong to the 46–53 years age group, 9% belong to the 53–59/\u0026gt; age group, and 2% each of the remaining ages are 66–75 years old. The majority of the participants were female (n=67), whereas 33 were male.\u003c/p\u003e\n\u003cp\u003eThe most common chronic pain experienced by the participants was back pain, neck pain, headache, migraine, and joint pain. Fifty-five percent of the participants were currently experiencing more than one pain, whereas 45% reported only one type of pain. Moreover, 45 of the participants had been suffering from chronic pain for more than 12 months, 29 had been suffering for more than 6 months, and 26 had been suffering for at least 3 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collection was performed through online platforms, specifically through Google Forms. Participants were recruited through posts on social media and in diverse groups of our targeted sample. In addition, the researcher connected with hospital practitioners to cater to chronic pain patients.\u003c/p\u003e\n\u003cp\u003eThe participants are then sent a secure link with the form, including the informed consent, purpose of the study, confidentiality, and opt-out options.\u003c/p\u003e\n\u003cp\u003eThe participants then completed the survey online. The survey took approximately 15 minutes to complete. Finally, the data will be collected for 2 weeks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was given to the participants prior to answering the survey while ensuring that opting out of the survey at any given point was an option for the participants if they felt uncomfortable proceeding. No identifying data were collected to ensure the anonymity of the participants. Finally, the participants’ answers are stored in a secure folder with passcode that the researcher can access only.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data yielded from the survey were analyzed through descriptive statistics. The demographics of the participants were analyzed via means and standard deviations to provide an overview of the sample population. Moreover, validity was determined through content validity, where three subject matter experts thoroughly reviewed the initial scale items and feedback was given to the researcher for further consideration before the pilot study.\u003c/p\u003e\n\u003cp\u003eAfter univariate statistical analysis, exploratory factor analysis and Cronbach’s alpha were used to determine the reliability of the items. Finally, Pearson’s r was used to investigate the relationships between mental well-being and the three factors.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eExploratory Factor Analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExploratory factor analysis was used to explore the factor structure of the mental well-being scale in relation to chronic pain. The principal component analysis procedure extracted three factors. Using the varimax raw rotation, 56 of the 60 items were considered acceptable items, with 1 item loaded to two factors. However, the researcher made the decision to load the 1 item, whichever was the highest factor. The highest loaded item is .85. The total mean score for all participants (N=100) along with the 55 remaining items was \u003cem\u003eM\u003c/em\u003e= .30. The consistency of the chronic pain mental well-being scale according to Cronbach\u0026rsquo;s alpha was .93, which was statistically high, indicating good interitem consistency. As a result, 55 items remained, and three factors were labeled after careful analysis of the remaining items: biological/physiological, psychosocial, and cultural factors. Originally, psychological and social factors were two different dimensions, but after an in-depth analysis, they were combined, and a cultural dimension was added.\u003c/p\u003e\n\u003cp\u003eTable 1 \u003cem\u003eAccepted Items with Their Factor Loading\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eFactor 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFactor 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eFactor 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e1: I feel physically exhausted due to my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.68835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e2: I have difficulty falling or staying asleep because of my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.68562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e3: My pain significantly interferes with my daily activities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.60375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e6: I take pain medication to lessen the severity of my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.62897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e10: I do not engage in physical activities due to pain (e.g. running, exercise).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.65884\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e12: Chronic pain has reduced my strength.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.73087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e13. My pain worsens with physical exertion.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.66791\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e14: I have trouble getting rest because of pain discomfort.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.77355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e15: I feel exhausted even with minimal effort because of pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.78112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e16: I avoid lifting heavy objects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.61256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e17: I feel stiff upon waking up in the morning.