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Cited by 4Cancer survivorship and carePediatric Pain Management TechniquesMusculoskeletal pain and rehabilitation

Improving well-being for individuals with persistent pain after surgery for breast cancer, lobular carcinoma in situ, or ductal carcinoma in situ: A randomized clinical trial

Open access
Stalls, Juliann M., Bovbjerg, Dana H., Somers, Tamara J., Plumb Vilardaga, Jennifer C., Kimmick, Gretchen G., McAuliffe, Priscilla F., Keefe, Francis J., Posluszny, Donna M. +7 more·2022·Contemporary Clinical Trials
DOI 10.1016/j.cct.2022.106934PMC PMC10001426
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Abstract

>276,000 Americans will be diagnosed with invasive breast cancer, lobular carcinoma in situ, or ductal carcinoma in situ this year and most will undergo breast surgery as part of their care. Although prognosis is excellent, many patients experience persistent post-surgical pain (PSP), which has no satisfactory pharmacological treatment. The causal contributions of pain-associated psychological factors (e.g., catastrophic thoughts about pain, psychological flexibility, self-efficacy) to the continuing burden of PSP have not yet been determined and may be opportune intervention targets. The randomized trial described here will compare the benefits of three manualized behavioral interventions for individuals with PSP. Participants will receive either: 1) self-guided health education (SGHE); 2) interventionist-guided health education (IGHE); or 3) interventionist-guided pain coping skills training with elements of acceptance and commitment therapy that specially target catastrophic thoughts about pain, self-efficacy, and psychological flexibility (CST-PSP). Participants will prospectively complete validated assessments of primary outcomes (PSP severity and interference) at baseline (pre-intervention) and 3-, 6-, and 12-months later. Validated measures of emotional distress and cancer-specific distress will be assessed as secondary outcomes. To test their roles as drivers of PSP, catastrophic thoughts about pain, self-efficacy, and psychological flexibility, will be assessed and statistically analyzed as mediators of hypothesized beneficial effects. The interventions' impacts on pain sensitivity and central sensitization will be investigated to test these physiological pathways as proximal drivers of PSP. To better characterize the patient experience, additional validated measures will be explored for associations with PSP, along with demographic and clinical factors. Trial registration: https://clinicaltrials.gov/ct2/show/NCT04225585, registered January 13, 2020 © 2022 Elsevier Inc.

Integrity signals

Registry

Crossref · 10.1016/j.cct.2022.106934

Cites

72 of 72 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

27 of 55 cited sources checked · 8 supported · 0 flagged · accuracy not yet measured

  • Interpretationcitation

    Behavioral interventions based on the biopsychosocial theory of pain and targeting psychosocial factors may be especially suitable for reducing persistent post-surgical pain in breast cancer survivors.

    “Behavioral intervention strategies that are grounded in the biopsychosocial theory of pain7, and target psychosocial factors thought to contribute to persistent pain in interaction with underlying central neurobiological processing and peripheral afferent inputs6, 8–11, may be especially well suited to ameliorate PSP among breast cancer suvivors6, 8.”
    Quote in the paperSubstantial claim3 of 6 sources checked
    • cites [7] source
    • cites [6] source
    • cites [8] source

      The Introduction supports targeting psychosocial factors within a biopsychosocial approach to persistent pain. The Social/Interpersonal Factors section reports an association between social support and less postoperative pain after breast-cancer surgery, but it does not establish that behavioral interventions are especially suited to reducing persistent postsurgical pain in breast cancer survivors. Page numbers were not available in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [9] source

      In “The human brain in chronic pain – a general model” (page unavailable), the paper describes chronic pain as involving interplay between brain processes and injury-related sensory input. It does not assess behavioral interventions or establish that they are especially suitable for persistent post-surgical pain in breast cancer survivors. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [10] source
    • cites [11] source

      The section “Reconciling ‘peripheralists’ and ‘centralists’” (page not provided) describes interactions between peripheral inputs and central pain processing and suggests that cognitive interventions may be preferable for some chronic pain conditions. It does not address persistent postsurgical pain in breast cancer survivors or establish that behavioral interventions are especially suitable for that population. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Premisecitation

    Breast cancer survivors who catastrophize about pain have greater persistent post-surgical pain in cross-sectional and prospective studies.

