Pain Resilience and Pain Self-Efficacy as Parallel Mediators of the Relationship Between Self-Critical Rumination and Pain-Specific Well-Being in Individuals With Chronic Pain: A Structural Equation Modeling Study

Numerical Rating Scales (NRS): In alignment with the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11), participants' pain intensity over the past week, the impact of pain on daily activities, and the level of pain-related distress will be assessed separately using 0-10 numerical rating scales. Pain intensity will be rated from 0 ("no pain") to 10 ("worst pain imaginable"); the impact of pain on daily life from 0 ("no impact") to 10 ("completely prevents my activities"); and pain-related distress from 0 ("no distress") to 10 ("extreme distress").

The University of Washington Pain-Related Self-Efficacy Scale-Short Form is a 6-item scale developed to assess patients' perceptions regarding their self-efficacy-or confidence-in performing daily, social, and personal activities despite pain. Each item is rated on a 5-point Likert-type scale ranging from 1 ("not at all confident") to 5 ("completely confident"). Total scores on the scale range from 6 to 30, with higher scores indicating a higher level of pain-related self-efficacy. The Cronbach's alpha value was reported as 0.87 in the study regarding the Turkish validity and reliability of the scale.

This scale was developed to assess well-being in the presence of pain among individuals with chronic pain, as well as the psychological, social, and lifestyle-related characteristics that support such well-being. The scale consists of a total of 11 items rated on a 5-point Likert scale ranging from 0 ("never") to 4 ("almost always"). The total score is calculated by summing the responses to all items and ranges from 0 to 44. Higher scores indicate a higher level of pain-related well-being; a score of 0 represents the minimum level, while a score of 44 represents the maximum level of pain-related well-being. In the study regarding the Turkish validity and reliability of the scale, the Cronbach's alpha value was reported as 0.713.

Self-Critical Rumination Scale: Developed by Smart et al. (2016) to assess ruminative processes associated with self-critical thoughts, this scale consists of 10 items. Respondents rate how well the statements describe them using a 4-point Likert-type scale (1 = does not describe at all, 2 = describes very little, 3 = describes moderately, 4 = describes very well). In the original study examining its psychometric properties, the scale's internal consistency coefficient was found to be .92, and it was determined to have a single-factor structure. It was also reported that the scale shows high correlations with constructs related to both self-criticism and rumination. In the study regarding the Turkish validity and reliability of the scale, the Cronbach's alpha value was reported as 0.89.

Pain Resilience Scale: This is a 14-item scale that assesses the cognitive, emotional, and behavioral responses individuals exhibit when facing intense or prolonged pain. The scale comprises two sub-dimensions: behavioral persistence (items 1-5) and a positive cognitive-emotional approach (items 6-14). Items are scored on a scale ranging from 0 ("never") to 4 ("always"). In the Turkish version of the PRS, only items 8, 11, and 12 are reverse-scored; for these items, the scoring is reversed from 4 ("always") to 0 ("never"). A high total score on the scale indicates a high level of pain resilience. The Cronbach's alpha value was reported as 0.920 in the study establishing the scale's validity and reliability in Turkish.