Psychosocial Influences On Painrelated Limitations In Cancer Survivors

Many individuals either discontinue or avoid activities that are associated with pain.97,98 These might include activities of daily living, social and recreational activities, or occupational activities.23 Research suggests that 15-20% of individuals with chronic musculoskeletal pain conditions will become permanently occupation-ally disabled.99,100

Few research investigations have addressed the nature or severity of functional limitations due to pain in cancer survivors.17,23,101 It is possible that the prevalence of pain-related disability in cancer survivors might be comparable to that observed in other pain conditions.97 102 In the study by Bishop and Warr,50 only one third of breast cancer survivors were employed outside the home; 20% were receiving disability benefits. Little is currently known about the degree to which pain accounts for reduced occupational involvement of cancer survivors. Changes in life priorities, or other symptoms such as fatigue might also contribute to reduced occupational involvement.

Although pain has typically been considered the primary determinant of functional limitations in chronic pain sufferers, it has also been suggested that pain and disability are distinct and partially independent phenomena.99,103 Research suggests that, in chronic pain patients, pain intensity rarely accounts for more that 10% of the variance in the severity of functional limitations.97 Although the relation between pain and functional limitations has yet to be examined in cancer survivors, Sullivan et al9 reported that pain symptoms accounted for only 9% of the variance in self-rated functional limitations in a sample of mixed neuropathic pain patients. In recent years, increasing attention has been devoted to assessing the degree to which psychosocial factors might contribute to heightened risk for prolonged pain-related functional limitations.

Numerous investigations have been conducted addressing the role of psychosocial factors in the prediction of prolonged pain and disability associated with work-related musculoskeletal conditions.26,104,105 Systematic reviews of prospective cohort studies indicate that initial levels of pain severity are predictive of prolonged pain-related disability.106 Gheldolf et al.107 found that pain-related fears were significant determinants of the inability to work in individuals with back pain. Cross-sectional and prospective studies have shown that high levels of pain catastrophizing are associated with more intense pain, more severe functional limitations, and more prolonged work absence.108-110 Lack of confidence in the ability to perform physical activities has been associated with more severe functional limitations.62,111 Pain severity and depressive symptoms have been associated with premature termination of involvement in pain management programs, with greater occupational disability, and have been implicated as factors contributing to the transition from acute to chronic pain.86,112-114 On the basis of this research, variables such as pain catastrophizing, pain-related fears (i.e., fear of movement/re-injury), self-efficacy, outcome expectancies, and depression have come to be construed as psychosocial risk factors for chronic pain and disability.104,115,116 Future research should examine whether psychosocial risk factors for pain-related disability identified in other pain conditions also predict pain-related disability in cancer survivors.

Table 1 provides a selective list of potential psychosocial risk factors for prolonged pain and disability in cancer survivors and the instruments commonly used to assess them.117-129 It is important to note that these scales were not specifically developed for use with cancer survivors and therefore reliability and validity of these scales with cancer survivors must be investigated rather than assumed.

Only recently has research begun to investigate risk factors for pain and functional limitations in cancer survivors. Presurgical pain severity has been shown to predict the development of chronic pain symptoms in women treated for breast cancer.130,131 Presurgical pain has been shown to contribute to acute pain following surgery and to acute and chronic phantom breast syndrome in women treated for breast cancer.132,133 Presurgical emotional distress has also been shown to predict postsurgical acute pain in women with breast cancer.134

Table 1. Measurement Instruments for Psychosocial Risk Factors for Pain and Disability

Risk factor



Catastrophizing Pain-related fears





Perceived limitations/ Pain beliefs

Person-Environment factors

Pain Severity

Pain Catastrophizing Scale Tampa Scale for Kinesiophobia Fear-Avoidance Beliefs Questionnaire

Beck Depression Inventory II Centre for Epidemiological Studies Scale for Depression

State-Trait Anxiety Inventory Pain Anxiety Symptom Scale

Chronic Pain Self-Efficacy Scale The Functional Self-Efficacy Scale

Coping Strategies Questionnaires Multidimensional Pain Inventory Vanderbilt Pain Management Inventory Pain Disability Index

Survey of Pain Attitudes Biobehavioral Pain Profile

McGill Pain Questionnaire Neuropathic Pain Scale

Sullivan et al11"7 Kori et al.118 Waddell et ai119 Beck et ai120 Radloff121

Spielberger et al122 McCracken123 Anderson et al124 Barry et al.64 Rosenstiel and Keefe46 Kerns et al.1'25 Brown and Nicassio68


Jensen et al}'22 Dalton et al.53


Galer and Jensen129

Pain severity in cancer survivors might impact on function by interfering with an individual's ability to attend or concentrate on a particular task to the degree required for successful completion.135 Numerous investigations have shown that pain engages attention and interrupts current cognitive activity.136 The attentional disruption effects of pain are greatest when the pain is novel, and unpredictable.137138 For the cancer survivor who experiences intermittent or persistent pain, negative effects of pain on attention might have a deleterious impact on his or her ability to perform social, recreational or occupational tasks. The relation between pain and compromised attentional processing in cancer survivors with pain should be investigated in future research.

Emotional arousal states such as anxiety and fear, particularly when associated with pain, can have a marked negative impact on task-related attentional engagement.136,139 Emotional distress has also been shown to impact negatively on individuals' ability to adequately perform cognitive tasks. Depressive symptoms can interfere with the processing of complex information.140 Depressive symptoms can also compromise the engagement of motivational resources necessary to perform various physical or cognitive tasks.141 The adequate management of emotional distress states might be a key component of success for treatment programs that aim to facilitate social, recreational, and occupational re-integration of the cancer survivor with pain.

Risk factor research with cancer survivors should lead to the development of screening tools for the identification of individuals at risk for problematic outcomes following cancer treatment. Individuals identified at risk might then be considered for targeted interventions that might prevent the development of persistent pain and disability following treatment. In the absence of knowledge about relevant prognostic factors for problematic outcomes, interventions specifically targeting prognostic factors cannot be developed as yet.96


A number of pharmacological interventions for cancer pain and post-cancer pain have been described in the literature.142 Different classes of medication such as over-the-counter analgesics, opioids, and anticonvulsant drugs have been shown to yield significant pain relief benefit, at least for a certain percentage of patients.2,3 The medical management of pain in cancer survivors is described in more detail in Chapter 10.

