The Pain Self-Efficacy Questionnaire, or PSEQ, is a 10-item patient-reported outcome measure used to assess how confident a client feels performing activities despite pain. Each item is scored from 0 to 6, giving a total score from 0 to 60. Higher scores indicate greater pain self-efficacy. The PSEQ can support education, activity planning and progress tracking, but it does not diagnose a condition, measure pain severity directly or clear someone for work, training or sport on its own.
Pain can affect more than symptoms alone. It can influence confidence, activity choices, work participation, training behaviour, social activity and the ability to keep doing valued tasks.
The Pain Self-Efficacy Questionnaire, commonly called the PSEQ, is a patient-reported outcome measure that assesses how confident a person feels doing activities despite pain.
It is commonly used for:
persistent pain
chronic low back pain
musculoskeletal pain
rehabilitation progress tracking
return-to-activity planning
pain education support
confidence monitoring
biopsychosocial assessment
activity and participation goal setting
The PSEQ is a 10-item questionnaire. Each item is scored from 0, meaning “not at all confident”, to 6, meaning “completely confident”. Total scores range from 0 to 60, where higher scores indicate stronger pain self-efficacy.
Outcome measure: Pain Self-Efficacy Questionnaire
Abbreviation: PSEQ
Body region: Not region-specific
Common use: Persistent pain and musculoskeletal pain contexts
Type: Patient-reported confidence / self-efficacy measure
Number of items: 10
Item score: 0–6
Total score range: 0–60
Higher score means: Greater confidence functioning despite pain
Lower score means: Lower confidence functioning despite pain
Best used for: Baseline assessment, education planning, confidence monitoring and progress tracking
Key limitation: PSEQ does not diagnose a condition, prove pain severity or determine clearance on its own
The PSEQ is a questionnaire that measures confidence in performing activities while experiencing pain.
It asks the client to rate how confident they are that they can do different activities at present, despite pain.
The PSEQ includes:
10 items
a 0–6 rating scale
a total score from 0–60
higher scores indicating greater pain self-efficacy
The official ePROVIDE listing identifies the PSEQ as an instrument developed by Nicholas and links it to the 2007 publication The Pain Self-Efficacy Questionnaire: Taking pain into account.
The PSEQ is best understood as a confidence and self-efficacy measure, not a pain severity scale and not a diagnostic test.
The PSEQ is used because confidence can influence activity, participation and progress.
A client may have similar pain levels to another person but report very different confidence with:
walking
work tasks
household activity
exercise
social activity
goal pursuit
pacing
flare-up management
returning to valued activities
The PSEQ can help professionals:
understand confidence despite pain
identify self-efficacy barriers
support pain education
guide graded activity planning
monitor confidence over time
support return-to-work or return-to-training conversations
combine self-report findings with physical assessment
improve documentation in Measurz
The PSEQ should support assessment reasoning and education. It should not be used to label the client or decide activity readiness on its own.
The PSEQ measures pain self-efficacy.
Pain self-efficacy refers to confidence in performing activities and managing life despite pain.
It may provide insight into:
confidence with activity
confidence with household tasks
confidence with work tasks
confidence with social participation
confidence pursuing goals
confidence coping with pain
willingness to engage in valued activities
perceived ability to function despite symptoms
It does not directly measure:
pain intensity
tissue damage
structural pathology
psychological diagnosis
motivation
effort
strength
range of motion
readiness to return to sport
readiness to return to work
The PSEQ may be useful for:
exercise professionals
rehabilitation practitioners
workplace health professionals
allied health support teams
strength and conditioning coaches working with injured clients
movement assessment professionals
students learning pain-related outcome measures
professionals using Measurz or MAT for structured progress tracking
It may be relevant for clients with:
persistent musculoskeletal pain
chronic low back pain
recurrent pain episodes
pain-related confidence loss
reduced participation
fear of flare-ups
difficulty returning to normal activity
difficulty progressing training
difficulty maintaining work or social activities
A 2020 systematic review of pain-related self-efficacy measures in people with back pain found that the PSEQ and Chronic Pain Self-Efficacy Scale were the most commonly used instruments, although many studies lacked some aspects of reliability and validity evidence.
Use the PSEQ when you want to understand how confident the client feels functioning despite pain.
It may be useful at:
initial assessment
onboarding
persistent pain review
flare-up review
pain education planning
graded activity planning
return-to-work planning
return-to-training planning
reassessment
discharge or progress review
The PSEQ is most useful when repeated over time using the same version and scoring method.
