Introduction
Chronic pain affects millions worldwide, significantly impacting quality of life and mental health. Consequently, tools that assess patients’ acceptance of chronic pain are essential for effective management. The Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), developed by Rosemary A. Fish, Brian McGuire, Micheal Hogan, Todd G. Morrison, and Ian Stewart in 2010, is a concise, validated instrument for evaluating pain acceptance. With over 300 citations on Google Scholar, the CPAQ-8 has gained traction for its role in predicting treatment outcomes and disability levels (Fish et al., 2010).
This article provides a comprehensive guide for experts, detailing the CPAQ-8’s features, applications, and significance in health psychology and pain management research.
Key Features of the Chronic Pain Acceptance Questionnaire-8 (CPAQ-8)
Purpose and Use
The CPAQ-8 assesses acceptance of chronic pain, focusing on two facets: activity engagement (pursuing life activities despite pain) and pain willingness (non-avoidance of pain). Specifically, it aids clinicians in predicting treatment outcomes and emotional distress, while researchers use it to study behavioral flexibility in pain management. Moreover, its brevity makes it ideal for clinical and research settings.
Target Population
The CPAQ-8 targets adults aged 18 and older, including young adults (18–24), middle-aged adults (25–44), older adults (45–64), and seniors (65+). Specifically, it is designed for individuals with chronic pain, making it highly relevant for pain management clinics and research studies.
Structure
The CPAQ-8 comprises 8 questions, divided into two subscales:
- Activity Engagement (AE, 4 items): Measures participation in life activities despite pain (e.g., “I lead a full life even though I have chronic pain”).
- Pain Willingness (PW, 4 items): Assesses non-avoidance of pain and reduced efforts to control it (e.g., “I avoid putting myself in situations where my pain might increase,” reverse-scored).
Each item uses a 7-point Likert scale (0 = never true, 6 = always true), providing a nuanced evaluation of pain acceptance.
Scoring Method
The CPAQ-8 uses a 7-point Likert scale (0–6) for each item, with scores calculated as follows:
- Activity Engagement (AE): Sum items 1, 3, 5, and 6 (range: 0–24).
- Pain Willingness (PW): Reverse-score items 2, 4, 7, and 8 (0 becomes 6, 1 becomes 5, etc.), then sum (range: 0–24).
- Total Score: Add AE and PW subscale scores (range: 0–48).
Interpretation: Higher scores indicate greater pain acceptance. For the Swedish version, clinically meaningful cut-offs include:
- Low Pain Acceptance: AE 0–9, PW 0–7
- High Pain Acceptance: AE 13–24, PW 12–24
These scores guide clinicians in assessing behavioral flexibility and researchers in evaluating treatment efficacy.
Administration Format
The CPAQ-8 takes less than 5 minutes to administer, making it highly efficient. It can be conducted via:
- Paper-based forms
- Digital (Online) platforms
- In-person (Interview)
- Phone/Video call
Its self-administered format, requiring no specialized training, enhances its practicality for busy clinical environments.
Applications of Chronic Pain Acceptance Questionnaire-8 (CPAQ-8)
The CPAQ-8 offers significant value in clinical and research settings:
- Monitoring: Tracks changes in pain acceptance during treatment, particularly in Acceptance and Commitment Therapy (ACT).
- Treatment Planning: Informs tailored interventions to enhance behavioral flexibility.
- Research: Widely used in studies evaluating psychological approaches to chronic pain management.
- Pain Rehabilitation: Effectively integrated into interdisciplinary pain rehabilitation programs to assess acceptance-based outcomes and guide therapeutic progress.
For instance, clinicians can use the CPAQ-8 to assess progress in ACT protocols, while researchers can explore its correlation with disability and emotional distress.
Languages and Availability
To ensure global accessibility, the CPAQ-8 is available in multiple languages, including:
- English
- Mandarin Chinese
- Spanish
- Japanese
- As well as Chinese, Spanish, Norwegian, Korean, Japanese, Swedish, Turkish, and Thai.
This multilingual availability enhances its utility in diverse clinical and research contexts.
The CPAQ-8 is free for non-commercial use with no formal license specified, making it accessible for academic and clinical purposes without financial barriers. However, users should cite the original publication when using it.