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.68659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e18: I find it hard to concentrate\u003c/p\u003e\n \u003cp\u003ebecause of my pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.64063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e19: The pain intensifies most days of the week.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.77509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e10: I regularly take medications for pain discomfort.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.76387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e24: I find it hard to concentrate when my pain flares up.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.58210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e25: I often feel stressed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.71533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e26. I am irritable, especially when in pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.74637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e28: I feel drained because of constant pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.67960\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e31: I feel like my pain is not manageable.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.63978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e32: I feel anxious thinking about my chronic/persistent pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.62536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e41: I feel disconnected from people because of my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.56314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e42: I find it difficult to spend time with other people due to my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.56963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e48: I feel I am a burden to my family and friends because of pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.53328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e60. I talk to my family and friends about my journey experiencing chronic/persistent pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.53426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e4: I feel energized to complete physical tasks despite my pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.65768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e5: I know how to effectively manage my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.52275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e7: I am able to perform everyday tasks despite my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.81196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e8: I maintain independence despite my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.68783\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e9: I feel productive even with chronic/persistent pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.67426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e21: I enjoy things that make me happy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.69111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e22: I manage to have a positive outlook in life despite my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.68356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e23: I can accomplish tasks without losing focus, even with pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.69726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e33: I feel confident to manage my pain symptoms.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.61911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.79960\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e35: I can do my normal routine despite my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.77706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e36: I look forward to the future despite my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.68602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e37: I feel capable of finding ways to enjoy life, despite chronic/persistent pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.79026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e38: I can easily adapt to different situations despite the pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.85378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e39: I can overcome setbacks caused by pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.84350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e40: I find different ways to cope with my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.78456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e44: I feel supported and encouraged.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.68952\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e46: My pain feels manageable when I\u0026rsquo;m around my family and friends.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.50711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e30: I feel helpless, especially when in pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.515277\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e43: I often avoid talking about my pain with other people.