Translation, cross-cultural adaptation, and validation of the italian version of the pain anxiety symptom scale 20 short form (PASS20-IT)

Background. The Pain Anxiety Symptoms Scale (PASS), particularly its short form (PASS-20), is a widely validated self-report instrument designed to assess pain-related anxiety(1). Rather than measuring general anxiety, it specifically evaluates fear and anxiety in response to pain, making it an excellent tool for phenotyping patients with persistent pain. This cross-sectional study aims to validate the Italian version of the short-form Pain Anxiety Symptoms Scale (PASS-20-IT).Methods. The Italian translation and cross-cultural adaptation process was based on international guidelines⁽², adhering to six rigorous phases: (a) two forward-translations from English to Italian; (b) synthesis of the forward-translations; (c) back-translations; (d) comparison between the back- translations and the original questionnaire by an expert committee; (e) pre-testing; and (f) final approval of the Italian version of the PASS-20. To validate the instrument, 200 participants with persistent pain were recruited to complete the PASS-20-IT alongside construct validity outcome measures, including the Generalized Anxiety Disorder-7 (GAD-7), the Pain Catastrophizing Scale (PCS), the Numerical Pain Rating Scale (NPRS), and the Graded Chronic Pain Scale (GCPS). The psychometric properties of the questionnaire will be evaluated by determining 8-day test-retest reliability(3), internal consistency(4), construct validity(5), and floor/ceiling effects(6).Expected Results. Psychometric validation of the PASS-20-IT for the assessment of pain-related anxiety.Conclusions. The PASS-20-IT project aims to provide the Italian clinical community with the first formal, psychometric-robust validation of the PASS-20. The expected findings will address a significant methodological gap, offering a brief and agile tool essential for the triage and phenotyping of patients suffering from persistent pain. Integrating the PASS-20 into clinical practice will represent a crucial advancement toward a genuine biopsychosocial approach, enabling the identification of non-nociceptive drivers of disability and the monitoring of treatment efficacy in reducing anxiety and avoidance behaviors.