Severity-Based Latent Profiles of Pain Catastrophizing and Their Cross-Sectional Associations with Fear of Pain, Sleep Quality, and Psychological Resilience in Patients Following Cardiac Surgery.

OBJECTIVE

This cross-sectional study aimed to identify latent profiles of pain catastrophizing among patients following cardiac surgery and to examine their concurrent associations with fear of pain, sleep quality, and psychological resilience. We further tested whether sleep quality and psychological resilience showed statistical indirect associations between pain catastrophizing profiles and fear of pain in a pre-specified cross-sectional model.

METHODS

This cross-sectional study included 468 patients who were assessed on postoperative days 3-5 after cardiac surgery at three tertiary Grade-A general hospitals in Zhejiang and Guangdong Provinces, China, between July 2024 and August 2025. Core variables were assessed using the Chinese Pain Catastrophizing Scale, the Simplified Chinese Fear of Pain Questionnaire-9, the Sleep Quality Questionnaire, and the Connor-Davidson Resilience Scale, respectively.

RESULTS

Latent profile analysis supported a three-profile solution with good classification accuracy (Entropy = 0.875), including low, moderate, and high severity pain catastrophizing profiles, accounting for 22.44%, 56.20%, and 21.36% of participants. The three profiles differed significantly in sleep quality (F = 24.624, P < 0.001), psychological resilience (F = 43.727, P < 0.001), and fear of pain (F = 798.921, P < 0.001). Relative to the low profile, both the moderate and high profiles positively predicted fear of pain (B = 0.962 and B = 1.944, respectively; both P < 0.001). In the cross-sectional indirect-effect model, sleep quality showed small but statistically significant indirect associations for both contrasts (moderate vs low: indirect effect = 0.026, 95% CI [0.004, 0.054]; high vs low: 0.035, 95% CI [0.005, 0.076]). Psychological resilience showed a statistically significant suppression-type indirect association only for the high- versus low-severity contrast (indirect effect = -0.058, 95% CI [-0.102, -0.020]).

CONCLUSION

These findings underscore the clinical importance of early identification and severity-stratified management of pain catastrophizing in postoperative patients, with particular attention directed toward moderate- and high-severity subgroups.