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.719411\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e45: I feel isolated due to chronic/persistent pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.552947\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e49: I worry others will think less of me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.680178\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e50: I feel ashamed and guilty when I cannot function well due to pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.596395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e51: I am not comfortable showing my pain discomfort in public\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.754638\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e52: I downplay the severity of my pain to avoid judgment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.696003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e53. I avoid complaining about my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.720971\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e54. I avoid being an inconvenience to others because of my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.558107\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e55. I tolerate pain in silence.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.678879\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e56: I do not cancel plans, even when experiencing severe pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.514479\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e58: I hide my pain to avoid negativity and being labeled as lazy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.716447\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 224px;\"\u003e\n \u003cp\u003e59: I avoid seeking help to manage my pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.717760\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1 shows the accepted items with their factor loadings. The factor means obtained using the sample (\u003cem\u003eN\u003c/em\u003e\u003cem\u003e=100\u003c/em\u003e) are shown in Table 2.\u003c/p\u003e\n\u003cp\u003eThe Cronbach\u0026rsquo;s Alpha values of the three factors were .95, .94, and .92, while the overall consistency of the 55 items was .937 which indicates high reliability.\u003c/p\u003e\n\u003cp\u003eTable 2\u0026nbsp;\u003cem\u003eMeans and Standard Deviations for the Factors of\u003c/em\u003e\u003cem\u003e\u0026nbsp;the Chronic Pain Mental Well-Being Scale (N=100)\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"320\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eBiological Domain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003ePsychosocial Domain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eCultural Domain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 shows the means and standard deviations across all the factors. The biological domain had a mean score of 3.3, the psychosocial domain had a mean score of 3.55, and the cultural domain had a mean score of 3.22. The standard deviations for all factors are .66, .52, and .75, respectively.\u003c/p\u003e\n\u003cp\u003eTable 3\u0026nbsp;\u003cem\u003eCorrelation Matrix of the Mental Well-Being Scale among Chronic Pain Sufferers\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"590\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eFactors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eBiological Domain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003ePsychosocial Domain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eCultural Domain\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eBiological Domain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e-0.579**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e0.417**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePsychosocial Domain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e-0.579**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eCultural Domain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0.417**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003e\n \u003cp\u003e**p\u0026lt;.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 shows the correlation matrix using Pearson\u0026rsquo;s r between factors of mental well-being in relation to chronic pain sufferers. The biological, psychosocial, and cultural domains are significantly related to each other. Meints \u0026amp; Edwards (2018) examined how psychosocial and cultural factors affect pain perception, which highlights the multifaceted nature of pain.\u003c/p\u003e"},{"header":"DISCUSSION AND CONCLUSION","content":"\u003cp\u003eIn the present study, three factors of mental well-being in relation to chronic pain were identified, namely, the biological, psychosocial, and cultural domains. The constructed and validated items underwent exploratory factor analysis to determine the acceptable items per factor. As a result, 55 items remained, and interitem consistency was analyzed via Cronbach’s alpha, which yielded high reliability for each factor and its overall consistency.\u003c/p\u003e\n\u003cp\u003eAccording to Meints \u0026amp; Edwards (2019), the biopsychosocial approach to pain emphasizes the multidimensionality of pain in terms of management, diagnosis, and perception. Additionally, Enriquez’s Kapwa Model (1992) provides a culturally unique approach to Filipino’s social interaction, therefore providing a cultural dimension to the developed scale.\u003c/p\u003e\n\u003cp\u003eThe present study focused on the development and validation of the Chronic Pain Mental Well-being Scale for Filipinos.