However, there are indications that cancer survivors might not always take full advantage of the pain management options available to them.143,144 Ward145 described a number of factors that influence individuals' decisions about the type of pain management approaches they will consider for the treatment of their pain. Ward reported that patients' fears about side effects or addiction, or concerns that pain complaints might be negatively perceived by treating professionals interfered with the proper management of pain symptoms. It has been suggested that the provision of accurate information about pain management options, and education about the appropriate use of pain medication should be an integral component of the treatment of cancer survivors.143-146

Concerns about side effects of pain medication might be particularly pertinent to the cancer survivor who wishes to resume pre-cancer role responsibilities. Certain medications used in the management of pain, such as some forms of antidepres-sants, can lead to excessive morning fatigue, dry mouth, nausea, and lethargy. Other medications, such as opioids, can result in mental clouding, and impaired coordination that can interfere with the adequate or safe performance of many activities of daily living. Although many side effects of pain medication dissipate in time, some individuals will continue to experience medication side effects of significant severity even after extended use. The cost-benefit analysis of balancing the pain reduction with the adverse side effects of medication might present particular challenges for the cancer survivor with pain who wishes to resume occupational involvement.

Cognitive-behavioral approaches have dominated psychological intervention research on cancer pain management. Cognitive-behavioral perspectives proceed from the view that an individual's interpretation, evaluation and beliefs about their health condition, and their coping repertoire with respect to pain and disability will impact on the degree of emotional and physical disability that will be associated with cancer.25,28 It is important to note that the term cognitive-behavioral does not refer to a specific intervention but, rather, to a class of intervention strategies. The strategies included under the heading of cognitive-behavioral interventions vary widely and may include self-instruction (e.g., motivational self-talk), relaxation or biofeedback, developing coping strategies (e.g., distraction, imagery), increasing assertiveness, minimizing negative or self-defeating thoughts, changing maladaptive beliefs about pain, and goal setting.67 A client referred for cognitive-behavioral intervention may be exposed to varying selections of these strategies.

In the early years of psychosocial oncology, numerous investigations assessed the effectiveness of cognitive-behavioral techniques to minimize the negative impact of aversive cancer treatment interventions.147 148 Education has been a key feature of many interventions aimed at assisting individuals cope with aversive effects of cancer treatment or persistent pain following treatment.144 145 149 Educational approaches have been used to increase individuals' understanding about pain symptoms, minimizing barriers to accessing options for pain treatment, and methods of managing the stresses associated with pain. Educational interventions have been offered as stand alone interventions, or in combination with interventions aimed at increasing the cancer survivors' ability to cope with pain symptoms.28

A number of cognitive-behavioral interventions have been developed to assist patients in coping with acute procedural pain that might be experienced during cancer treatment. For example, distraction strategies and imagery-based strategies have been used for the management of procedural pain in both children and adults.147,148 Pain control strategies are typically taught prior to exposure to the painful procedure, and patients might then be coached through the procedure by a clinician. The results of several investigations suggest that these methods can be effective in reducing pain symptoms and emotional distress associated with painful cancer treatment.150-152

Albeit important intervention tools for acute procedural pain, strategies such as distraction, imagery, and hypnosis may have limited applicability for persistent pain. The high attentional resource demands of these strategies might interfere with a person's ability to engage in any other activity while utilizing the strategy. The attentional resource demands of these strategies also place limits on the duration of time that they can be invoked to deal with a pain episode. For the patient who must deal with pain symptoms throughout the day, for months or years, even though they may wax and wane, alternate approaches to pain management are needed.

Keefe et al.153 described a three-session cognitive-behavioral, partner-assisted, pain-management intervention for terminally ill cancer patients. The program of intervention was developed on the basis of research with osteoarthritis patients showing that partner-assisted pain management improved the physical and emotional function of the pain patient as well as the emotional functioning of the spouse or caregiver.153 The three-session program included (1) education about the nature of pain experience and different options for pain control, (2) instruction in the use of pain coping strategies, and (3) instruction in activity pacing. The intervention program was delivered by nurse educators. Patient and partner outcomes following participation in the partner-assisted intervention were compared to a usual care control group. Although there were no significant differences between groups on patient outcomes, there was a trend toward reduced pain and increased quality of life. The partners in the partner-assisted intervention showed significant increases of confidence in their ability to assist the patients in methods of pain control.146 The authors suggested that the modest impact of the intervention on patient outcomes might have been due to the severity of physical and emotional distress experienced by the terminally ill patients. It is possible that this type of intervention, perhaps longer in duration, or combined with medication, might be useful for cancer survivors and their partners.

Few interventions have addressed the efficacy of pain management interventions for cancer survivors.22,154 In a recent study, Dalton et al}hh examined the effects of coping skills training on pain and distress of cancer survivors. In one group, patients received a standardized intervention program consisting of education, coping skills training, problem-solving, cognitive-restructuring, and relaxation. A second treatment condition consisted ofsimilar elements but was customized to the patients'

pain problem profile. Both treatment conditions yielded more positive pain-related outcomes than the control group.155 Tailoring the intervention to the patient's pain profile led to more rapid improvement than the standardized intervention.