Reliability and Validity
The CPAQ-8 is recognized as a highly reliable and valid instrument for assessing chronic pain acceptance. Its psychometric strength is demonstrated by a Cronbach’s alpha of 0.78–0.88, indicating good internal consistency. More specifically, subscale reliability coefficients range from 0.82 to 0.88 for the Activity Engagement (AE) subscale and from 0.76 to 0.84 for the Pain Willingness (PW) subscale. In addition, the scale shows strong test-retest reliability and moderate construct validity, as reflected by correlation coefficients (r) ranging from 0.40 to 0.60, supporting its stability and convergent validity over time.
Limitations and Considerations
However, despite its strengths, the CPAQ-8 has a few limitations:
- Self-report: Patients may be influenced by social desirability bias, potentially skewing responses.
- Cultural Bias: The scale may reflect cultural assumptions embedded in its development, which can affect its validity across diverse populations.
- Social Desirability Bias: Respondents may consciously or unconsciously provide answers they believe are more acceptable or favorable, which can compromise the authenticity of results.
- Age Restrictions: Not suitable for individuals under 18, requiring alternative tools like CPAQ-A for adolescents.
- Less Sensitive to Change: Its brevity may reduce sensitivity to subtle changes in pain acceptance over time.
Other Versions and Related Questionnaires
Alternative Versions of CPAQ-8
- CPAQ/CPAQ-R: 20-item version for adults.
- CPAQ-P: 16-item parent-reported version for children.
- CPAQ-A: 20-item version for adolescents.
- CPAQ-A8: 8-item version for adolescents.
- CPAQ-C: 15-item version for clinicians.
Complementary Questionnaires
- Chronic Pain Values Inventory (CPVI): Assesses values-based actions in chronic pain management.
- Tampa Scale for Kinesiophobia (TSK): Measures fear of movement due to pain.
Additional Resources
For more information on the CPAQ-8 and to access the full questionnaire, visit the following resources:
- Download the CPAQ-8 Questionnaire (PDF)
- For inquiries, contact Rosemary A. Fish at rosemaryfish@gmail.com.
- Psychometric Review
Frequently Asked Questions (FAQ)
- Who can use the CPAQ-8?
Clinicians and researchers use the CPAQ-8 for adults aged 18+ with chronic pain in clinical or research settings. - How long does it take to complete the CPAQ-8?
Patients typically take less than 5 minutes to complete the CPAQ-8, ensuring efficiency in clinical use. - How is the CPAQ-8 administered?
The CPAQ-8 can be administered via paper-based, digital (online), in-person interview, or phone/video call formats, offering flexibility. - Is there any cost to using the CPAQ-8?
The CPAQ-8 is free for non-commercial use, requiring only citation of the original publication.
A word from ResRef about Chronic Pain Acceptance Questionnaire-8 (CPAQ-8)
The Chronic Pain Acceptance Questionnaire-8 (CPAQ-8) efficiently captures core facets of pain acceptance, making it indispensable for clinicians tracking behavioral flexibility in chronic pain management. Its brevity and robust validation support widespread use across diverse populations.
References
- Fish, R. A., McGuire, B., Hogan, M., Morrison, T. G., & Stewart, I. (2010). Validation of the Chronic Pain Acceptance Questionnaire (CPAQ) in an Internet sample and development and preliminary validation of the CPAQ-8. Pain, 149(3), 435–443. (link)
- Pasutharnchat, K., Seangrung, R., Lertmongkonaksorn, P., & Kamdeang, S. (2025). Validation of the Thai Version of the Chronic Pain Acceptance Questionnaire-8 (CPAQ-8T) in chronic pain patients. Journal of Pain Research, 18, 947–957. (link)
- Zure, M., & Menekşeoğlu, A. K. (2023). Validation of the Turkish Chronic Pain Acceptance Questionnaire-8. Turkish Journal of Physical Medicine and Rehabilitation, 69(2), 216–221. (link)
1 thought on “Chronic Pain Acceptance Questionnaire-8 (CPAQ-8): A Full Guide for Researchers and Clinicians”
I really appreciate the effort you put into simplifying research concepts. This article is a great example of how academic content can be both accessible and useful.