    “BCSs who experience catastrophic thoughts about their pain have greater PSP in both cross-sectional and prospective studies13–15”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [13] source

      The Results report that survivors with persistent breast pain had higher pain catastrophizing than survivors without it, supporting the cross-sectional association. The Introduction says a meta-analysis of prospective studies found no significant downstream effect of psychological factors on persistent breast pain, and the Discussion identifies this paper’s own data as cross-sectional. The prospective-studies portion is therefore not supported. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [14] source
    • cites [15] source
  • Premisecitation

    Psychological flexibility and self-efficacy may contribute to differences in pain severity and the impact of persistent post-surgical pain.

    “Two additional psychosocial variables that may contribute to differences in the experience of pain severity and the impact of PSP are: 1) psychological flexibility18–20, a flexible behavior pattern broadly oriented toward ones chosen personal values, even in the presence of discomforts (such as pain), and 2) self-efficacy21–25, the belief in one’s ability to effectively manage pain.”
    Quote in the paperSubstantial claim4 of 8 sources checked
    • cites [18] source

      The Introduction links psychological flexibility processes to the severity and impact of chronic pain, and the Results (Mediation analyses) associate changes in those processes with pain intensity and interference. The study concerns adults receiving CBT for chronic pain, not specifically persistent post-surgical pain, so it does not establish that relationship for PSP. The self-efficacy clause has separate citations and is not attributed to this source. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [19] source
    • cites [20] source

      The Pain Interference section (page unavailable) reports that psychological flexibility explained differences in pain interference among people with chronic pain, and the Introduction describes values-oriented behavior despite pain. The study does not establish this relationship specifically for persistent post-surgical pain or show that psychological flexibility explains differences in pain severity. The sentence cites other sources for self-efficacy, so that part is not attributed to this paper. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [21] source
    • cites [22] source
    • cites [23] source
    • cites [24] source

      The citation is attached to the self-efficacy portion of the sentence, not psychological flexibility. The Results (Model Results; page unavailable) associate exercise self-efficacy with fatigue and depression in breast cancer survivors. The Measures section assesses confidence in exercising, not managing pain; the paper does not establish a relationship with persistent post-surgical pain severity or its impact. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [25] source

      The Self-efficacy and Full sample sections describe exercise-related self-efficacy and its association with well-being in breast cancer survivors. They do not establish that confidence in managing pain contributes to post-surgical pain severity or impact. This citation is attached to self-efficacy, not to the separate psychological-flexibility claim. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
  • Premisecitation

    Catastrophic thinking is associated with increased pain sensitivity and central sensitization.

    “and increased pain sensitivity and central sensitization4, 16”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [4] source

      The Discussion links pain catastrophizing to a possible pathway involving pain sensitivity, but does not establish a direct association. The Preoperative Risk Factors section discusses central sensitization as a theorized contributor to chronic pain after surgery, without linking it specifically to catastrophic thinking. Page numbers are unavailable in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [16] source
  • Study design and conductcitation

    The IGHE and SGHE arms were selected as active comparison groups to address possible non-specific intervention effects.

    “IGHE/SGHE were chosen as active comparison groups to address possible non-specific aspects of intervention effects based on our prior studies36–38.”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [36] source

      The Discussion (page unavailable) describes a comparison of two active treatment conditions and considers whether improvements reflected non-specific effects such as time and attention. But this paper studied coping-skills training versus education/support; it does not identify IGHE or SGHE or say those arms were selected for that purpose. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [37] source

      The Methods > Training Conditions passage says the arthritis-education control was used to account for non-specific factors, including therapist attention, time, and expectations for improvement. The paper does not identify IGHE or SGHE arms or say that those specific groups were selected. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [38] source

      The Materials and Methods (Interventions; page not available) says general health education was chosen as a comparison condition to control for attention and time, supporting the rationale for addressing nonspecific effects. The paper describes one individual, phone-based general-health-education comparison group, not separate IGHE and SGHE arms. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 21
  • May combine two claims. 21

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Pain sensitivity and central sensitization have been found to be related to persistent post-surgical pain.