\u003c/p\u003e\n\u003cp\u003eThe Chronic Pain Mental Well-being Scale for Filipinos aims to measure the mental well-being scale of Filipino individuals suffering from chronic pain. This scale is divided into three categories, namely, the biological domain, psychosocial domain, and cultural domain. The physiological factors (biological domain) focused on the physical aspects of chronic pain to the patient’s mental well-being, including subdomains of pain intensity, physical functioning, sleep disturbances, fatigue, and medication use. The second domain is the psychosocial factor, which includes the emotional and cognitive aspects of mental well-being in relation to chronic pain. It includes subdomains such as pain catastrophizing, emotional resilience, coping strategies, mental health symptoms, and self-efficacy. Moreover, it also added the social perceptions of chronic pain sufferers in relation to pain. The cultural domain aims to measure the cultural dynamics and interpersonal relationships of patients, incorporating factors that are uniquely Filipino, such as \u003cem\u003ehiya\u003c/em\u003e and \u003cem\u003epakikisama\u003c/em\u003e. Additionally, Garay et al. (2020)\u003cs\u003e,\u003c/s\u003e highlighted that Filipinos are survivors of circumstances; thus, resilience is one of the themes of this domain. This also includes items on support systems, \u003cem\u003ehiya, pakikisama\u003c/em\u003e, and social stigma.\u003c/p\u003e\n\u003cp\u003eAdditionally, this scale is intended to be administered to Filipinos aged 18-75 years who are experiencing any type of chronic pain for at least 3 months. The scores and scale interpretations are as follows: a score of 240 or higher indicates critical low mental well-being, suggesting that an individual may find it difficult to adjust and cope with pain, as well as increasing the risk of developing mental health problems secondary to pain. A score of 181–239 indicates low mental well-being, with individuals having difficulties coping with pain, which raises significant concerns about their well-being. A strong need for support and intervention is suggested, whereas a score of 121--180 suggests moderate mental well-being and that the individual may have slight difficulty adapting and coping with pain; support may be beneficial. A score of 120 indicates generally positive mental well-being, indicating that the individual is able to cope positively and adapt to changes caused by pain.\u003c/p\u003e\n\u003cp\u003eCompared with existing mental well-being scales, the present study focused on a scale made for Filipinos and their experiences in relation to chronic pain, which aims to bridge the gap toward a culturally appropriate assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eImplications and limitations of the\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003estudy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe development of the Chronic Pain Mental Well-being Scale for Filipinos aims to understand pain and the factors affecting mental well-being. It aims to be utilized as a culturally relevant scale to measure chronic pain and mental well-being for Filipinos to address culturally unique experiences influencing pain perception and management (Sá et al., 2019).\u003c/p\u003e\n\u003cp\u003eThis study aims to increase awareness of Filipino’s experiences of pain since it is often understudied in Filipino communities. In addition, we hope to promote effective treatment strategies that improve the pain management and quality of life of Filipino chronic pain sufferers.\u003c/p\u003e\n\u003cp\u003eHowever, this study has several limitations that can be further improved by future researchers. First, this study included only 100 participants, which may not represent most of the population in the Philippines that is suffering from chronic pain. Moreover, communication with other allied health professionals may also be beneficial in ensuring that the study can be used in hospital settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researcher adheres to the WHO Declaration of Helsinki 1964, ensuring ethical standards and procedures for research with human beings. Informed consent form was given to the participants to ensure that their participation is voluntary. I acknowledge that my initial submission did not include documentation from an institutional ethics review committee approval. I confirm that while my research was conducted with the utmost respect for ethical principles, formal approval from Mapúa University’s Institutional Review Board was obtained with approval # ETH-RS-006.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data set is available upon request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author has declared no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor's contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKimberly Joanna C. Dayrit significantly contributed to the research and preparation of this manuscript from topic conceptualization to journal submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researcher would like to acknowledge the participants and mentors who helped complete this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKimberly Joanna C. Dayrit\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAnnag\u0026uuml;r, B. B., Uguz, F., Apiliogullari, S., Kara, İ., \u0026amp; Gunduz, S. (2014). Psychiatric Disorders and Association with Quality of Sleep and Quality of Life in Patients with Chronic Pain: A SCID-Based Study. \u003cem\u003ePain Medicine\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(5), 772\u0026ndash;781.https://doi.org/10.1111/pme.12390\u003c/li\u003e\n \u003cli\u003eBoateng, G. O., Neilands, T. B., Frongillo, E. A., Melgar-Qui\u0026ntilde;onez, H. R., \u0026amp; Young, S. L. (2018). Best practices for developing and validating scales for health, social, and behavioral research: A primer. Frontiers in Public Health, 6(149).https://doi.org/10.3389/fpubh.2018.00149\u003c/li\u003e\n \u003cli\u003eBolton, D., \u0026amp; Gillett, G. (2019). The Biopsychosocial Model 40 Years On. \u003cem\u003eThe Biopsychosocial Model of Health and Disease\u003c/em\u003e, \u003cem\u003e1\u003c/em\u003e(1), 1\u0026ndash;43.https://doi.org/10.1007/978-3-030-11899-0_1\u003c/li\u003e\n \u003cli\u003eBulisig, J. A. C., \u0026amp; Aruta, J. J. B. R. (2022). Measurement and predictors of mental well-being in community samples in the Philippines during the COVID-19 crisis: does religious coping matter? \u003cem\u003eMental Health, Religion \u0026amp; Culture\u003c/em\u003e, 1\u0026ndash;16.https://doi.org/10.1080/13674676.2022.2031939\u003c/li\u003e\n \u003cli\u003eCampbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., Bywaters, D., \u0026amp; Walker, K. (2020). Purposive sampling: Complex or simple? Research case examples. \u003cem\u003eJournal of Research in Nursing\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(8), 652\u0026ndash;661.https://doi.org/10.1177/1744987120927206\u003c/li\u003e\n \u003cli\u003eClemente, Jose Antonio \u0026amp; Belleza, Delia \u0026amp; Yu, Angela \u0026amp; Catibog, Diane \u0026amp; Solis, Goyena \u0026amp; Laguerta, Jason. (2008). Revisiting the Kapwa Theory: Applying Alternative Methodologies and Gaining New Insights.