Use caution when:
the client cannot complete the questionnaire independently
language or literacy affects responses
the wrong language version is used
the client interprets confidence questions as judgement
the score is used to label the client
the result is interpreted without physical and functional context
the score is used as a pass/fail clearance decision
The PSEQ should not be used to:
diagnose a pain condition
diagnose anxiety or depression
diagnose a psychological disorder
confirm pain severity
determine whether pain is “real”
prove motivation or effort
clear someone for work, training or sport
replace a supportive conversation
replace professional judgement
PSEQ questionnaire
PSEQ scoring guide or calculator
Measurz recording workflow
Client-reported symptom and function notes
Baseline and retest dates
Optional related measures, such as:
Oswestry Disability Index
Roland-Morris Disability Questionnaire
Quebec Back Pain Disability Scale
Fear-Avoidance Beliefs Questionnaire
Tampa Scale for Kinesiophobia
Örebro Musculoskeletal Pain Screening Questionnaire
pain score
activity exposure notes
work participation notes
Explain the purpose of the questionnaire before the client completes it.
Example wording:
“This questionnaire helps us understand how confident you feel doing activities despite pain. It does not diagnose anything on its own, but it helps us plan education, activity progressions and progress tracking.”
The PSEQ can be completed:
on paper
digitally
independently
verbally if assistance is needed
before a session
during reassessment
as part of a Measurz workflow
Ask the client to:
read each statement carefully
rate how confident they feel at present
use the 0–6 scale
answer every item where possible
ask for clarification if they do not understand wording
complete the same version at each retest
Record whether the PSEQ was completed:
independently
digitally
on paper
verbally
with assistance
This supports repeatability and helps interpret change over time.
If assistance is needed:
explain instructions without leading the answer
avoid telling the client which score to choose
avoid challenging responses during completion
record that assistance was provided
use the same assistance approach at retest where possible
Do not guess missing responses.
For best practice:
record missing items
encourage completion of all 10 items
avoid calculating a total score if the form is incomplete unless the scoring guide allows it
interpret incomplete scores cautiously
use the same version and scoring rules at retest
The PSEQ includes 10 items.
Each item is scored from:
0: not at all confident
6: completely confident
The total score is calculated by adding all 10 items.
Score range:
0–60
Scoring direction:
Higher score: greater pain self-efficacy
Lower score: lower pain self-efficacy
Retest at meaningful points, such as:
baseline
after pain education
after graded activity progressions
after a flare-up
after increased training or work exposure
during persistent pain monitoring
discharge or progress review
For consistency, record:
date
current pain behaviour
current activity exposure
recent flare-ups
current work or training exposure
education or graded exposure stage
current goals
any major life, work or training changes
The PSEQ is a self-report questionnaire, so it does not create physical testing risk.
However, very low or worsening scores may suggest the need to:
explore confidence respectfully
review education
adjust graded activity planning
support pacing and goal setting
consider additional support where appropriate
collaborate with other professionals when distress or participation restriction is significant
The PSEQ produces a total score from 0 to 60.
Higher scores indicate greater pain self-efficacy.
Lower scores indicate lower confidence functioning despite pain.
0: very low confidence across all items
60: very high confidence across all items
A higher PSEQ score may suggest:
greater confidence functioning despite pain
stronger confidence with activity participation
better perceived coping ability
greater confidence pursuing goals
fewer self-efficacy-related barriers to progression
A lower PSEQ score may suggest:
lower confidence functioning despite pain
greater concern about activity
reduced perceived coping ability
lower confidence with goals, work or daily tasks
possible need for education, pacing or graded exposure support
A PSEQ score does not prove:
diagnosis
pain severity
tissue damage
psychological disorder
motivation
effort level
readiness to return to work
readiness to return to sport
whether one intervention caused change
Example wording:
“Your PSEQ score suggests you are not yet feeling very confident doing some activities while pain is present. This does not mean anything is wrong with you psychologically. It gives us a useful starting point for education, graded activity and tracking confidence over time.”
For general fitness clients, the PSEQ may help identify whether pain-related confidence is affecting:
gym participation
walking
lifting
daily activity
pacing
confidence after flare-ups
Interpretation cautions:
recent flare-ups may lower scores
pain education can change confidence
physical capacity should still be assessed
For athletes, PSEQ may help identify broad confidence functioning despite pain, but it may not capture sport-specific readiness fully.
Interpretation should also include:
sport-specific confidence
return-to-training exposure
workload history
pain response to sport tasks
psychological readiness measures where relevant
sport-specific functional testing
A high PSEQ score should not be treated as return-to-sport clearance on its own.
For workplace contexts, PSEQ may help identify confidence with function despite pain.