Clinical findings suggesting that pain contributes only modestly to disability, and that pain management programs yield only minimal change in pain levels have led many investigators to reconsider whether pain reduction should be the primary goal of psychological interventions for individuals with persistent pain.96,156 Research suggests that programs that maximize activity involvement and resumption of key life roles are the ones most likely to be associated with return to pre-illness (or pre-injury) levels of functioning.157-159

As can be seen from the list of strategies included in cognitive-behavioral pain management programs, some are clearly linked to facilitating resumptions of life role activities (e.g., goal setting) while others are primarily palliative in nature (e.g., relaxation, imagery). In a related fashion, many cognitive-behavioral interventions have as their primary focus the reduction of emotional distress or the reduction of pain. While emotional distress and pain no doubt contribute to functional limitations, the reduction of emotional distress and pain are typically not sufficient to contribute in a meaningful manner to resumption of life role activities.159 There are grounds to caution the use of overly palliative or passive psychological intervention strategies in the treatment of individuals with persistent pain when functional restoration is also a major goal. In other domains of practice, palliative or passive intervention strategies have been shown to accentuate as opposed to ameliorate pain-related disability.97

There have been a number of recent studies that have highlighted that the psychological predictors of pain are quite distinct from the psychological predictors of disability.110,160 These findings suggest that if disability reduction is the goal of treatment, interventions will differ from those that would be considered if pain reduction was the goal of treatment.161 Clearly, from a quality of life perspective, maximizing or restoring function in cancer survivors is of primary concern.

In recent years, a number of risk factor targeted interventions have been developed for the prevention of pain-related disability associated with musculoskeletal conditions.162-164 These approaches differ from traditional psychosocial interventions for pain insofar as individuals are selected for treatment on the basis of psychosocial risk profiles, and interventions are designed to specifically target prognostic factors for pain-related disability. Research to date indicates that treatment-related reductions in psychological risk factors can yield significant improvement in pain severity, depression, and return to work.115,162-165 Intervention approaches that target risk factors for disability associated with post-cancer pain might prove to be effective in restoring function, maximizing full social participation and increasing quality of life in cancer survivors.


As this review indicates, questions concerning the psychosocial dimensions of pain and function in cancer survivors have yet to find a place on the priority list of many research agendas. Although the magnitude of the pain problem in cancer survivors has been known for some time, basic questions about the nature and severity of functional limitations in cancer survivors with pain have yet to be addressed. Research describing the adverse impact of pain symptoms on the lives of cancer survivors will

Table 2. Building a Research Agenda: Priority Areas

1. Determining the prevalence of mental health problems in cancer survivors with pain.

2. Identification of vulnerability and resilience factors for depression in cancer survivors with pain.

3. The development and evaluation of interventions for the management of depression in cancer survivors with pain.

4. Examining the influence of opioids on the efficacy of interventions for depression in cancer survivors with pain.

5. Identification of vulnerability and resilience factors for functional limitations in cancer survivors with pain.

6. Development of screening measures for the detection of risk factors for pain and functional limitations in cancer survivors.

7. Investigating the role of fatigue as a determinant of health and behavioral health outcomes in cancer survivors with pain.

8. Investigating the effects of pain severity on attention and concentration in cancer survivors with pain.

9. Examining the determinants of decisions to discontinue employment in cancer survivors with pain. 10. Investigating the efficacy of interventions designed to reduce functional limitations and facilitate life role reintegration in cancer survivors with pain.

be required in order to mobilize the resources necessary to meet the treatment needs of this ever-growing population.

Research will also be required to identify the determinants of behavioral health outcomes and functional limitations in cancer survivors with pain. In the absence of this information, the development of intervention programs is likely to proceed with little empirical direction. In the interim, based on the literature addressing the psychological determinants of pain and pain-related disability in other domains of pain research, intervention strategies that aim to reduce helplessness and catastrophic thinking, increase perceived control and self-efficacy, and maximize resumption of important life role activities may contribute to more positive health and behavioral health outcomes for cancer survivors.28,165,166 Table 2 provides a summary of priority research areas relevant to psychosocial factors associated with pain outcomes in cancer survivors.

Cancer survivors will continue to experience debilitating symptoms of pain following treatment that can impact on function. Once symptoms of pain become chronic, available methods of managing pain, whether pharmacological or psychological, have only modest impact on suffering and function. If individuals at risk for persistent post-cancer pain and those with high levels of pain-related disability can be identified before the problem becomes chronic, individuals' suffering might be prevented or reduced to a significant degree. There is an urgent need to develop a stronger research basis for the development of interventions aimed at preventing and managing the pain and its functional impact among cancer survivors with different types of cancers. Given the pending increase in the size of the cancer survivor population and the inherent morbidity and personal and societal costs associated with persistent pain following cancer treatment, increased knowledge ofthe determinants of post-cancer pain and disability will be important both for improving quality of life of patients and maximizing the overall cost-effectiveness of cancer treatment.


1. Aziz, N.M., and Rowland, J.H. Trends and advances in cancer survivorship research: Challenge and opportunity. Semin. Radiat. Oncol. 2003; 13: 248-66.

2. Portenoy, R.K. Cancer pain management. Clin. Adv. Hematol. Oncol. 2005; 3(1): 30-2.

3. Cleeland, C.S., Portenoy, R.K., Rue, M., Mendoza, T.R., Weller, E., Payne, R., et al. Does an oral analgesic protocol improve pain control for patients with cancer? An intergroup study coordinated by the Eastern Cooperative Oncology Group. Ann. Oncol. 2005; 16(6): 972-80.

4. Evans, R.C., and Rosner, A.L. Alternatives in cancer pain treatment: The application of chiropractic care. Semin. Oncol. Nurs. 2005; 21(3): 184-9.

5. Carr, D.B., Goudas, L., Balk, E.M., Bloch, R., Ioannidis, J.P., and Lau, J. Evidence report on the treatment of pain in cancer patients. J. Natl. Cancer Inst. 2004; 32: 23-31.

6. Dalton, J.A., Carlson, J., Blau, W., Lindley, C., Greer, S.M., and Youngblood, R. Documentation of pain assessment and treatment: How are we doing? Pain Manage. Nurs. 2001; 2: 54-64.

7. Peters, C.M., Ghilardi, J.R., Keyser, C.P., Kubota, K., Lindsay, T.H., Luger, N.M., etal. Tumor-induced injury of primary afferent sensory nerve fibers in bone cancer pain. Exp. Neurol. 2005; 193(1): 85100.