    “which have been found to be related to PSP16, 17”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [16] source
    • cites [17] source

  • May combine two claims.

    Premisecitation

    Catastrophic thinking is associated with higher emotional distress and more anxiety and depression symptoms.

    “catastrophic thinking is also associated with higher levels of emotional distress, symptoms of anxiety and depression13”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    People with persistent post-surgical pain report greater emotional distress, more interference with daily activities, and worse overall quality of life.

    “Individuals experiencing PSP also report heightened emotional distress, interference with daily activities, and poorer overall quality of life4.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] source

      The Psychosocial Impairments and Quality of Life section reports negative effects on mood, daily activities, and overall quality of life; its Quality of Life subsection describes impaired daily and customary functioning. These passages concern persistent post-mastectomy pain, so they do not establish the claim for persistent post-surgical pain across surgery types. Page numbers were not supplied. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Impact of Event Scale is a validated measure of cancer-related intrusive thoughts and avoidance over the past week with internal consistency of .88.

    “The Impact of Event Scale (IES)49 measures cancer-related intrusive thoughts and avoidance during the past week using 15 items (Cronbach’s α = .88)50.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [49] source
    • cites [50] source

  • May combine two claims.

    Study design and conductcitation

    The PEG is a validated three-item measure of pain intensity and interference with internal consistency between .73 and .89.

    “The validated 3-item PEG score, is the average of pain intensity (P), interference with enjoyment in life (E), and interference with general activity (G) over the past week (Cronbach’s α = .73-.89).42–45”
    Quote in the paperNot a substantial claim4 of 4 sources checked
    • cites [42] source
    • cites [43] source

      The Methods > Measures section describes the PEG as a validated three-item measure with one average-pain item and two interference items, scored as their mean. Our copy does not give a Cronbach’s α range of .73–.89 or specify the past-week recall period; searches for those details did not find them. No page number is available in the indexed passages. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [44] source

      The Methods (Outcome Assessment) confirm that PEG averages three past-week items: pain intensity, interference with enjoyment of life, and interference with general activity. The Results (Internal Reliability and Interscale Correlations) report Cronbach’s α of .69 for PEG, not .73–.89; those values are reported for other scales. (LLM, conf=0.91)

      Experimental — accuracy not yet measured
    • cites [45] source

      The Heat Map (p. 4) identifies PEG as Pain intensity, Enjoyment of life, and General activity and reports validity data for it; the References (p. 9) identify it as a validated three-item measure of pain intensity and interference. Our copy does not report the claimed Cronbach’s α range of .73–.89 or specify that the score averages responses over the past week. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Pain coping skills training strategies improve coping skills, reduce the impact of catastrophic thoughts about pain, and increase self-efficacy.

    “PCST-based strategies improve skills for coping with painful situations, reduce the impact of experiencing catastrophic thoughts about pain, and increase self-efficacy28–30.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [28] source

      The Introduction says pain coping skills training teaches skills for managing pain and targets self-efficacy. But the Results and Discussion report self-efficacy gains in both the intervention and control groups, with no significant between-group effect; the paper does not report a reduction in the impact of catastrophic thoughts about pain. Section labels are available in our copy, but page numbers are not. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [29] source
    • cites [30] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Adherence to intervention protocols is rated for 20% of randomly selected sessions, with a session-level adherence criterion of at least 90%.

    “Ratings of adherence to the intervention protocols are made for 20% of randomly selected sessions. Criteria for protocol adherence is defined for each session as a score of ≥90% on an adherence rating scale39–41.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [39] source
    • cites [40] source
    • cites [41] source

      The Methods > Measures > Interventionist Adherence passage (page not provided) says 20% of mCoaching calls are randomly selected for fidelity checks and adherence ratings. It does not specify a ≥90% session-level criterion; it also says mCBT ratings initially cover 50% of sessions, falling to 20% after the first year. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    If baseline imbalance is suspected, propensity scores and marginal structural modeling will be used to adjust for potential confounding.

    “If baseline imbalance in treatment groups is suspected, propensity scores62 and marginal structural modeling (MSM)63 will be used to adjust for potential confounding variables.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [62] source
    • cites [63] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The PHQ-8 is a validated measure of depressive symptoms over the past two weeks with internal consistency between .86 and .89.

