P-108 - (Poster #108) Exploring the Impact of Pain Intensity, Acceptance, and Catastrophizing on Psychological Distress in Cancer Patients

Pain and psychological distress are intimately linked in cancer care, especially among patients experiencing chronic pain. Pain intensity, acceptance, and catastrophizing are key psychosocial variables that influence how patients perceive and respond to pain, ultimately shaping emotional outcomes. Pain acceptance—defined as the willingness to experience pain without attempting to avoid or control it—is associated with lower psychological distress and better coping. In contrast, pain catastrophizing involves exaggerated, negative thought patterns that may heighten emotional suffering. While the relationships among these variables have been explored in Western populations, limited research has addressed their interplay in Arab contexts, including Egypt, where cultural and religious values may influence coping behaviors. In such settings, strong family networks and faith-based perspectives may moderate how pain is appraised and managed. Despite the known psychological toll of cancer-related chronic pain, the extent to which pain acceptance and catastrophizing contribute to distress in Egyptian patients remains unclear. Understanding these dynamics is critical to developing effective, culturally sensitive interventions.

Purpose/Objectives:

This study aimed to examine the associations between pain intensity, pain acceptance, and pain catastrophizing with psychological distress among cancer patients in Egypt suffering from chronic pain. Specifically, it sought to (1) measure the prevalence of psychological distress in this population, (2) assess the relationships among pain-related variables and psychological distress, and (3) identify significant predictors of psychological distress through multivariate regression analysis.

Methods: A cross-sectional study was conducted among 406 adult cancer patients with chronic pain (≥3 months duration) recruited from outpatient oncology clinics across Egypt. Eligible participants were Arabic-speaking, had a confirmed cancer diagnosis, and were cognitively capable of completing the study questionnaires. Standardized Arabic versions of the Numeric Rating Scale (NRS) for pain intensity, Chronic Pain Acceptance Questionnaire (CPAQ), Pain Catastrophizing Scale (PCS), and Kessler Psychological Distress Scale (K10) were administered. Surveys were completed in clinical settings with assistance from trained research staff to ensure privacy and comprehension. Descriptive statistics summarized demographic and clinical characteristics. Bivariate relationships between pain-related variables and psychological distress were assessed using simple linear regression. Multiple linear regression was used to identify independent predictors of psychological distress while adjusting for relevant sociodemographic and clinical variables. Ethical approvals were obtained from all participating institutions, and written informed consent was secured from each participant. Data were analyzed using IBM SPSS Statistics v29, with significance set at p < .05. Confidentiality and data integrity were maintained throughout the study

Results:

Of the 406 participants, 63.5% were male with a mean age of 47.8 years (SD = 12.3). A large majority (88.4%) experienced psychological distress: 37.4% mild, 31.3% moderate, and 19.7% severe. The average K10 score was 25.5 (SD = 5.8), reflecting moderate distress.
The mean pain intensity was 4.3 (SD = 2.1), with average scores of 62.5 (SD = 9.5) for pain acceptance and 28.4 (SD = 6.9) for pain catastrophizing. Simple linear regression showed significant relationships between psychological distress and all three pain-related variables: pain intensity (B = 0.498, p = .009) and catastrophizing (B = 0.035, p = .03) were positively associated, while pain acceptance was inversely related (B = -0.255, p < .001). Notably, pain acceptance accounted for the greatest variance in distress (42%), compared to pain intensity (34%) and catastrophizing (12%).

In the multiple regression model (R² = 0.505, p < .001), seven factors significantly predicted higher psychological distress: increased pain intensity (B = 0.498, p = .007), lower pain acceptance (B = -0.260, p < .001), comorbid chronic illness (B = 1.730, p = .010), current smoking (B = 1.129, p = .027), unemployment (B = -0.997, p = .033), advanced cancer stage (B = 1.783, p = .050), and having a gynecologic cancer diagnosis (B = 3.563, p < .001). Pain catastrophizing was not a significant predictor in the multivariable model (p = .468). These findings highlight pain acceptance and intensity as central influences on distress, while also emphasizing the role of broader clinical and sociodemographic factors.

This study underscores the critical role of pain acceptance and intensity in predicting psychological distress among Egyptian cancer patients with chronic pain. Pain acceptance emerged as the most robust protective factor, reinforcing its importance in therapeutic strategies aimed at improving psychological resilience. Although initially significant, pain catastrophizing did not remain a key predictor when accounting for other variables, suggesting that distress in this population may be more directly influenced by tangible pain experiences and cultural coping frameworks.

Clinical implications point to the value of integrating acceptance-based interventions—such as Acceptance and Commitment Therapy (ACT)—into oncology pain management. These approaches may enhance patients' psychological adjustment by fostering engagement in meaningful life activities despite ongoing pain. Moreover, factors such as smoking, unemployment, comorbid illness, advanced disease, and specific cancer types were also associated with higher distress, supporting the need for comprehensive, personalized psychosocial care. Future research should explore these associations longitudinally and test intervention models adapted to cultural norms and healthcare system realities in low- and middle-income countries. Embedding biopsychosocial models into routine cancer care has the potential to reduce suffering, improve treatment adherence, and enhance overall quality of life for patients facing the dual burden of cancer and chronic pain.