8. Pronneke, R., and Jablonowski, H. [Pain therapy in cancer patients]. MMW Fortschr. Med. 2005; 147(22): 27-30.

9. Grond, S., Zech, D., Diefenbach, C., Radbruch, L., and Lehmann, K.A. Assessment of cancer pain: A prospective evaluation in 2266 cancer patients referred to a pain service. Pain 1996; 64: 107-14.

10. Caraceni, A., and Portenoy, R.K. An international survey of cancer pain characteristics and syndromes. IASP Task Force on cancer pain. Pain 1999; 82: 263-74.

11. Berglund, G., Bolund, C., Fornander, T., Rutqvist, L.E., and Sjoden, P.O. Late effects of adjuvant chemotherapy and post-operative radiotherapy on quality of life among breast cancer patients. Eur. J. Cancer 1991; 27: 1075-81.

12. Bjordal, K., Mastekaasa, A., and Kaasa, S. Self-reported satisfaction with life and physical health in long-term cancer survivors and a matched control group. Eur. J. Cancer 1995; 31: 340-5.

13. Dow, K.H., Ferrell, B.R., Leigh, S., Ly, J., and Gulasekaram, P. An evaluation of the quality of life among long-term survivors of breast cancer. Breast Cancer Res. Treat. 1996; 39: 261-73.

14. MacDonald, L., Bruce, J., Scott, N.W., Smith, W.C., and Chambers, W.A. Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome. Br. J. Cancer 2005; 92: 225-30.

15. Carpenter, J.S., Andrykowski, M.A., Sloan, P., Cunningham, L., Cordova, M.J., Studts, J.L., et al Postmastectomy/postlumpectomy pain in breast cancer survivors. J. Clin. Epidemiol. 1998; 51: 128592.

16. Chaplin, J.M., and Morton, R.P. A prospective, longitudinal study of pain in head and neck cancer patients. Head Neck 1999; 21: 531-7.

17. Cleeland, C.S. The impact of pain on the patient with cancer. Cancer 1984; 54: 2635-41.

18. Jung, B.F., Herrmann, D., Griggs, J., Oaklander, A.L., andDworkin, R.H. Neuropathic pain associated with non-surgical treatment of breast cancer. Pain 2005; 118(1-2): 10-14.

19. Foley, K.M. Advances in cancer pain management in 2005. Gynecol. Oncol. 2005; 99(3, Suppl 1): S126.

20. Cleeland, C.S., Bennett, G., Dantzer, R., Dougherty, P.M., et al. Are the symptoms of cancer and cancer treatment sue to a shared biologic mechanism? Cancer 2003; 97: 2919-25.

21. McCarthy, N.J. Care of the breast cancer survivor: Increased survival rates present a new set of challenges. Postgrad.. Med. 2004; 116(4): 39-40, 42, 45-6.

22. Syrjala, K., and Chapko, M. Evidence for a biopsychosocial model of cancer treatment-related pain. Pain 1995; 61: 69-79.

23. Dar, R., Beach, C., Barden, P., and Cleeland, C.S. Cancer pain in the marital system: A study of patients and their spouses. J. Pain Symptom Manage. 1992; 7: 87-93.

24. Turk, D., and Okifuji, A. Psychological factors in chronic pain: Evolution and revolution. J. Consult Clin. Psychol. 2002; 70: 678-90.

25. Turk, D. Biopsychosocial perspective on chronic pain. In: Gatchel, R., and Turk, D. (eds.). Psychological Approaches to Pain Management. Guilford: New York, 1996.

26. Feuerstein, M. A multidisciplinary approach to the prevention, evaluation, and management of work disability. J. Occup. Rehabil. 1991; 1: 5-12.

27. Evans, R.L., and Connis, R.T. Comparison of brief group therapies for depressed cancer patients receiving radiation treatment. Public Health Rep. 1995; 110: 306-11.

28. Keefe, F.J., Abernethy, A.P., and Campbell, L.C. Psychological approaches to understanding and treating disease-related pain. Ann. Rev. Psychol. 2005; 56: 601-30.

29. Dalton, J.A., and Feuerstein, M. Biobehavioral factors in cancer pain. Pain 1988; 33: 137-47.

30. McWilliams, L., Cox, B., and Enns, M. Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample. Pain 2003; 106: 127-33.

31. France, R.D., Houpt, J.L., Skott, A., and Krishnan, K.R. Depression as a psychopathological disorder in chronic low back pain patients. J. Psychosom. Res. 1986; 30: 127-33.

32. Bishop, S., Edgley, K., Fisher, R., and Sullivan, M. Screening for depression in chronic low back pain with the Beck Depression Inventory. Can. J. Rehabil. 1993; 7: 143-8.

33. Rodin, G., Craven, J., and Littlefield, C. Depression in the Medically III: An Integrated Approach. Bruner Mazel: New York, 1991.

34. Massie, M.J. Prevalence of depression in patients with cancer. J. Natl. Cancer Inst. Monogr. 2004; 32: 57-71.

35. Recklitis, C., O'Leary, T., and Diller, L. Utility of a routine psychological screening in the childhood cancer survivor clinic. J. Clin. Oncol. 2003; 21: 787-92.

36. Kelsen, D.P., Portenoy, R.K., Thaler, H.T., Niedzwieki, D., Passik, S.D., et al. Pain and depression in patients newly diagnosed pancreas cancer. J. Clin. Oncol. 1995; 13: 748-55.

37. Avis, N.E., Smikth, K.W., McGraw, S., R.G. S., Petronis, V.M., and Carver, C.S. Assessing quality of life in adult cancer survivors. Qual. Life Res. 2005; 14: 1007-23.

38. Ganz, P.A., Desmond, K.A., Leedham, B., Rowland, J.H., Meyerwitz, B.E., and Belin, T.R. Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study. J. Natl. Cancer Inst. 2002; 94: 39-49.

39. Glover, J., Dibble, S.L., Dodd, M.J., and Miaskowski, C. Mood states in oncology outpatients: does pain make a difference? J. Pain Symptom Manage. 1995; 10: 120-128.

40. McCorkle, R., Tzuh Tang, S., Greenwald, H., Holcombe, G., and Lavery, M. Factors related to depressive symptoms among long-term survivors of cervical cancer. Health Care Women Int. 2006; 27: 45-58.

