The Psychological Inflexibility in Pain Scale (PIPS) in Brazilian patients with chronic cancer pain: translation, cross-cultural adaptation, and validation study

Authors

Keywords:

Cancer pain, Surveys and questionnaires, Chronic pain, Cognitive fusion, Avoidance, Psychological inflexibility

Abstract

BACKGROUND: The Psychological Inflexibility in Pain Scale (PIPS) was developed to measure avoidance and cognitive fusion.

OBJECTIVES: To translate, cross-culturally adapt, and analyze the measurement properties of the Psychological Inflexibility in Pain Scale (PIPS) in Brazilian patients with chronic cancer pain.

METHODS: Questionnaire translation, cross-cultural adaptation, and validation studies were conducted in two hospitals in northeastern Brazil. The measurement properties tested included structural validity, construct validity, reliability, and internal consistency. The following assessment instruments were used in addition to the PIPS: Pain Catastrophizing Scale (PCS), Barthel Index, Edmonton Symptom Assessment Scale (ESAS), and Hospital Anxiety and Depression Scale (HADS).

RESULTS: The study sample consisted of 122 patients, most of whom were women (65.6%) with a mean age of 49 years. Most patients had uterine cancer (23%) and leukemia (9.8%). We identified problems in the two-dimensional structure of the PIPS by presenting three inadequate fit indices. Adequate reliability was observed in both domains. Regarding the avoidance domain, there was a correlation with a magnitude > 0.30 with the depression domain of the HADS, and correlations with a magnitude < 0.30 with the anxiety domain of the HADS, the PCS domains, and the Barthel Index. The cognitive fusion domain did not correlate with any of these scales (P > 0.05). No ceiling or floor effects were observed.

CONCLUSION: The Brazilian version of the PIPS is reliable; however, the instrument does not have a valid internal structure and the cognitive fusion domain is not a valid construct.

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Author Biographies

Sergio Paulo Mariano de Aguiar, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil

MD. Master’s student, Programa de Pós-Graduação em Saúde do Adulto, Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil.

Daniela Bassi-Dibai, Universidade Ceuma, São Luís, Maranhão, Brazil

PT, PhD. Professor, Programa de Pós-Graduação em Biociências Aplicadas à Saúde, Universidade Ceuma, São Luís (MA), Brazil.

Letícia Padilha Mendes, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil

PE teacher. Master’s student, Programa de Pós-graduação em Educação Física, Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil.

Naara Rayane Moura Cutrim, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil

Undergraduate student, Departamento de Enfermagem, Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil.

César Leonardo Ribeiro Guedes, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil

PT. Master’s student, Programa de Pós-Graduação em Educação Física, Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil.

Jocassia Silva Pinheiro, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil

PE teacher. Doctoral student, Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil.

Daniel Nunes Morais, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil

PE teacher. Master’s student, Programa de Pós-Graduação em Saúde do Adulto, Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil.

Carlos Wagner de Sousa Campos Neto, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil

Undergraduate student, Departamento de Educação Física, Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil.

Plínio da Cunha Leal, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil

MD, PhD. Professor, Programa de Pós-Graduação em Saúde do Adulto; Programa de Pós-Graduação em Educação Física, Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil.

Almir Vieira Dibai Filho, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil

PT, PhD, Departamento de Educação Física; Programa de Pós-Graduação em Saúde do Adulto; Programa de Pós-Graduação em Educação Física, Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil.

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Published

2026-01-29

How to Cite

1.
Aguiar SPM de, Bassi-Dibai D, Mendes LP, Cutrim NRM, Guedes CLR, Pinheiro JS, Morais DN, Campos Neto CW de S, Leal P da C, Dibai Filho AV. The Psychological Inflexibility in Pain Scale (PIPS) in Brazilian patients with chronic cancer pain: translation, cross-cultural adaptation, and validation study. Sao Paulo Med J [Internet]. 2026 Jan. 29 [cited 2026 Apr. 23];144(1):1-8. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/3488

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Vol. 144 No. 1 (2026)

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Original Article

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