    “The Patient Health Questionnaire Screener (PHQ-8) measures depressive symptoms over the past two weeks using 8 items from the 9-item version of the scale (Cronbach’s α = .86-.89)47.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [47] source

      The Appendix shows that the PHQ-9 asks about symptoms over the last two weeks, and the Results report Cronbach’s α values of 0.86 and 0.89 for the PHQ-9. The cited paper does not establish the validity or internal consistency of the eight-item PHQ-8; the reported values apply to the nine-item scale. Page numbers are not available in our copy. (LLM, conf=0.89)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Acceptance and Action Questionnaire is a validated measure of psychological flexibility with internal consistency between .78 and .88.

    “The Acceptance and Action Questionnaire (AAQ-II) measures psychological flexibility using 7 items (Cronbach’s α = .78-.88)53.”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    Adverse side effects and dependence risk limit long-term use of pharmacologic treatments for persistent post-surgical pain.

    “Adverse side effects (e.g., sedative effects) and risk for dependence also limit their long-term use6.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] source

  • May combine two claims.

    Premisecitation

    Pharmacologic treatments help manage acute pain after surgery but are much less effective for persistent post-surgical pain.

    “Pharmacologic interventions aid in the management of acute pain during the initial recovery period following surgery but are much less effective for PSP5.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Interventionists follow a standardized interventionist manual.

    “Interventionists also follow a standardized interventionist manual.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The GAD-7 is a validated measure of anxiety symptoms over the past two weeks with internal consistency of .92.

    “The Generalized Anxiety Disorder Screener (GAD-7) measures symptoms of anxiety over the past two weeks using 7 items (Cronbach’s α = .92)48.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All use and disclosure of protected health information comply with HIPAA guidelines.

    “All use and disclosure of PHI comply with HIPAA guidelines.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Randomization is stratified by study site and surgical procedure type and is performed by a centralized program in the subject tracking database.

    “Randomization is stratified by the two geographically disparate study sites and type of surgical procedure (mastectomy with reconstruction, mastectomy without reconstruction, breast conserving surgery) and is completed by a centralized program within the subject tracking database.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study will likely be underpowered to examine effects of demographic characteristics such as age, race/ethnicity, and gender identity on outcomes.

    “Finally, this study will likely be underpowered to examine the potential effects of demographic characteristics such as age, race/ethnicity, and gender identity on outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    For mediation aims, power analyses indicate the study can detect small path coefficients and a small indirect effect.

    “For Aim 2 and Aim 3, power for testing mediation was examined in two ways. First, using a bootstrap method, and interpolating from the standardized parameter estimates of Fritz and MacKinnon61, we can detect an effect size ranging from 0.14 (small) to 0.26 (reasonably small) for the group to mediator path, and the mediator to pain outcomes path, giving rise to a relatively small indirect effect”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Pain Catastrophizing Scale is a validated measure of catastrophic thinking during painful experiences with internal consistency of .87.

    “The Pain Catastrophizing Scale (PCS) measures the degree to which women experience catastrophic thinking during painful experiences using 13 items (Cronbach’s α = .87)51.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    The measures used in the study have been shown to be valid and reliable and have been widely used in prior research.

    “Each measure has been shown to be valid and reliable and has been widely utilized in previous research.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The study includes validated and reliable self-report assessments, objective quantitative sensory testing assessments, and objective measures of dysfunction.

    “Another strength of this study is the inclusion of validated and reliable self-report assessments, objective QST assessments, and objective measures of dysfunction.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The CST-PSP intervention was developed and tested in a preliminary study.

    “CST-PSP was developed and tested in a preliminary study33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Chronic Pain Self-Efficacy Scale Function Scale is a validated measure of perceived self-efficacy for activities with internal consistency of .87.

    “The Chronic Pain Self-Efficacy Scale (CPSS): Function Scale (FSE) measures perceived self-efficacy for engaging in activities (e.g., household, social, and recreational) using 9 items (Cronbach’s α = .87)52.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A family-wise multiple-comparison adjustment will divide the overall alpha for each hypothesis by the number of comparisons.