\u003c/li\u003e\n \u003cli\u003eGaray, G., Garay, M. C., \u0026amp; Martinez, H. (2020). Resilience Amidst Adversity: The Many Faces of Resilience in Filipinos. \u003cem\u003eInternational Journal of Social Science and Humanities Research\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(2), 327\u0026ndash;335.https://www.researchpublish.com/upload/book/paperpdf-1593090736.pdf\u003c/li\u003e\n \u003cli\u003e\u0026zwnj;Lamm, K., Lamm, A., \u0026amp; Edgar, D. (2020). Scale Development and Validation: Methodology and Recommendations. Journal of International Agricultural and Extension Education, 27(2), 24\u0026ndash;35.https://doi.org/10.5191/jiaee.2020.27224\u003c/li\u003e\n \u003cli\u003eLu, H., \u0026amp; Javier, F. (2012). Prevalence and Treatment of Chronic Pain in the Philippines. \u003cem\u003eSemantic Scholar\u003c/em\u003e.https://doi.org/10.3860/PJIM.V49I2.2449\u003c/li\u003e\n \u003cli\u003eMeints, S. M., \u0026amp; Edwards, R. R. (2018). Evaluating psychosocial contributions to chronic pain outcomes. \u003cem\u003eProgress in Neuro-Psychopharmacology and Biological Psychiatry\u003c/em\u003e, \u003cem\u003e87\u003c/em\u003e(87), 168\u0026ndash;182.https://doi.org/10.1016/j.pnpbp.2018.01.017\u003c/li\u003e\n \u003cli\u003eS\u0026aacute;, K. N., Moreira, L., Baptista, A. F., Yeng, L. T., Teixeira, M. J., Galhardoni, R., \u0026amp; de Andrade, D. C. (2019). Prevalence of chronic pain in developing countries: systematic review and meta-analysis. \u003cem\u003ePAIN Reports\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(6), e779.https://doi.org/10.1097/PR9.0000000000000779\u003c/li\u003e\n \u003cli\u003eSamuels, Peter \u0026amp; Gilchrist, Mollie. (2014). Pearson Correlation.\u003c/li\u003e\n \u003cli\u003eSimply Psychology. (2024, August 9). \u003cem\u003eVygotsky\u0026apos;s Sociocultural Theory Of Cognitive Development\u003c/em\u003e. https://www.simplypsychology.org/vygotsky.html\u003c/li\u003e\n \u003cli\u003eWade, D. T., \u0026amp; Halligan, P. W. (2017). The Biopsychosocial Model of Illness: a Model Whose Time Has Come. \u003cem\u003eClinical Rehabilitation\u003c/em\u003e, \u003cem\u003e31\u003c/em\u003e(8), 995\u0026ndash;1004.https://doi.org/10.1177/0269215517709890\u003c/li\u003e\n \u003cli\u003eMohamed Zaki, L. R., \u0026amp; Hairi, N. N. (2015). A Systematic Review of the Prevalence and Measurement of Chronic Pain in Asian Adults. \u003cem\u003ePain Management Nursing\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(3), 440\u0026ndash;452.https://doi.org/10.1016/j.pmn.2014.08.012\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"chronic pain, Filipinos, hiya, pakikisama, mental well-being","lastPublishedDoi":"10.21203/rs.3.rs-7023629/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7023629/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eChronic pain affects 10.4% of the general population in the Philippines, yet scales used to measure the well-being of patients are derived from Western practice. This study developed and validated the Chronic Pain Mental Well-Being Scale for Filipinos to bridge the gap between culturally appropriate tools and measure the well-being of chronic pain patients. Data was collected from 100 Filipinos who have been experiencing chronic pain for at least six months. After exploratory factor analysis, results showed that three factors namely biological, psychosocial, and cultural domains affect mental well-being of patients related to chronic pain. This scale is divided into three categories namely Biological, Psychosocial, and Cultural Domains. The biological factors focused on the physical aspects of chronic pain including pain intensity, physical functioning, sleep disturbances, fatigue, and medication use. The psychosocial factor which includes the emotional and cognitive aspects of mental well-being to chronic pain. It includes pain catastrophizing, emotional resilience, coping strategies, mental health symptoms, and self-efficacy. Moreover, it also added the social perceptions of chronic pain sufferers to pain. The cultural domain aims to measure the cultural dynamics and relationships of patients that are uniquely Filipino and modeled from Enriquez\u0026rsquo; Kapwa framework of \u003cem\u003ehiya\u003c/em\u003e and \u003cem\u003epakikisama\u003c/em\u003e.\u003c/p\u003e","manuscriptTitle":"Development and Validation of a Chronic Pain Mental Well-Being Scale for Filipinos: A Basis for the Assessment and Well-Being Program for People with Chronic Pain","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-05 10:32:49","doi":"10.21203/rs.3.rs-7023629/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"63a708ac-8a27-4c96-b2e6-6ab21d21f354","owner":[],"postedDate":"September 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-15T07:38:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-05 10:32:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7023629","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7023629","identity":"rs-7023629","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}