41. Spiegel, D., Sands, S., and Koopman, C. Pain and depression in patients with cancer. Cancer 1994; 74: 2570-8.

42. Zaza, C., and Baine, N. Cancer pain and psychological factors: A critical review of the literature. J. Pain Symptom Manage. 2002; 24(5): 526-42.

43. Banks, S., and Kerns, R. Explaining high rates of depression in chronic pain: A diathesis-stress formulation. Psychol. Bull. 1996; 119: 95-110.

44. Stewart, D.E., Wong, F., Duff, S., Melancon, C.H., and Cheung, A.M. "What doesn't kill you makes you stronger": An ovarian cancer survivor survey. Gynecol. Oncol. 2001; 83: 537-42.

45. Sullivan, M.J., and D'Eon, J.L. Relation between catastrophizing and depression in chronic pain patients. J. Abnorm. Psychol. 1990; 99(3): 260-3.

46. Rosenstiel, A., and Keefe, F. The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment. Pain 1983; 17: 33-44.

47. Turner, J.A., Jensen, M.P., and Romano, J.M. Do beliefs, coping, and catastrophizing independently predict functioning in patients with chronic pain? Pain 2000; 85(1-2): 115-25.

48. Sullivan, M.J., Thorn, B., Haythornthwaite,J.A., Keefe, F., Martin, M., Bradley, L.A., etal. Theoretical perspectives on the relation between catastrophizing and pain. Clin. J. Pain 2001; 17(1): 52-64.

49. Beck, A.T., Rush, A.J., Shaw, B.F., and Emery, G. Cognitive Therapy for Depression. Guilford: New York, 1978.

50. Bishop, S.R., and Warr, D. Coping, catastrophizing and chronic pain in breast cancer. J. Behav. Med. 2003; 26: 265-81.

51. Gill, K., Mishel, M., Belyea, M., Germino, B., and Porter, L. Triggers of uncertainty and long-term treatment side effects in older African American and Caucasian breast cancer survivors. Oncol. Nurs. Forum 2004; 31: 633-9.

52. Buck, R., and Morley, S. Thinking about cancer pain: Coping, catastrophizing and attention to pain. Clin. J. Pain (in press).

53. Dalton, J.A., Feuerstein, M., Carlson, J., and Roghman, K. Behavioral pain profile: Development and psychometric properties. Pain 1994; 57: 95-107.

54. Arnstein, P., Caudill, M., Mandle, C.L., Norris, A., and Beasley, R. Self-efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients. Pain 1999; 80: 483-91.

55. Geisser, M., Roth, R., Theisen, M., Robinson, M., and Riley, J. Negative affect, self-report of depressive symptoms, and clinical depression: Relation to the experience of chronic pain. Clin. J. Pain 2000; 16: 110-20.

56. Maxwell, D., Gatchel, R.J., and Mayer, T.G. Cognitive predictors of depression in chronic low back pain: Toward an inclusive model. J. Behav. Med. 1998; 21: 131-43.

57. Haythornthwaite, J., Sieber, W.J., and Kerns, R.D. Depression and the chronic pain experience. Pain 1991; 46: 177-84.

58. Kerns, R.D., Rosenberg, R., and Otis, J.D. Self-appraised problem-solving and pain-relevant social support as predictors of the experience of chronic pain. Ann. Behav. Med. 2002; 24: 100-5.

59. Shaw, W., Feuerstein, M., Haufler, A., Berkowitz, S., and Lopez, M. Working with low back pain: Problem-solving orientation and function. Pain 2001; 93: 129-37.

60. Kerns, R.D., and Haythornthwaite, J.A. Depression among chronic pain patients: Cognitive-behavioral analysis and effect on rehabilitation outcome. J. Consult. Clin. Psychol. 1988; 56(6): 870-6.

61. Smith, T.W., O'Keefe, J.L., and Christensen, A.J. Cognitive distortion and depression in chronic pain: Association with diagnosed disorders. J. Consult. Clin. Psychol. 1984; 62: 195-8.

62. Lackner, J., Carosella, A., and Feuerstein, M. Pain expectancies, pain, and functional self-efficacy as determinants of disability in patients with chronic low back disorders. J. Consult. Clin. Psychol. 1996; 64: 212-20.

63. Lorig, K., Chastain, R.L., Ung, E., Shoor, S., and Holman, H.R. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum. 1989; 32(1): 37-44.

64. Barry, L.C., Guo, Z., Kerns, R.D., Duong, B.D., and Reid, M.C. Functional self-efficacy and pain-related disability among older veterans with chronic pain in a primary care setting. Pain 2003; 104(1-2): 131-7.

65. Beckham, J.C., Rice, J.R., and Talton, S.L. Relationship of cognitive constructs to adjustment in rheumatoid arthritis patients. Cogn. Ther. Res. 1994; 18: 479-98.

66. Bandura, A. Self-Efficacy: The Exercise of Control. Freeman: New York, 1977.

67. Turk, D., Meichenbaum, D., and Genest, M. Pain and Behavioral Medicine: A Cognitive-Behavioral Perspective. Guilford: New York, 1983.

68. Brown, G.K., and Nicassio, P.M. Development of a questionnaire for the assessment of active and passive coping strategies in chronic pain patients. Pain 1987; 31: 53-64.

69. Buck, R., and Morley, S. A daily process design study of attentional pain control strategies in the self-management of cancer pain. Eur. J. Pain 2006; 10: 385-98.

70. Dalton, J., and Feuerstein, M. Fear, alexithymia, and cancer pain. Pain 1989; 38: 159-70.

71. Turk, D.C. Remember the distinction between malignant and benign pain? Well, forget it. Clin. J. Pain 2002; 18: 75-6.

72. McCracken, L.M., and Eccleston, C. Coping or acceptance: What to do about chronic pain? Pain 2003; 105: 197-204.

73. McCracken, L., and Turk, D. Behavioral and cognitive-behavioural treatment for chronic pain. Spine 2002; 27: 2560-73.

