The Mediating Effect of Perceived Injustice and Pain Catastrophizing in the Relationship of Pain on Fatigue and Sleep in Breast Cancer Survivors: A Cross-Sectional Study

Abstract

Objective Multidimensional aspects of pain have raised awareness about cognitive appraisals, such as perceived injustice (PI) and pain catastrophizing (PC). It has been demonstrated that they play an important role in patients’ pain experience. However, the mediating effect of these appraisals has not been investigated in breast cancer survivors (BCS), nor have they been related to fatigue and sleep. Methods Cross-sectional data from 128 BCS were analysed by structural path analysis with the aim to examine the mediating effect of PI and PC in the relationship of pain on fatigue and sleep. Results The indirect mediating effects of PI on fatigue (CSI*PI = 0.21; P < 0.01 and VAS*PI = 1.19; P < 0.01) and sleep (CSI*PI = 0.31; P < 0.01 and VAS*PI = 1.74; P < 0.01) were found significant for both pain measures (Central Sensitization Inventory (CSI) and Visual Analogue Scale (VAS)). PC, on the other hand, only mediated the relationship between pain measured by VAS and fatigue (VAS*PC = 0.80; P = 0.03). Positive associations were found, indicating that higher pain levels are positively correlated with PI and PC, which go hand in hand with higher levels of fatigue and sleep problems. Conclusion PI is an important mediator in the relationship of pain on fatigue and sleep, while PC is a mediator on fatigue after cancer treatment. These findings highlight that both appraisals are understudied and open new perspectives regarding treatment strategies in BCS.

Latent Class Symptom Profiles of Colorectal Cancer Survivors with Cancer-Related Cognitive Impairment

“…Several studies reported that the bi-directional relationship between pain, cognitive impairment, sleep, and fatigue, which could partly be due to shared biological mechanisms [5,10,39]. However, evidence indicates pain precedes other psychoneurological symptoms in cancer survivors [40,41] rather than vice versa [42]. In CRC survivors, multiple pain mediators exist in tumor cells, which then, attach to receptors expressed by primary afferent pain nerve bers A and C [43].…”

Effect of perceived injustice-targeted pain neuroscience education compared with biomedically focused education in breast cancer survivors: a study protocol for a multicentre randomised controlled trial (BCS-PI trial)

“…Perceived injustice is related to lower quality of life, and perceived injustice rather than pain catastrophising mediates the relationship between pain and quality of life in BCSs 14. Moreover, perceived injustice is an important mediator in the relationship of pain on fatigue and sleep 19. The mediating effect of perceived injustice with quality of life, sleep and fatigue among BCSs shows that perceived injustice is not only understudied but also underappreciated and undertreated 20.…”

“… 14 Moreover, perceived injustice is an important mediator in the relationship of pain on fatigue and sleep. 19 The mediating effect of perceived injustice with quality of life, sleep and fatigue among BCSs shows that perceived injustice is not only understudied but also underappreciated and undertreated. 20 Therefore, it might be important to incorporate perceived injustice as a treatment target in the rehabilitation of BCSs.…”