The Relationship Between Fear Avoidance Belief and Threat Learning in Postoperative Patients After Lung Surgery: An Observational Study

Lihong Bao,1,&ast; Chunfen Peng,2,&ast; Jingting He,2 Chengqin Sun,1 Lijuan Feng,1 Yang Luo1 1Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yang Luo; Jingting He, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China, Email yangluo@hust.edu.cn; hejingting@hust.edu.cnBackground: The role of fear-avoidance beliefs (FAB) in patients with chronic pain has been widely confirmed. However, few conclusions have been drawn about its role in postoperative patients.Objective: To explore the characteristics of FAB in postoperative patients after lung surgery as well as the effect of threat learning on FAB.Methods: Between May and September 2022, this study recruited 150 participants who had undergone thoracoscopic surgery. Variables such as age, gender, education, chronic pain, fear of pain, surgery method, pain intensity, FAB, cough, ambulation and threat learning were collected and subjected to correlation analysis and stepwise regression.Results: The correlation analysis revealed that FAB was associated with age (r = − 0.183, p < 0.05), gender (r = − 0.256, p < 0.01), and preoperative FOP-9 (r = 0.400, p < 0.01). Postoperative variables such as pain intensity (r = 0.574, p < 0.01), initiation day of ambulation (r = 0.648, p < 0.01), total numbers of ambulation (r = − 0.665, p < 0.01), and cough performance (r = − 0.688, p < 0.01) were correlated with FAB. Furthermore, FAB was highly correlated with indicators of threat learning: direct (r = 0.556, p < 0.01), observation (r = 0.655, p < 0.01), and instruction (r = 0.671, p < 0.01). The highest variance explanation model of stepwise regression which explained 52.8% of the variance including instruction (B=1.751; p< 0.01), direct (B=1.245; p< 0.01), observation (B=0.768; p< 0.01), age (B=− 0.085; p< 0.01), and surgery method (B=1.321; p< 0.05).Conclusion: Patients commonly experience FAB after lung surgery, which can directly affect their recovery behaviors such as ambulation and active coughing. The formation of FAB is influenced by threat learning, which suggests that controlling threat learning is important in preventing postoperative FAB.Keywords: fear-avoidance, threat learning, fear of pain, postoperative pain, lung surgery