74. McCracken, L.M. Learning to live with the pain: Acceptance of pain predicts adjustment in persons with chronic pain. Pain 1998; 74: 21-7.

75. Kornblith, A.B. Psychosocial adaptation of cancer survivors. In: Holland, J.C. (ed.). Psycho-oncology. Oxford University Press: New York, 1998.

76. Gotay, C.C., and Muraoka, M.Y. Quality of life in long-term survivors of adult-onset cancers. J. Natl. Cancer Inst. 1998; 90: 656-67.

77. Andersen, B.L. Surviving cancer. Cancer 1994; 74: 1484-95.

78. Turk, D.C. A diathesis-stress model of chronic pain and disability. Pain Res. Manage. 2002; 7: 9-19.

79. Fleishman, S.B. Treatment of symptom clusters: Pain, depression and fatigue. J. Natl. Cancer Inst. Monogr. 2004; 32: 119-23.

80. Meek, P.M., Nail, L.M., Barsevick, A., Schwartz, A.L., Stephen, S., and Whitmer, K. Psychometric testing for fatigue instruments for use with cancer patients. Nurs. Res. 2000; 49: 181-90.

81. Holland, J.C., Morrow, G.R., Schmale, A., Derogatis, L., Stefanek, M., Berenson, S., et al. A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. J. Clin. Oncol. 1991; 9: 1004-11.

82. Burns, J., Kubilis, A., Bruehl, S., Harden, R., and Lofland, K. Do changes in cognitive factors influence outcome following multidisciplinary treatment of chronic pain? A crossed-lagged panel analysis. J. Consult. Clin. Psychol. 2003; 71: 81-91.

83. Sullivan, M.J.L., Adams, H., Thibault, P., Corbiere, M., and Stanish, W. Initial depression severity and the trajectory of recovery following cognitive-behavioral intervention for chronic pain. J. Occup. Rehabil. 2006; 16: 63-74.

84. Sullivan, M.J.L., Gauthier, N., Tremblay, I. Mental health outcomes of chronic pain. In Wittink, H. (ed.). Evidence, Outcomes and Quality ofLifeinPain Treatment: A Handbook for Pain Treatment Professionals. Elsevier: Amsterdam, 2006.

85. McGregor, B.A., Antoni, M.H., Boyers, A., Alferi, S.M., Blomberg, B.B., and Carver, C.S. Cognitive-behavioral stress management increases benefit finding and immune function among women with early stage breast cancer. J. Psychosom. Res. 2004; 56: 1-8.

86. Sullivan, M., Reesor, K., Mikail, S., and Fisher, R. The treatment of depression in chronic low back pain: Review and recommendations. Pain 1992; 50: 5-13.

87. Polatin, P.B. Integration of pharmacotherapy and psychological treatment of chronic pain. In: Gatchel, R.J., Turk, D.C. (eds.). Psychological Approaches to Pain Management. Guilford; New York, 1996.

88. Campbell, L., Clauw, D., and Keefe, F. Persistent pain and depression: A biopsychoscial perspective. Biol. Psychiatry 2003; 54: 399-409.

89. Sullivan, M.J.L., Gauthier, N.L., Ialongo Lambin, D., Adams, H., and Catchlove, R. Où en est la recherche sur le traitement de la depression chez les patients souffrant de douleur chronique? Douleur et Analgésie 2005; 2: 61-6.

90. Mullan, F. Seasons of survival: Reflections of a physician with cancer. New Engl. J. Med. 1985; 313: 270-3.

91. Moadel, A.B., Ostroff, J.S., and Schantz, S.P. Head and neck cancer. In: Holland, J.C. (ed.). Psycho-oncology. Oxford University Press: New York, 1998.

92. Mechanic, D. Illness behavior, social adaptation, and the management of illness. J. Nerv. Ment. Dis. 1977; 165: 79-87.

93. Mechanic, D., and Volkart, E.H. Stress, illness behavior, and the sick role. Am. Sociol. Rev. 1961; 26: 51-8.

94. Romano, J., Turner, J., Jensen, M., Friedman, L., Bulcroft, R., Hops, H., etal Chronic pain patient-spouse interactions predict patient disability. Pain 1995; 65: 353-60.

95. Block, A., Kremer, E., and Gaylor, M. Behavioral treatment of chronic pain: The spouse as a discriminative cue for pain behavior. Pain 1980; 8: 243-52.

96. Sullivan, M., Feuerstein, M., Gatchel, R.J., Linton, S.J., and Pransky, G. Integrating psychological and behavioral interventions to achieve optimal rehabilitation outcomes. J. Occup. Rehabil. 2005; 15: 475-89.

97. Waddell, G. The Back Pain Revolution. Churchill Livingstone: London, UK, 1998.

98. Sullivan, M.J., Lynch, M.E., and Clark, A.J. Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions. Pain 2005; 113(3): 310-15.

99. Fordyce, W.E. Back Pain in the Workplace. IASP Press: Seattle WA, 1995.

100. Spitzer, W., LeBlanc, F., and Dupuis, M. A scientific approach to the assessment and management of activity-related spinal disorders: A monograph for clinicians. Spine 1987; 12(Suppl 75): S3-59.

101. Keating, N.L., Norredam, M., Landrum, B.B., Huskamp, H.A., and Meara, E. Physical and mental health status of older long-term cancer survivors. J. Am. Ger. Soc. 2005; 53: 2145-52.

102. Hewitt, M., Rowland, J.H., and Yancik, R. Cancer survivors in the United States: Age, health, and disability. J. Geron. 2003; 58: 82-91.

103. Feuerstein, M., Berkowitz, S., and Huang, G. Predictors of occupational low back disability: Implications for secondary prevention. J. Occup. Environ. Med. 1999; 41: 1024-31.

104. Waddell, G., Burton, A., and Main, C. Screening to Identify People at Risk of Long-Term Incapacity for Work. Royal Society of Medicine Press: London, UK, 2003.

105. Linton, S.J. New Avenues for the Prevention of Chronic Musculoskeletal Pain and Disability. Elsevier: Amsterdam, 2002.

