Abstract
BACKGROUND: Pain Catastrophizing (PC) is a prevalent maladaptive cognitive - affective response after lung cancer surgery, linked to poor outcomes. The mechanisms between sub - acute pain and PC development within 3 months are unclear. Conventional pain management often neglects psychological and social factors related to PC and recovery. According to the biopsychosocial model, multiple factors are associated with PC, but their mediating pathways are not fully understood.Therefore, grounded in the stress and coping theory and the pain threat appraisal theory, first examines the multiple-parallel mediating roles of introspection, negative attentional bias, and social support between pain intensity and PC in early-stage lung cancer patients post - surgery. METHODS: A cross-sectional study recruited 414 early-stage lung cancer patients within 3 months post-surgery from ambulatory care follow-up and day ward treatment at a tertiary hospital from May to August 2025. Questionnaires were used for investigation, and parallel mediation was tested by structural equation modeling. RESULTS: The average PCS score was 30.49 ± 6.27. PC was positively correlated with pain intensity, interoceptive awareness, and negative attentional bias, and negatively correlated with social support. Interoceptive awareness, negative attentional bias, and social support together accounted for 59.81% of the total effect, with social support having the most prominent effect (31.05%)-substantially larger than interoceptive awareness (5.51%) and negative attentional bias (5.91%). CONCLUSION: Post-operative PC levels in early-stage lung cancer patients are moderate to high. Pain intensity is directly and indirectly related to PC. Healthcare professionals are advised to develop a multidimensional, phased, and integrated intervention framework including pain management, cognitive behavioral therapy, and mindfulness training. This approach can effectively reduce PC and support precise prevention and intervention.