ArticlePain research & management2025
Establishing Pain Thresholds for Functional Recovery After Lung Cancer Surgery: A Mediation Analysis of the Surgery-Pain-Functioning Causal Pathway.
Article in Pain research & management, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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Abstract
Objective: Pain is one of the most common and long-lasting symptoms after lung cancer surgery, potentially impairing physical functioning. This study aims to investigate to what extent pain mediates the association between the different surgical approaches (single-port VATS versus multiport VATS or thoracotomy) and postoperative functional recovery after lung cancer surgery, with the goal of establishing clinically actionable pain score thresholds. Methods: In a prospective cohort study including 1381 patients, pain and functional status (activity limitation and walking difficulty) were assessed daily in hospital with the Perioperative Symptom Assessment for Lung Surgery (PSA-Lung). The structural equation model (SEM) was used to investigate the mediation effect of pain in the surgery-pain-functioning pathway. The pain thresholds on postoperative day (POD) 1, 2, and 3 for optimal functional recovery were identified, corresponding to the cutoff points of pain categorization that demonstrated the largest indirect effects in the models. Results: The surgical approach had a significant indirect effect on activity limitation and walking difficulty through pain severity ( Conclusion: Our study quantified the partial mediating effects of pain between surgical approaches and postoperative functional status in patients with lung cancer surgery. The mediation effect-based pain thresholds support precise strategies for postoperative functional rehabilitation, which is considered the major goal of enhanced recovery after surgery.
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