Psychosocial factors contribute to the disability and distress associated with chronic pain in ambulatory patients attending an Australian cancer center

Abstract

Purpose: The prevalence, characteristics, and optimal management of chronic pain in cancer survivors remain uncertain. This study aimed to estimate its prevalence, origin, and severity, while examining the role of mood and unhelpful thoughts and beliefs in pain-related distress and disability. Methods: Ambulatory adults visiting the cancer center of a university teaching hospital in Sydney, Australia, were invited to participate in a de-identified cross-sectional survey. The survey included demographics, clinical information, and responses to validated pain questionnaires. Results: Out of 362 patients attending the center during the survey period, 346 (96%) returned completed surveys. Among them, 120 (35%) believed they were cured or in remission. 60 (17%, 95%CI 14%-20%) reported pain persisting for more than three months, with 35 (57% of those in pain) attributing it to unrelated comorbidities. 39 (11% of survey participants) reported moderate to severe interference with functioning due to pain. Pain interference correlated in the expected direction with depression, pain catastrophizing, and low pain self-efficacy (all p<0.01). Low pain self-efficacy significantly contributed to physical interference even when controlling for pain intensity. Similarly, pain catastrophizing contributed to pain-related distress. Conclusion: Chronic pain was prevalent in those surveyed, often stemming from comorbidities. Over 10% of respondents reported high-impact chronic pain, linked to depressed mood, low pain self-efficacy, and pain catastrophizing.