Setting. Thoracic surgery department of a tertiary hospital. Background. Fear of pain (FOP) has been recognized as an influential moderator and determinant of the perception and disability of chronic pain. However, studies on FOP in postoperative acute pain are few and inconsistent. Objective. To explore whether FOP is related to pain intensity after thoracic surgery and provide a reference for FOP study in postoperative pain. Methods. From February to March 2022, 89 patients completed Chinese Version of Fear of Pain-9 Items (FOP-9), Chinese version of the Brief Pain Inventory (BPI, including least, worst, and average pain) and Simplified Chinese version of the Pain Catastrophizing Scale (PCS). Correlation analyses and mediation analyses were used for exploring the relationship between factors. Results. Mediation analyses showed that the total effects of FOP-9 on BPI all were significant (least pain: effect = 0.085, , 95% CI = 0.019∼0.151; worst pain: effect = 0.116, , 95% CI = 0.037∼0.196; average pain: effect = 0.102, , 95% CI = 0.031∼0.174) indicating that FOP-9 was a predictor to BPI. The 95% bias-corrected bootstrap confidence interval of estimate of indirect effect between FOP-9 and least pain/average pain through PCS was −0.036∼0.024 and −0.003∼0.069 (all contain zero), which indicated that PCS is not a mediator between FOP-9 and least pain/average pain. However, the estimate of indirect effect between FOP-9 and worst pain through PCS were 0.048 (95% CI = 0.095∼0.088), and direct effect was not statistically significant (95% CI = −0.017∼0.153), indicating that PCS acted as a complete intermediary between FOP-9 and worst pain. FOP-9 and PCS showed significant positive prediction effect on worst pain. Conclusions. Both trait FOP and state FOP were associated with higher postoperative pain reports after thoracic surgery. Trait FOP influences postoperative pain through the mediating effect of state FOP.

Background: The fear of pain (FOP) and fear avoidance belief (FAB) play a crucial role in the occurrence and development of chronic pain. However, the dynamics of these factors in postsurgical pain appear to differ, with the FOP often learned from others rather than directly caused by painful experiences. Psychological resilience refers to an individual’s capacity to adapt effectively to adversity, challenges, and threats, and may play a significant role in overcoming the FOP and avoidance behavior. Objective: The aim of this study was to investigate the role of psychological resilience in overcoming the FOP and avoidance behavior among surgical patients undergoing lung surgery. Methods: Participants were recruited at the Wuhan Union Hospital. Psychological resilience was measured using the Connor-Davidson Resilience Scale. The FOP was assessed using the simplified Chinese version of the Fear of Pain-9 items. The FAB was measured using the Physical Activity subscale of the Fear-Avoidance Beliefs Questionnaire. Activity recovery was assessed through questions related to social activities and household responsibilities. The adaptive least absolute shrinkage and selection operator (Lasso) regression analysis under nested cross-validation was used to identify key factors affecting postoperative FOP and activity recovery. Results: A total of 144 participants were included in the final analysis. The results showed that preoperative FOP (coefficient=8.620) and FAB (coefficient=8.560) were mainly positively correlated with postoperative FOP, while psychological resilience (coefficient=−5.822) and age (coefficient=−2.853) were negatively correlated with it. These average R² of these models was 73% (SD 6%). Psychological resilience was the most important factor in predicting activity recovery, and these models obtained an average accuracy of 0.820 (SD 0.024) and an average area under the curve of 0.926 (SD 0.044). Conclusions: Psychological resilience was negatively associated with the postoperative FOP and positively with activity recovery in patients who underwent lung surgery. Patients with higher resilience are more likely to cope effectively with postsurgical pain and recover activities sooner. These findings highlight the importance of assessing and potentially enhancing psychological resilience in the perioperative period to improve postoperative outcomes.

Purpose: This study aimed to obtain a translation and validation of the Fear of Pain Questionnaire 9 Items (FOP-9) into simplified Chinese. Methods: The questionnaire was translated following the forward-backward method. The final version was filled out by (n = 300) patients. Cronbach’s coefficient was calculated to test the internal consistency of simplified Chinese version of FOP-9 (sc-FOP-9), and 50 painless patients completed the sc-FOP-9 questionnaire within a 2-weeks interval to evaluate test–retest reliability. To verify the construct validity, exploratory factor analysis was used to explore the factor structure, and confirmatory factor analysis was conducted to evaluate the goodness fit of models. Results: Satisfactory psychometric qualities were obtained (Cronbach’s α of the total score was 0.873 and intraclass correlation coefficient was 0.975). Three first-order models were tested and all show a good model fit and the 3-factor structure may be better due to its higher factor loading. Conclusion: The sc-FOP-9 is a reliable and valid instrument to evaluate the fear of pain among Chinese patients with or without pain. Fear of pain may have an important effect on perioperative pain and chronic pain, and this tool is a good complement to the measurement in mainland China.

Kinesiophobia is a significant barrier to recovery after thoracic surgery. We aimed to determine the efficacy of an integrated intervention combining Protection Motivation Theory (PMT) and exposure therapy for reducing kinesiophobia and improving postoperative outcomes. In this single-center, randomized, double-blind, controlled trial, we enrolled 144 patients with kinesiophobia (Tampa Scale for Kinesiophobia [TSK-17-C] score ≥37) following thoracoscopic pulmonary surgery. Participants were randomized 1:1 to receive either a structured PMT-based psychological and graded exposure-behavioral intervention on postoperative day 1 (POD1) (experimental group, n=72) or routine care with standard pain education (control group, n=72). The primary outcome was the TSK-17-C score on POD3. The experimental group exhibited a significantly lower adjusted mean TSK-17-C score on POD3 compared to the control group (28.26 vs 36.13, respectively; adjusted mean difference, −7.86; 95% CI, −8.37 to −7.35; P <0.001). The intervention also led to a more improved pain trajectory (P=0.048 for time-by-group interaction) and superior cough capacity on POD3 (P <0.001). The intervention was safe and well-tolerated. An integrated psychological-behavioral intervention combining PMT and exposure therapy effectively reduces kinesiophobia, alleviates pain, and improves cough capacity in the early postoperative period for patients undergoing thoracic surgery. This nurse-led protocol provides a non-pharmacological approach that may enhance recovery and help mitigate the “pain-fear-avoidance” cycle.