Psychology RootsPain and Distress Scale
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About Pain and Distress Scale
Scale Name
Pain and Distress Scale
Author Details
William W.K. Zung
Translation Availability
English
Background/Description
The Pain and Distress Scale (PAD), developed by William W.K. Zung in 1983, is a self-administered tool designed to provide a brief measure of mood and behavioral changes associated with acute pain, without directly assessing pain severity. Published in Journal of Clinical Psychiatry (1983), the PAD includes 20 items selected clinically to reflect psychological and physical reactions to pain, such as limitations in daily activities, agitation, depression, and decreased alertness. Items are grouped conceptually: one addresses pain (item 18), six cover mood changes (items 1, 2, 15–17, 19), and 13 focus on behavioral changes. Respondents use a 4-point frequency scale (higher scores indicate more frequent symptoms), with a flexible time frame (e.g., past week). Total scores are summed and expressed as a percentage of the maximum score.
The PAD was validated with 122 pain patients and 195 controls (mean age ≈ 18–65 years, mixed gender, U.S.-based), showing significant group discrimination. It is used in pain management, psychology, and clinical settings to assess pain-related distress.
Administration, Scoring and Interpretation
- Obtain the PAD from Zung (1983) or Journal of Clinical Psychiatry, ensuring ethical permissions.
- Explain to participants (adults 18+ with acute pain) that the questionnaire measures pain-related mood and behavior changes, emphasizing confidentiality and voluntary participation.
- Administer the 20-item self-report scale in clinical or research settings, with respondents rating frequency on a 4-point scale over a specified period (e.g., past week).
- Estimated completion time is 5–10 minutes.
- Ensure a private, supportive environment; provide pain management resources (e.g., referrals) and adapt for accessibility (e.g., large print, assistance) if needed.
Reliability and Validity
The PAD demonstrates strong psychometric properties (Zung, 1983). Internal consistency is high (Cronbach’s alpha = 0.89, N = 317). Test-retest reliability is not explicitly reported but inferred as moderate (r ≈ 0.70–0.80) based on similar scales. Inter-rater reliability is not applicable due to self-report but is consistent with standardized scoring.
Convergent validity is supported by significant discrimination between pain patients and controls (p < 0.01), with 11 items achieving 84.4% sensitivity and 99.5% specificity via discriminant analysis. Discriminant validity is evidenced by its focus on mood/behavior changes rather than pain intensity. Factor analysis reveals six factors blending mood and behavioral items, supporting a multifaceted construct validity. The PAD reliably assesses pain-related distress. Pairing with the McGill Pain Questionnaire or visual analog scales enhances comprehensive assessment.
Available Versions
20-Items
Reference
Zung W. W. (1983). A self-rating pain and distress scale. Psychosomatics, 24(10), 887–894. https://doi.org/10.1016/S0033-3182(83)73140-3
Important Link
Scale File:
Frequently Asked Questions
What does the Pain and Distress Scale measure?
It measures mood and behavioral changes associated with acute pain, not pain severity.
Who is the target population?
Adults (18+) with acute pain in clinical or research settings.
How long does it take to administer?
Approximately 5–10 minutes.
Can it inform interventions?
Yes, it assesses distress to guide psychological and pain management interventions.
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