Does pain acceptance predict physical and psychological outcomes in cancer outpatients with pain?
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 out patients 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 oncol ogy 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 out comes. Activity engagement and pain willing ness significantly predicted pain interference with function (P=0.033 and P=0.041 respec tively). However, only activity engagement pre dicted anxiety (P=0.001) and depression (P<0.001). These findings support the benefi cial role of pain acceptance in patients’ func tional adaptation to cancer-related pain. Activity engagement in particular, shows promise in fostering psychological well-being. Further studies could confirm its role in reduc ing anxiety and depression in cancer patients with pain and whether it should be included in cancer pain management interventions.
1. Glover J, Dibble SL, Dodd MJ, Miaskowski C. Mood states of oncology outpatients - does pain make a difference. J Pain Symptom Manage 1995;10:120-8.
2. Laird BJA, Boyd AC, Colvin LA, Fallon MT. Are cancer pain and depression interdependent? A systematic review. Psycho-Oncology 2009;18:459-64.
3. Zaza C, Baine N. Cancer pain and psychosocial factors: a critical review of the literature. J Pain Symptom Manage 2002;24:526-42.
4. McCracken LM. Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain 1998;74:21-7.
5. Vowles KE, McCracken LA, Eccleston C. Patient functioning and catastrophizing in chronic pain: The mediating effects of acceptance. Health Psychology 2008;27:
S136-43.
6. McCracken LM, Eccleston C. A prospective study of acceptance of pain and patient functioning with chronic pain. Pain 2005;118:164-9.
7. Nicholas MK, Asghari A. Investigating acceptance in adjustment to chronic pain: is acceptance broader than we thought? Pain 2006;124:269-79.
8. McCracken LM, Vowles KE, Eccleston C. Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. Behav Res Ther 2005;43:1335-46.
9. Viane I, Crombez G, Eccleston C, et al. Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal. Pain 2003;106:65-72.
10. Gauthier LR, Rodin G, Zimmermann C, et al. Acceptance of pain: a study in patients with advanced cancer. Pain 2009;143:147-54.
11. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity. A literature review. Arch Intern Med 2003;163:2433-45.
12. Aukst-Margetic B, Jakovljevic M, Margetic B, et al. Religiosity, depression and pain in patients with breast cancer. Gen Hosp Psychiatry 2005;27:250-5.
13. Jack L, Scott A, Colvin L, et al. Pain and depression in cancer patients: a longitudinal study. BMJ Supportive Palliative Care 2011;1:A11.
14. Badr H, Laurenceau JP, Schart L, et al. The daily impact of pain from metastatic breast cancer on spousal relationships: a dyadic electronic diary study. Pain 2010;151:644-54.
15. Parmelee PA, Harralson TL, Smith LA, Schumacher HR. Necessary and discretionary activities in knee osteoarthritis: do they mediate the pain-codepression relationship? Pain Med 2007;8:449-61.
16. Williamson GM, Schulz R. Activity restriction mediates the association between pain and depressed affect - a study of younger and older adult cancer-patients. Psychol Aging 1995;10:369-78.
17. Chen ML, Chang HK, Yeh CH. Anxiety and depression in Taiwanese cancer patients with and without pain. J Adv Nurs 2000;32:944-51.
18. Velikova G, Selby PJ, Snaith PR, Kirby PG. The relationship of cancer pain to anxiety. Psychother Psychosom 1995;63:181-4.
19. Thielking P. Cancer pain and anxiety. Curr Pain Headache Rep 2003;7:249-61.
20. Stjernsward J. WHO cancer pain relief program. Cancer Surveys 1988;7:195-208.
21. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 1994;23:129-38.
22. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 1983;67:361-70.
23. Geiser DS. A comparison of acceptance-focused and control-focused psychological treatments in a chronic pain treatment center. Phd dissertation. University of Nevada, 1992.
24. McCracken LM, Vowles KE, Eccleston C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain 2004;107:159-66.
25. McCracken LM, Zhao-O'Brien J. General psychological acceptance and chronic pain: there is more to accept than the pain itself. Eur J Pain 2010;14:170-5.
26. Veehof MM, Oskam MJ, Schreurs KMG, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. Pain 2011;152:533-42.
27. Portenoy RK, Kornblith AB, Wong G, et al. Pain in ovarian cancer patients. Prevalence, characteristics, and associated symptoms. Cancer 1994;74:907-15.
28. Turk DC. Remember the distinction between malignant and benign pain? Well, forget it. Clin J Pain 2002;18:75-6.
29. Bukberg J, Penman D, Holland JC. Depression in hospitalized cancer-patients. Psychosom Med 1984;46:199-212.
30. Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr 2004;57-71.
31. Becker N, Bondegaard Thomsen A, Olsen AK, et al. Pain epidemiology and health related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center. Pain 1997;73:393-400.
32. Williams AC, Richardson PH, Nicholas MK et al. Inpatient vs. outpatient pain management: results of a randomised controlled trial. Pain 1996;66:13-22.
33. Aass N, Fosss SD, Dahl AA, Aloe TJ. Prevalence of anxiety and depression in cancer patients seen at the Norwegian Radium Hospital. Eur J Cancer 1997;33:
1597-604.