Significant others' pain responses and pain intensity in head and neck cancer (HNC) patients: a path analysis of psychological mediators of pain.

BACKGROUND: Significant others' pain responses have been identified as influential factors in patients' pain experiences; however, the underlying mechanisms remain unclear, particularly in patients with HNC who frequently experience prominent pain. This study aimed to explore the relationship between significant others' pain responses and pain intensity, and to analyze the role of pain self-efficacy and pain acceptance as mediators in this context. METHODS: This cross-sectional study included 361 HNC patients. Participants were assessed using the Chinese version of the West Haven-Yale Multidimensional Pain Inventory (WHYMPI), the Pain Self-Efficacy Questionnaire (PSEQ), the 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8), and the Numerical Rating Scale (NRS). A chain mediation model was constructed and validated using structural equation modeling. RESULTS: The mean item scores for solicitous and distracting responses were 4.47 ± 1.08 and 2.83 ± 1.43, respectively, while the median item score for punishing response was 1.00 (0, 4.00). Pain intensity was weakly positively correlated with solicitous response (r = 0.117, P < 0.05). Punishing response indirectly exacerbated pain intensity via the chain mediation of pain self-efficacy and pain acceptance (P < 0.01). Distracting response indirectly decreased pain intensity via the chain mediation of pain self-efficacy and pain acceptance (P < 0.01). CONCLUSION: Nursing staff should encourage significant others to adopt distracting response when the patient experiences pain, while minimizing punishing and overly solicitous responses. Additionally, enhancing pain self-efficacy and pain acceptance can strengthen the pain-relieving effects of distracting response and mitigate the negative impact of punishing response in patients with HNC.