Application of a cancer pain belief modification program for patients with oral cancer in China: a mixed methods...

To explore the feasibility and mechanism of CPBMP among patients with oral cancer in China.

We conducted a mixed methods study that included a single-center, randomized controlled trial to determine the effect of CPBMP on pain in patients with oral cancer and a semistructured interview to explore the mechanism of action of CPBMP and factors influencing its implementation. A total of 76 individuals participated in the RCT. Patients were randomized to receive a standard recovery protocol (control group) or the CPBMP (intervention group). The outcomes included pain, pain catastrophizing, fear of pain, self-efficacy, and quality of life. Saliva samples of cortisol were collected from 12 randomly selected participants in each group. From the intervention arm, 10 participants were randomly selected for interviews in this study. The semistructured questions were analyzed using content analysis.

There was a significant difference in pain intensity, fear of pain, pain catastrophizing, pain self-efficacy, and quality of life (all p < 0.001) between the intervention and control groups. There was a significant difference over time in pain intensity, fear of pain, pain catastrophizing, pain self-efficacy, and quality of life (all p < 0.05). The interaction effects were significant for pain intensity, fear of pain, pain catastrophizing, pain self-efficacy, and quality of life (all p < 0.001). There was a significant difference in the morning (p = 0.028) and at 17:00 (p = 0.036) salivary cortisol level between the experimental group and the control group within 24 h before the beginning of radiotherapy. There was no significant difference in salivary cortisol slopes between the intervention and control groups (p > 0.05). The interview results included two parts: "psychological mechanism of CPBMP" and "implementation of CPBMP, situational factors, and feedback." The former extracted four themes: "effects of emotion regulation on pain," "changes in pain cognition," "impact of self-efficacy on pain," and "improvement of pain coping skills," and five subthemes. The latter extracted three themes: "implementation of CPBMP (acceptability)," "situational factors," and "feedback and improvement," and eight subthemes.

The CPBMP showed a positive effect on promoting patients' pain intensity, fear of pain, pain catastrophizing, pain self-efficacy, and quality of life, which effect is affected by individual characteristics. And CPBMP improves pain-related outcomes through psychological adjustment and regulation of HPA axis activity.