    “A simple family-wise strategy for adjusting (to prevent inflated significant results, to reduce false positives) for multiple comparisons will be adopted where overall alpha for each hypothesis will be divided by the number of comparisons.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Interventionists receive interactive training with study clinical supervisors and are trained to competency before delivering the protocols.

    “interventionists participate in interactive trainings with study clinical supervisors and are trained to competency prior to protocol delivery.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study received approval from the institutional review boards at Duke University and the University of Pittsburgh.

    “This study was approved by Institutional Review Boards (IRB) at Duke and Pittsburgh.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All analyses will follow intention-to-treat principles.

    “All analyses will be based on intention to treat (ITT) principles.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Missing data will be handled with linear mixed models under a missing-at-random assumption.

    “Data missing at random (MAR) will be accommodated by use of linear mixed models for analysis under the assumption of MAR.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The missing outcome data are missing at random.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study plans a final sample of 450 participants and assumes 20% overall attrition from an initial sample of 564.

    “Recruitment of a final sample of 450 individuals is planned, with a conservative estimated overall attrition rate of 20% for an initial sample of 564 individuals.”
    Quote in the paperNot a substantial claim
29 of 29

  • The paper relies on this without support.

    Randomized intervention studies that demonstrate causal relationships between catastrophic thoughts about pain and persistent post-surgical pain are currently lacking.

    “but randomized interventional studies to demonstrate causal relationships are currently lacking.”

  • The authors state this as an assumption.

    The missing outcome data are missing at random.

    “Data missing at random (MAR) will be accommodated by use of linear mixed models for analysis under the assumption of MAR.”

  • The authors state this as an assumption.

    Continuous or interval outcome variables are approximately normally distributed or have been transformed to normality.

    “It is assumed that continuous or interval scale outcome variables will be approximately normally distributed, or already transformed to normality using a suitable transformation.”

  • The paper relies on this without support.

    No well-established approach currently provides satisfactory clinical management of persistent post-surgical pain.

    “There is currently no well-established approach for satisfactory clinical management of PSP.”

  • The paper relies on this without support.

    The causal contributions of pain-associated psychological factors to the continuing burden of persistent post-surgical pain have not yet been determined.

    “The causal contributions of pain-associated psychological factors (e.g., catastrophic thoughts about pain, psychological flexibility, self-efficacy) to the continuing burden of PSP have not yet been determined”
5 of 5

Cites

Flagged first, then by citations

6 of the 78 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Arthur, 2020, Feasibility trial of targeted pain coping skills training for persistent pain after breast cancer surgery [published abstract], Ann. Behav. Med., 54

Cited by

Sorted by citations

Related

Authors
Stalls, J. M., Bovbjerg, D. H., Somers, T. J., Plumb Vilardaga, J. C., Kimmick, G. G., McAuliffe, P. F., Keefe, F. J., Posluszny, D. M., Sullivan, M. J. L., Erkanli, A., Reed, S. D., Sutton, L., Owen, L., Massa, L., & Shelby, R. A.
Affiliations
  • Duke University (US)
  • University of Pittsburgh (US)
  • Duke Medical Center (US)
  • McGill University (CA)
Corresponding author
Stalls, Juliann M.
ORCID
Venue
Contemporary Clinical Trials
Publisher
Elsevier BV
Published
2022-11
Volume
122
Pages
106934
ISSN
1551-7144 (ISSN-L)
DOI
10.1016/j.cct.2022.106934
PMC
PMC10001426
OpenAlex
W4296545265
Cited by
4
References
78
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 1
FWCI
0.31
Type
journal article
Language
en
Open access
Licence
Locations
  • Contemporary Clinical Trials (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (1R01CA249959-01)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
persistent post-surgical pain, breast cancer, lobular carcinoma in situ, ductal carcinoma in situ, breast surgery, psychological flexibility, self-efficacy, acceptance and commitment therapy, pain coping skills training, health education, emotional distress, cancer-specific distress, central sensitization, pain sensitivity, well-being
MeSH terms
Breast Carcinoma In Situ, Adaptation, Psychological, Breast Neoplasms, Carcinoma, Intraductal, Noninfiltrating, Female, Humans, Pain, Acceptance and Commitment Therapy

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Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

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