Role of self-efficacy for pain management and pain catastrophizing in the relationship between pain severity and depressive symptoms in women with breast cancer and pain

Abstract

Purpose

This study evaluated the relationship between pain and depressive symptoms through pain self-efficacy and pain catastrophizing in breast cancer patients with pain.

Design

Secondary analysis of a randomized trial investigating a cognitive-behavioral pain management protocol.

Sample

Females (N = 327) with stage I–III breast cancer and report of at least moderate pain.

Methods

Pain severity, pain self-efficacy, pain catastrophizing, and depressive symptoms were measured. The proposed model was assessed using structural equation modeling.

Results

Higher pain severity was significantly related to lower pain self-efficacy and higher pain catastrophizing. Lower pain self-efficacy and higher pain catastrophizing were significantly related to more depressive symptoms. Higher pain severity was significantly associated with more depressive symptoms through lower pain self-efficacy and higher pain catastrophizing. The association between pain severity and depressive symptoms was not significant when specified as a direct effect.

Conclusion

Pain severity related to depressive symptoms in breast cancer patients via pain self-efficacy and pain catastrophizing.

Implications for psychosocial providers

Measurement of pain self-efficacy and pain catastrophizing should be incorporated into comprehensive pain assessments for women with breast cancer, as these variables may be relevant therapeutic targets. Psychosocial symptom management interventions should include strategies that increase pain self-efficacy and decrease pain catastrophizing because these pain-related cognitive variables appear to drive the relationship between pain severity and depressive symptoms.

Keywords:

• Breast cancer
• depression
• pain catastrophizing
• pain self-efficacy
• pain severity

Authors’ contributions

All authors contributed to the study conception and design. Material preparation, recruitment, delivery of study intervention, and data collection were performed by Joseph G. Winger, PhD, Shannon N. Miller, BPH, Jennifer C. Plumb Vilardaga, PhD, Catherine Majestic, PhD, Sarah A. Kelleher, PhD, and Tamara J. Somers, PhD. Data analyses were performed by Hannah M. Fisher, PhD and Juliann Stalls, PhD. The first draft of the manuscript was written by Hannah M. Fisher, PhD, and Juliann Stalls, PhD, and all authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript.

Consent to participate

Informed consent was obtained from all individual participants included in this study.

Consent for publication

The authors affirm that human research participants provided informed consent for publication of the data included in this publication.

Disclosure statement

The authors have no relevant financial or nonfinancial interests to disclose.

Ethics approval

Procedures complied with ethical guidelines and received Duke University Institutional Review Board approval (Pro00070823).

Funding

This study was funded through NIH/NCI 1R01CA202779-01 awarded to senior author, Tamara J. Somers, PhD. The work of Joseph G. Winger, PhD, was supported, in part, by a Kornfeld Scholars Program Award from the National Palliative Care Research Center.