Tutelman Perri R, Chambers Christine T, Noel Melanie, Heathcote Lauren C, Fernandez Conrad V, Flanders Annette, MacLeod Julia, Sherry Simon B, Simard Sébastien, Stern Maya, Stewart Sherry H, Urquhart Robin
Departments of Psychology and Neuroscience.
Centre for Pediatric Pain Research.
Clin J Pain. 2022 Jul 1;38(7):484-491. doi: 10.1097/AJP.0000000000001049.
Theoretical models suggest that anxiety, pain intensity, and pain catastrophizing are implicated in a cycle that leads to heightened fear of cancer recurrence (FCR). However, these relationships have not been empirically examined. The objective of this study was to examine the relationships between anxiety symptoms, pain intensity, pain catastrophizing, and FCR in childhood cancer survivors and their parents and to examine whether pain catastrophizing predicts increased FCR beyond anxiety symptoms and pain intensity.
The participants were 54 survivors of various childhood cancers (Mage=13.1 y, range=8.4 to 17.9 y, 50% female) and their parents (94% mothers). Children reported on their pain intensity in the past 7 days. Children and parents separately completed measures of anxiety symptoms, pain catastrophizing, and FCR.
Higher anxiety symptoms were associated with increased pain intensity, pain catastrophizing, and FCR in childhood cancer survivors. Higher anxiety symptoms and pain catastrophizing, but not child pain intensity, were associated with FCR in parents. Hierarchical linear regression models revealed that pain catastrophizing explained unique variance in both parent (ΔR2=0.11, P<0.01) and child (ΔR2=0.07, P<0.05) FCR over and above the effects of their own anxiety symptoms and child pain.
The results of this study provides novel data on the association between pain and FCR and suggests that a catastrophic style of thinking about pain is more closely related to heightened FCR than one's anxiety symptoms or the sensory pain experience in both childhood cancer survivors and their parents. Pain catastrophizing may be a novel intervention target for survivors and parents struggling with fears of recurrence.
理论模型表明，焦虑、疼痛强度和疼痛灾难化思维与导致癌症复发恐惧（FCR）加剧的循环有关。然而，这些关系尚未得到实证检验。本研究的目的是探讨儿童癌症幸存者及其父母的焦虑症状、疼痛强度、疼痛灾难化思维与癌症复发恐惧之间的关系，并检验疼痛灾难化思维是否能预测除焦虑症状和疼痛强度之外癌症复发恐惧的增加。
参与者为54名患各种儿童癌症的幸存者（平均年龄=13.1岁，范围=8.4至17.9岁，50%为女性）及其父母（94%为母亲）。儿童报告了他们过去7天的疼痛强度。儿童和父母分别完成了焦虑症状、疼痛灾难化思维和癌症复发恐惧的测量。
儿童癌症幸存者中，较高的焦虑症状与疼痛强度增加、疼痛灾难化思维和癌症复发恐惧有关。父母的癌症复发恐惧与较高的焦虑症状和疼痛灾难化思维有关，但与儿童的疼痛强度无关。分层线性回归模型显示，疼痛灾难化思维在其自身焦虑症状和儿童疼痛影响之外，解释了父母（ΔR2=0.11，P<0.01）和儿童（ΔR2=0.07，P<0.05）癌症复发恐惧中的独特变异。
本研究结果提供了关于疼痛与癌症复发恐惧之间关联的新数据，并表明在儿童癌症幸存者及其父母中，对疼痛的灾难性思维方式比焦虑症状或疼痛的感觉体验与癌症复发恐惧加剧的关系更为密切。疼痛灾难化思维可能是困扰复发恐惧的幸存者和父母的一种新的干预目标。
