Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; University College Dublin, Dublin, Ireland.
J Pain. 2018 Mar;19(3):301-316. doi: 10.1016/j.jpain.2017.11.002. Epub 2017 Nov 16.
Age differences are not evident in pain-related stoicism and cautiousness in people with cancer pain. Little is known about the factors associated with these pain-related attitudes or age-related patterns in these associations. The present cross-sectional study investigated the biopsychosocial correlates of the attitudes in younger and older patients with advanced cancer. Pain-related stoicism (fortitude, concealment, superiority) and cautiousness (self-doubt, reluctance) were assessed using the Pain Attitudes Questionnaire-Revised (PAQ-R). Participants, 155 younger (younger than 60 years old) and 114 older (60 years old or older) patients with advanced cancer completed the PAQ-R and measures of sociodemographic and medical characteristics, pain intensity, cognitive-affective pain-related responses, physical functioning, psychological distress and well-being, and psychosocial functioning. Backwards regression analyses identified correlates for each PAQ-R factor separately for younger and older patients. Activity engagement was a frequent correlate, but its relationship with concealment was the only association common to both age groups. Younger and older patients exhibited different avoidance-related constructs suggesting relational challenges in the former group (avoidant attachment) and intrapersonal fear in the latter (cognitive avoidance). Medical correlates also showed age differences: younger patients showed symptom-focused correlates, whereas older patients showed aging-related correlates. Findings support a biopsychosocial framework of cancer-pain adaptation incorporating a lifespan-developmental perspective.
To our knowledge, this article is the first to identify biopsychosocial correlates of stoic and cautious attitudes toward cancer pain in younger and older patients with advanced cancer. Findings highlight possible age-related motivations for greater pain-related stoicism or cautiousness and can potentially inform interventions addressing challenges in cancer-pain adaptation in advanced cancer.
在癌症疼痛患者中，年龄差异在与疼痛相关的坚忍和谨慎态度方面并不明显。人们对这些与疼痛相关的态度或这些关联中的年龄相关模式相关的因素知之甚少。本横断面研究调查了年轻和老年晚期癌症患者这些态度的生物心理社会相关性。使用修订后的疼痛态度问卷-修订版（PAQ-R）评估与疼痛相关的坚忍（刚毅、掩饰、优越感）和谨慎（自我怀疑、不情愿）。155 名年轻（<60 岁）和 114 名老年（≥60 岁）晚期癌症患者完成了 PAQ-R 以及社会人口学和医学特征、疼痛强度、认知情感相关的疼痛反应、身体功能、心理困扰和幸福感以及心理社会功能的测量。向后回归分析分别为年轻和老年患者确定了每个 PAQ-R 因素的相关性。活动参与是一个常见的相关性，但它与掩饰的关系是两个年龄组共有的唯一关联。年轻和老年患者表现出不同的回避相关结构，这表明前者组存在关系挑战（回避型依恋），后者组存在内在恐惧（认知回避）。医学相关性也表现出年龄差异：年轻患者表现出症状为中心的相关性，而老年患者表现出与衰老相关的相关性。研究结果支持将癌症疼痛适应纳入生命发展视角的生物心理社会框架。
据我们所知，本文首次确定了年轻和老年晚期癌症患者对癌症疼痛的坚忍和谨慎态度的生物心理社会相关性。研究结果突出了与年龄相关的更强的疼痛相关坚忍或谨慎的可能动机，并可能为解决晚期癌症中癌症疼痛适应的挑战提供信息。