Interpretation should also include:
job demands
work status
modified duties
work expectations
confidence with work tasks
functional capacity
return-to-work planning
For older adults, PSEQ may help identify whether pain is affecting participation confidence.
Interpretation should consider:
general health
balance confidence
comorbidities
social support
walking tolerance
independent living goals
The PSEQ is more commonly used in adults.
For youth clients, consider:
comprehension
school and sport context
parent or guardian influence
whether a youth-specific measure may be more suitable
For persistent pain, PSEQ can help monitor whether confidence is changing alongside activity and participation.
Interpretation should also consider:
pain self-efficacy
fear-avoidance beliefs
kinesiophobia
mood and stress
sleep
work demands
flare-up history
participation goals
Meaningful change helps determine whether a score change is likely to matter.
Key terms:
MCID / MIC: the smallest change that may be meaningful to clients or professionals, depending on method used
MDC: the amount of change likely needed to exceed measurement error
SEM: estimated measurement error around a score
Responsiveness: ability of the questionnaire to detect change over time
A 2016 study in people with chronic low back pain examined responsiveness and minimal important change for the PSEQ, PSEQ-2 and PSEQ-4. The study states that the full PSEQ is a valid and reliable patient-reported instrument for assessing pain self-efficacy in chronic low back pain and that shorter versions had satisfactory measurement properties in mixed chronic pain populations.
Meaningful change values should be matched to:
full PSEQ versus short version
chronic low back pain versus other pain presentations
language version
baseline score
intervention or education context
follow-up timeframe
When interpreting PSEQ change:
compare the total score with baseline
check whether confidence changes match activity exposure
compare with pain, disability and function measures
look for changes in behaviour and participation
consider recent flare-ups or setbacks
avoid over-interpreting very small changes
Reported meaningful change values may vary by:
persistent pain condition
low back pain versus broader musculoskeletal pain
baseline confidence
education approach
follow-up timeframe
language version
scoring version
When no matching MCID, MDC or SEM exists, interpretation should rely more heavily on:
baseline comparison
repeated measurement
client conversation
activity exposure
work participation
disability scores
professional judgement
Universal PSEQ norms are limited and should be used cautiously.
The PSEQ is best interpreted through:
baseline comparison
score change over time
client goals
current activity exposure
pain and disability measures
confidence-related conversation
Practical guidance:
Lower scores suggest lower pain self-efficacy.
Higher scores suggest greater pain self-efficacy.
A high score does not guarantee readiness for sport, work or training.
A low score should prompt support and education, not judgement.
Repeated scores are often more useful than one isolated result.
Comparison should consider:
pain duration
pain condition
activity exposure
work status
recent flare-ups
previous pain education
language version
cultural context
disability level
support systems
The PSEQ has post-2000 evidence supporting its use, especially in persistent pain and musculoskeletal pain contexts.
The official ePROVIDE listing identifies the 2007 Nicholas paper as the primary published source for the PSEQ.
A 2021 systematic review of PSEQ measurement properties in musculoskeletal disorders reported that the PSEQ is one of the most frequently used patient-reported measures for pain self-efficacy and aimed to identify, appraise and synthesise its psychometric properties.
A 2020 systematic review of pain-related self-efficacy measures in people with back pain reported that PSEQ and the Chronic Pain Self-Efficacy Scale were the most commonly used instruments, but many studies lacked some aspects of reliability and validity evidence.
Reliability and validity are stronger when:
the correct version is used
the correct language version is used
all 10 items are completed
missing items are handled consistently
the same scoring method is repeated
results are interpreted in context
PSEQ is paired with disability, function and pain measures
Interpret cautiously when:
multiple items are missing
the client has difficulty understanding statements
the score is used to label the client
the score is used as a stand-alone return-to-activity decision
a shortened version is used without noting its specific scoring and evidence
the language version has limited validation evidence
Common errors include:
treating PSEQ as a diagnosis
using the score to label the client
interpreting low confidence as poor motivation
using PSEQ as return-to-work clearance
using PSEQ as return-to-sport clearance
not recording missing items
using different versions across retests
over-interpreting one score
failing to discuss results respectfully
failing to pair the score with function and physical assessment
Limitations include:
self-report may be influenced by recent pain, stress or flare-ups
high scores do not prove readiness
low scores do not prove poor effort
universal norms are limited
meaningful change evidence varies by population
it does not capture sport-specific readiness
it should be paired with physical, functional and psychosocial assessment
The PSEQ may help professionals:
document baseline confidence despite pain
identify self-efficacy-related barriers
guide pain education
support graded activity planning
support pacing discussions
monitor confidence change over time
support return-to-work or return-to-training conversations
improve client-centred communication
strengthen Measurz reports
For fitness clients, it can help show whether pain-related confidence is affecting training progression.
