Abstract
Pain acceptance has been associated with improved physical and psychosocial well-being in chronic non-malignant pain patients. However, its effects are unclear in cancer outpatients with pain. Our aim was to determine whether pain acceptance predicts reduced pain, pain interference with function, anxiety, and depression in cancer outpatients. We recruited 116 outpatients from a tertiary oncology center, with various types of cancer and pain levels. Patients completed the Brief Pain Inventory, the Hospital Anxiety and Depression Scale and the Chronic Pain Acceptance Questionnaire, the latter of which comprises activity engagement and pain willingness. We carried out multiple regression analyses, adjusting for patient characteristics and outcomes. Activity engagement and pain willingness significantly predicted pain interference with function (P=0.033 and P=0.041 respectively). However, only activity engagement predicted anxiety (P=0.001) and depression (P<0.001). These findings support the benefi- cial role of pain acceptance in patients’ functional adaptation to cancer-related pain. Activity engagement in particular, shows promise in fostering psychological well-being. Further studies could confirm its role in reducing anxiety and depression in cancer patients with pain and whether it should be included in cancer pain management interventions.
Highlights
Aspects of cancer pain, such as increasing intensity and duration, have been linked to diminished quality of life, poor functioning and psychological distress, regardless of differences in measurement and type of patients.[1,2,3] Pain acceptance could help cancer patients adapt to pain, since it has proven valuable in determining physical and emotional adjustment to chronic non-malignant pain
The authors did not break down the analysis by acceptance subscales, but our findings suggest that focusing interventions on continuing activities as normal despite pain will be most useful for improving both physical and psychological outcomes, at least in cancer patients
The present study provides additional evidence for the role of acceptance in adaptation to pain interference with function and psychological distress in cancer outpatients
Summary
Aspects of cancer pain, such as increasing intensity and duration, have been linked to diminished quality of life, poor functioning and psychological distress, regardless of differences in measurement and type of patients.[1,2,3] Pain acceptance could help cancer patients adapt to pain, since it has proven valuable in determining physical and emotional adjustment to chronic non-malignant pain. Gauthier et al.[10] reported an association between pain acceptance and psychological well-being in patients with advanced cancer, but no association with pain or physical function. This finding has important implications, especially given that cancer patients frequently experience co-morbid pain and depression,[2] two factors that react to one another and share common biological pathways.[11] The neurotransmitter imbalance occurring in depression is associated with greater sensitivity to pain and changes in pain perception.[11,12] the direction of causality between pain and depression remains unspecified,[13] and it is possible that activity restriction may mediate the paindepression relationship.[14,15,16] evidence of the association between cancer pain and anxiety is limited; it is unclear whether anxiety exists due to variables occurring mainly in outpatient settings, such as waiting for procedures or test results.[17,18] Studies have reported that patients’ functional status and life disruption are critical in predicting abnormal anxiety levels.[17,19]
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