Impact of Psychological Resilience on the Fear of Pain and Activity Recovery in Postsurgical Patients: Observational Cohort Study.

Abstract

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.