106. Schultz, I.Z., et al. Psychosocial factors predictive of occupational low back disability: Towards development of a return-to-work model. Pain 2004; 107(1): 77-85.

107. Gheldof, E., et al. The differential role of pain, work characteristics and pain-related fear in explaining back pain and sick leave in occupational settings. Pain 2005; 113(1): 71-81.

108. Picavet, H.S., Vlaeyen, J.W., and Schouten, J.S. Pain catastrophizing and kinesiophobia: Predictors of chronic low back pain. Am. J. Epidemiol. 2002; 156(11): 1028-34.

109. Linton, S.J. Do psychological factors increase the risk for back pain in the general population in both a cross-sectional and prospective analysis? Eur. J. Pain 2005; 9(4): 355-61.

110. Sullivan, M.J., Stanish, W., Waite, H., Sullivan, M., and Tripp, D.A. Catastrophizing, pain, and disability in patients with soft-tissue injuries. Pain 1998; 77(3): 253-60.

111. Kaivanto, K., Estlander, A., and Moneta, G. Isokinetic performance in low back pain patients: The predictive power of the Self-Efficacy Scale. J. Occup. Rehabil. 1995; 5: 87-99.

112. Rush, A.J., Polatin, P., and Gatchel, R.J. Depression and chronic low back pain: Establishing priorities in treatment. Spine 2000; 25(20): 2566-71.

113. Carroll, L.J., Cassidy, J.D., and Cote, P. Depression as a risk factor for onset of an episode of troublesome neck and low back pain. Pain 2004; 107(1-2): 134-9.

114. Carosella, A.M., Lackner, J.M., and Feuerstein, M. Factors associated with early discharge from a multidisciplinary work rehabilitation program for chronic low back pain. Pain 1994; 57(1): 69-76.

115. Sullivan, M., Ward, L.C., Tripp, D., French, D., Adams, A., and Stanish, W. Secondary prevention of work disability: Community-based psychosocial intervention for musculoskeletal disorders. J. Occup. Rehabil. 2005; 15: 377-92.

116. Sullivan, M., Feuerstein, M., Gatchel, R.J., Linton, S.J., and Pransky, G. Integrating psychological and behavioral interventions to achieve optimal rehabilitation outcomes. J. Occup. Rehabil. 2005; 15: 475-89.

117. Sullivan, M., Bishop, S., and Pivik,J. The Pain Catastrophizing Scale: Development and validation. Psychol. Asses. 1995; 7: 524-32.

118. Kori, S., Miller, R., and Todd, D. Kinesiophobia: A new view of chronic pain behavior. Pain Manage. 1990; Jan: 35-43.

119. Waddell, G., Newton, M., Henderson, I., Somerville, D., and Main, C.J. A Fear-Avoidance Beliefs Questionnaire (FABQ) and their role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993; 52: 157-68.

120. Beck, A., Steer, R., and Brown, G.K. Manual for the Beck Depression Inventory—II. Psychological Corporation: San Antonio, TX, 1996.

121. Radloff, L.S. The CES-D Scale: A self-reported depression scale for research in the general population. Appl. Psychol. Meas. 1977; 1: 385-401.

122. Spielberger, C.D., Gorsuch, R.L., andLushen, R.E. Manual for the State-Trait Anxiety Inventory. Counselling Psychologists Press: Palo Alto, CA, 1970.

123. McCracken, L.M., Zayfert, C., and Gross, R.T. The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain. Pain 1992; 50(1): 67-73.

124. Anderson, K.O., Dowds, B.N., Pelletz, R.E., and Edwards, W.T. Development and initial validation of a scale to measure self-efficacy beliefs in patients with chronic pain. Pain 1995; 63: 77-84.

125. Kerns, R.D., Turk, D.C., and Rudy, T.E. The West Haven Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985; 23: 345-56.

126. Pollard, C.A. Preliminary validity study of the pain disability index. Percept. Mot. Skills 1984; 59(3): 974.

127. Jensen, M.P., Romano, J.M., Turner, J.A., and Lawler, B.K. Relationship of pain-specific beliefs to chronic pain adjustment. Pain 1994; 57: 301-9.

128. Melzack, R. The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1975; 1: 277-99.

129. Galer, B.S., and Jensen, M.P. Development and preliminary validation of a pain measure specific to neuropathic pain: The Neuropathic Pain Scale. Neurology 1997; 48: 332-8.

130. Tasmuth, T., Blomqvist, C., and Kalso, E. Chronic post-treatment symptoms in patients with breast cancer operated in different surgical units. Eur. J. Surg. Oncol. 1999; 25: 38-43.

131. Perkins, F.M., and Kehlet, H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 2000; 93: 1123-33.

132. Kroner, K., Knudsen, U.B., Lundby, L., and Hvid, H. Long-term phantom breast pain after mastectomy. Clin. J. Pain 1992; 8: 346-50.

133. Kroner, K., Krebs, B., Skov, J., and Jorgensen, H.S. Immediate and long term phantom breast syndrome after mastectomy: Incidence, clinical characteristics and relationship to pre-mastectomy breast pain. Pain 1989; 36: 327-34.

134. Katz, J., Poleshuck, E.L., Andrus, C.H., Hogan, L.A., Jung, B.F., Kulick, D.I., et al Risk factors for acute pain and its persistence following breast cancer surgery. Pain 2005; 119(1-3): 16-25.

135. Veldhuijzen, D.S., Kenemans, J.L., van Wijck, A.J.M., Kalkman, C.J., and Volkerts, E.R. Processing capacity in chronic pain patients: A visual event-related potentials study. Pain 2006; 121: 60-8.

136. Crombez, G., Eccleston, C., Baeyens, F., and Eelen, P. When somatic information threatens, catastrophic thinking enhances attentional interference. Pain 1998; 75: 187-98.

137. Crombez, G., Baeyens, F., and Eelen, P. Sensory and temporal information about impending pain: The influence of predictability of pain. Behav. Res. Ther. 1994; 32: 611-22.