For workplace clients, it can help identify confidence around work tasks and activity participation.
For persistent pain clients, it can help monitor whether confidence changes alongside pain, disability and exposure.
For Measurz users, PSEQ is most useful when combined with:
Oswestry Disability Index
Roland-Morris Disability Questionnaire
Quebec Back Pain Disability Scale
Fear-Avoidance Beliefs Questionnaire
Tampa Scale for Kinesiophobia
Örebro Musculoskeletal Pain Screening Questionnaire
pain score
activity exposure notes
work participation notes
Record:
outcome measure name: Pain Self-Efficacy Questionnaire / PSEQ
version used: 10-item, PSEQ-2, PSEQ-4 or other
date completed
completion method: paper, digital, interview or assisted
language/version used
condition or presentation being tracked
total score
score range:
full PSEQ: 0–60
direction of scoring: higher score indicates greater pain self-efficacy
missing items, if any
assistance provided, if any
current pain score, if relevant
current disability score, if relevant
current activity exposure
current work or training exposure
key low-confidence themes
confidence or participation goals
education or graded activity notes
baseline comparison
MCID/MIC/MDC comparison where supported
related physical assessment findings
interpretation notes
retest date
referral or collaboration notes where appropriate
Record whether the main concern appears to be:
low activity confidence
low work confidence
low social or participation confidence
flare-up confidence issue
mixed self-efficacy limitation
unclear due to incomplete responses
This improves:
repeatability
communication
client education
assessment reasoning
monitoring over time
team consistency
reporting quality
The PSEQ measures how confident a client feels performing activities despite pain.
The full PSEQ has 10 items.
Each item is scored from 0 to 6. The total score ranges from 0 to 60.
Yes. Higher scores indicate greater confidence functioning despite pain.
No. PSEQ measures pain self-efficacy. It does not diagnose the cause of pain, pain severity or a psychological condition.
Yes. PSEQ is commonly used in persistent and chronic pain contexts, including chronic low back pain and musculoskeletal pain populations.
Meaningful change varies by population and version. Research has examined responsiveness and minimal important change in chronic low back pain, but values should be matched to the specific client group and PSEQ version.
It can support return-to-work or return-to-activity reasoning, but it should not be the only decision measure. It should be combined with function, activity exposure, pain behaviour, physical testing and professional judgement.
The PSEQ is a 10-item pain self-efficacy questionnaire.
Each item is scored from 0 to 6.
Total scores range from 0 to 60.
Higher scores indicate greater confidence functioning despite pain.
PSEQ does not diagnose pain cause, psychological status or activity readiness.
It is useful for education planning, graded activity and progress tracking.
Meaningful change values should be matched to the client population and version.
Measurz should record version, total score, completion method, missing items, activity exposure, confidence themes, baseline comparison and related physical findings.
Dubé, M.-O., Langevin, P., Roy, J.-S., & Desmeules, F. (2021). Measurement properties of the Pain Self-Efficacy Questionnaire in populations with musculoskeletal disorders: A systematic review. Pain Practice. https://doi.org/10.1111/papr.13049
Chiarotto, A., Vanti, C., Cedraschi, C., Ferrari, S., de Lima e Sá Resende, F., Ostelo, R. W. J. G., Pillastrini, P., & Terwee, C. B. (2016). Responsiveness and minimal important change of the Pain Self-Efficacy Questionnaire and short forms in patients with chronic low back pain. The Journal of Pain, 17(6), 707–718. https://doi.org/10.1016/j.jpain.2016.02.012
Di Pietro, F., Catley, M. J., McAuley, J. H., Parkitny, L., Maher, C. G., Costa, L. O. P., & Macedo, L. G. (2014). Rasch analysis supports the use of the Pain Self-Efficacy Questionnaire. Physical Therapy, 94(1), 91–100. https://doi.org/10.2522/ptj.20130217
Nicholas, M. K. (2007). The Pain Self-Efficacy Questionnaire: Taking pain into account. European Journal of Pain, 11(2), 153–163. https://doi.org/10.1016/j.ejpain.2005.12.008
Shirley Ryan AbilityLab. (2024). Pain Self-Efficacy Questionnaire. RehabMeasures Database. https://www.sralab.org/rehabilitation-measures/pain-self-efficacy-questionnaire
Turner, J. A., Holtzman, S., & Mancl, L. (2007). Mediators, moderators, and predictors of therapeutic change in cognitive-behavioral therapy for chronic pain. Pain, 127(3), 276–286. https://doi.org/10.1016/j.pain.2006.09.005
