Development and validation of the pain response inventory for children.

The Pain Response Inventory (PRI) was developed as a multidimensional instrument to assess children's responses to recurrent pain. The PRI assesses 3 broad factors—Active, Passive, and Accommodative—each with subscales representing specific strategies for with pain. Confirmatory factor analysis was used to derive and cross-validate the factor structure of the PRI in 3 different samples of children and adolescents: school children, abdominal pain patients, and former abdominal pain patients. The subscales were found to be internally consistent and reasonably stable. Validity of the subscales was assessed by examining the relations of particular strategies to various outcome indicators, including functional disability, somatization symptoms, and depressive symptoms. Results indicated that different types of health outcome were predicted by different patterns of PRI strategies, thus supporting the utility of a multidimensional approach to the assessment of responses to pain. With the formulation of the gate-control theory of pain (Melzack & Wall, 1965), it became generally recognized that the experience of pain is not a purely sensory phenomenon related to tissue damage. Rather, it is also influenced by cognitive, behavioral, and emotional factors. This model suggests that effective pain management cannot rely solely on interventions directed at the source of tissue damage but also must include interventions designed to modify psychosocial factors that affect nociceptive processing (McGrath & Hillier, 1996). This multidimensional model of pain has been the impetus for the rapid growth in behavioral science research on pain in the past two decades. Cognitive and behavioral responses to often studied under the rubric of coping with pain, are of particular interest because they may be amenable to change through interventions by health professionals. Moreover, such responses may significantly lessen pain and associated disability and thereby complement and even decrease the need for more invasive pharmacological or surgical interventions. Studies of adult pain patients suggest that certain strategies (typically ' 'passive'' strategies, such as taking to bed, restricting one's activities, or