138. Crombez, G., Eccleston, C., Baeyens, F., and Eelen, P. The disruptive nature of pain: An experimental investigation. Behav. Res. Ther. 1996; 34: 911-18.

139. Bradley, M.M., Bruce, B.N., and Lang, P.J. Picture media and emotion: Effects of a sustained affective context. Psychophysiology 1996; 33: 662-70.

140. Kampf-Sherf, O., Zlotogorski, Z., Gilboa, A., Speedie, L., Lereya,J., Rosca, P., etal. Neuropsycholog-ical functioning in major depression and responsiveness to selective serotonin reuptake inhibitors antidepressants. J. Affect. Disord. 2004; 82: 453-59.

141. Nestler, E.J., Barrot, M., DiLeone, R.J., Eisch, A.J., Gold, S.J., and Monteggia, L.M. Neurobiology of depression. Neuron 2002; 34: 13-25.

142. Fine, P.G., Miaskowski, C., and Paice, J.A. Meeting the challenges in cancer pain management. J. Supp. Oncol. 2004; 2: 5-22.

143. Kimberlin, C., Brushwood, D., Allen, W., Radson, E., and Wilson, D. Cancer patient and caregiver experiences: communication and pain management issues. J. Pain Symptom Manage. 2004; 28: 56678.

144. Allard, P., Maunsell, E., Labbe, J., and Dorval, M. Educational interventions to improve cancer pain control: A systematic review. J. Palliat. Med. 2001; 4: 191-203.

145. Ward, S.E., Donovan, H.S., Owen, B., Grosen, E., and Serlin, R. An individualized intervention to overcome patient-related barriers to pain management in women with gynecologic cancers. Res. Nurs. Health 2000; 23: 393-405.

146. Keefe, F.J., Ahles, T.A., Sutton, L., Dalton, J., Baucom, D., Pope, M.S., et al. Partner-guided cancer pain management at the end of life: A preliminary study. J. Pain Symptom Manage. 2005; 29(3): 263-72.

147. Syrjala, K.L., Cummings, C., and Donaldson, G.W. Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: A controlled clinical trial. Pain 1992; 48: 137-46.

148. Syrjala, K.L., Donaldson, G.W., Davis, M.W., Kippes, M.E., and Carr, J.E. Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: A controlled clinical trial. Pain 1995; 63(2): 189-98.

149. Oliver, J.W., Kravitz, R.L., Kaplan, S.H., and Meyers, F.J. Individualized patient education and coaching to improve pain control among cancer outpatients. J. Clin. Oncol. 2001; 19: 2206-12.

150. Montgomery, G.H., Weltz, C.R., Seltz, M., and Bovbjerg, D.H. Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients. International. J. Clin. Exp. Hypnosis 2002; 50: 17-32.

151. Liossi, C., and Hatira, P. Clinical hypnosis in the alleviation of procedure-related pain in pediatric oncology patients. Int. J. Clin. Exp. Hypnosis 2003; 47: 4-28.

152. Liossi, C., and Hatira, P. Clinical hypnosis versus cognitive behavioral training for pain management with pediatric cancer patients undergoing bone marrow aspirations. Int. J. Clin. Exp. Hypnosis 1999; 47: 104-16.

153. Keefe, F.J., Caldwell, D.S., and Baucom, D. Spouse-assisted skills training in the management of osteoarthritis knee pain. Arthritis Care Res. 1996; 9: 279-91.

154. Redd, W.H. Behavioral intervention for cancer treatment side effects. J. Natl. Cancer Inst. 2001; 93: 810-23.

155. Dalton, J.A., Keefe, F.J., Carlson, J., and Youngblood, R. Tailoring cognitive-behavioral treatment for cancer pain. Pain Manage. Nurs. 2004; 5: 3-18.

156. Vlaeyen, J.W., and Morley, S. Cognitive-behavioral treatments for chronic pain: What works for whom? Clin. J. Pain 2005; 21(1): 1-8.

157. Linton, S., Boersma, K.,Jansson, M., Svard, L., andBotvalde, M. The effects of cognitive-behavioral and physical therapy preventive interventions in pain-related sick leave: A randomized controlled trial. Clin. J. Pain 2005; 21: 109-19.

158. George, S., Fritz, J., Bialosky, J., and Donald, D. The effect of fear-avoidance-based physical therapy intervention for acute low back pain: Results of a randomized controlled trial. Spine 2003; 28: 255160.

159. Sullivan, M.J., and Stanish, W.D. Psychologically based occupational rehabilitation: the Pain-Disability Prevention Program. Clin. J. Pain 2003; 19(2): 97-104.

160. Schultz, I., and Gatchel, R. Research and practice directions in risk for disability prediction and early intervention. In: Schultz, I., and Gatchel, R. (eds.). Handbook of Complex Occupational Disability Claims: Early Risk Identification, Intervention and Prevention. Springer: New York, 2005.

161. Sullivan, M.J.L. Emerging trends in secondary prevention of pain-related disability. Clin. J. Pain 2003; 19: 77-9.

162. Sullivan, M.J.L., Adams, H., Rhodenizer, T., and Stanish, W. A psychosocial risk factor targeted intervention for the prevention of chronic pain and disability following whiplash injury. Phys. Ther. 2006; 86: 8-18.

163. Linton, S.J. Nw Avenues for the Prevention of Chronic Musculoskeletal Pain and Disability. Elsevier: Amsterdam, 2002.

164. Vlaeyen, J.W., de Jong, J., Geilen, M., Heuts, P.H., and van Breukelen, G. The treatment of fear of movement/(re)injury in chronic low back pain: Further evidence on the effectiveness of exposure in vivo. Clin. J. Pain 2002; 18(4): 251-61.

165. Robb, K.A., Williams, J.E., Duvivier, V., and Newham, D.J. A pain management program for chronic cancer-treatment-related pain: A preliminary study. J. Pain 2006; 7: 82-90.

166. Taylor, S.E., Helgeson, V.S., Reed, G.M., and Skokan, L.A. Self-generated feelings of control and adjustment to physical illness. J. Soc. Issues 1997; 47: 91-109.

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Present Power

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