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Patient-reported outcome measure

PSEQ Calculator

Pain Self-Efficacy Questionnaire

The Pain Self-Efficacy Questionnaire measures how confident a person is in carrying out activities despite their pain, scoring ten statements from 0 to 6 for a total of 0 to 60, where higher scores indicate stronger self-efficacy and 40 or more is the commonly cited threshold for a good functional prognosis.

Free to use10 items~3 min0–60, higher is better

Confidence despite pain

Please rate how confident you are that you can do the following things at present, despite the pain. Rate from 0, not at all confident, to 6, completely confident. Remember this is not about whether you have been doing these things, but about how confident you are that you can do them at present, despite the pain.

1I can enjoy things, despite the pain.
2I can do most of the household chores (for example tidying up, washing dishes) despite the pain.
3I can socialise with my friends or family members as often as I used to do, despite the pain.
4I can cope with my pain in most situations.
5I can do some form of work, despite the pain. (Work includes housework, and paid and unpaid work.)
6I can still do many of the things I enjoy doing, such as hobbies or leisure activities, despite the pain.
7I can cope with my pain without medication.
8I can still accomplish most of my goals in life, despite the pain.
9I can live a normal lifestyle, despite the pain.
10I can gradually become more active, despite the pain.

What the PSEQ score means

PSEQ scores run from 0 to 60, where a higher score is better. The bands below are conventional reporting categories, not diagnostic cut-offs.

  • Very low self-efficacy0–19

    Very low confidence in functioning despite pain. Strongly associated with disability, distress and poor response to treatment that requires active participation.

  • Low self-efficacy20–29

    Low confidence. Addressing self-efficacy directly is likely to be necessary before a graded activity programme will succeed.

  • Moderate self-efficacy30–39

    Moderate confidence. Below the commonly cited threshold of 40, above which outcomes are generally better.

  • High self-efficacy40–49

    At or above the commonly cited threshold of 40, associated with better function and lower disability.

  • Very high self-efficacy50–60

    Strong confidence in performing activities despite pain, consistently associated with the best functional outcomes.

Clinically important thresholds

A change in score only matters if it exceeds the smallest difference patients actually notice. Every threshold below is reported with the population it was derived in — a threshold quoted without its population is not usable.

TypeValueSubscalePopulationFollow-upSource
MCID8.5 points—Chronic pain, multidisciplinary pain management programme—Chiarotto A 2015
Criterion≥ 40 associated with substantially better function and return to work—Chronic pain—Nicholas MK 2007
MDC11 points—Chronic low back pain—Chiarotto A 2015

MCID is the smallest change a patient perceives as meaningful. PASS is the score above which patients consider their state acceptable. SCB is a substantial rather than minimal benefit. MDC is the smallest change exceeding measurement error. Criterion is a published cut-off, definition or performance figure belonging to a classification or decision rule — it is not a change score and should not be read as one.

How the score is calculated

Stated in full so the calculation can be independently checked, and reproduced by hand if needed.

Each of the ten statements is rated from 0 (not at all confident) to 6 (completely confident). The PSEQ total is the simple sum of the ten item scores, giving a range from 0 to 60. A higher score indicates stronger self-efficacy — greater confidence in performing activities despite pain. No items are reverse scored.

Missing data

The developer published no substitution rule. All ten items should be completed; an incomplete total is reported here as provisional and is not comparable with published thresholds.

Instrument profile

Developer
Michael K. Nicholas
Institution
University of Sydney Pain Management Research Institute, Australia
First published
1989
Items
10
Response format
7-point confidence scale, scored 0–6
Score range
0 to 60
Direction
Higher score = better
Recall period
Current, taking pain into account
Completion time
About 3 minutes
Age range
Adults
Regions
General Health, Spine
Conditions
Chronic pain, Chronic low back pain, Persistent musculoskeletal pain, Fibromyalgia
Procedures
Pain management programme, Graded activity rehabilitation
Languages
English, German, Dutch, Swedish, Spanish, Chinese, Japanese
Test–retest (ICC)
0.73–0.79
Internal consistency
Cronbach's alpha 0.92
Validity
Predicts disability, distress and return to work more strongly than pain intensity does, and is one of the best-supported psychological measures in musculoskeletal pain.
Responsiveness
Highly responsive to pain management programmes and to cognitive behavioural interventions, and change in PSEQ mediates a substantial share of the improvement in disability.
Ceiling effect
Ceiling effect in patients with mild or acute pain, most of whom score close to 60.

Normative values

Reference values from published cohorts, for comparison against the score you calculated.

PopulationAgeMeanSD
Chronic pain patients entering a pain management programme—21–2712
Chronic pain patients after a successful programme—38–45—

When to use the PSEQ

Well suited to

  • Chronic or persistent musculoskeletal pain, where psychological factors drive disability more than tissue pathology does.
  • Before a graded activity or rehabilitation programme, where low self-efficacy predicts poor engagement and identifies who needs the psychological component addressed first.
  • Alongside a disability measure such as the Oswestry or Roland-Morris, which it complements rather than duplicates.

Limitations and poor fits

  • Acute pain, where the ceiling effect limits discrimination and the construct is less relevant.
  • As a measure of pain intensity or of disability — it measures neither.
  • As a screening tool for psychological distress, for which dedicated measures exist.

PSEQ compared with other instruments

Instruments measuring a related construct, with the practical difference between them.

InstrumentItemsRangeWhat it adds
TSK-111111–44The TSK-11 is the 11-item short form of the Tampa Scale of Kinesiophobia, which drops the four reverse-scored items and items 9 and 14 of the original, scores each remaining statement 1 to 4 for a total of 11 to 44, and reads a higher total as more fear of movement and (re)injury.
ODI100–100The Oswestry Disability Index measures how far low back pain restricts ten everyday activities, scoring each section from 0 to 5 and expressing the total as a percentage from 0% (no disability) to 100% (maximum disability).
RMDQ240–24The Roland-Morris Disability Questionnaire measures physical disability from low back pain by counting how many of 24 statements a patient agrees with, giving a score from 0 (no disability) to 24 (maximum disability).

Copyright and permitted use

Published openly because it is the question every clinician and researcher asks before using an instrument, and almost nobody answers it.

Free to useRights holder: Michael K. Nicholas

The PSEQ is made available by its developer free of charge for clinical and research use, and is reproduced widely in pain management practice. The developer asks that it be used unmodified and that the source be acknowledged.

References

  1. Nicholas MK. The pain self-efficacy questionnaire: taking pain into account. European Journal of Pain. 2007.PMID 16949331
  2. Chiarotto A, Vanti C, Ostelo RW, et al.. The Pain Self-Efficacy Questionnaire: cross-cultural adaptation into Italian and assessment of its measurement properties. Pain Practice. 2015.PMID 25353056
  3. Dubé MO, Langevin P, Roy JS. Measurement properties of the Pain Self-Efficacy Questionnaire in populations with musculoskeletal disorders: a systematic review. Pain Reports. 2021.PMID 34901677

Editorial status

Not yet reviewedQueued for clinical review by Sam Tuffun, PT, DPT. Sign-off has not taken place — this is a placeholder assignment, not a completed review.