• Astrid Lahousse, Sergei Ivakhnov, Jo Nijs PhD, David Beckwée PhD, Wilfried Cools PhD, César Fernández de Las Peñas PhD, Eva Roose, and Laurence Leysen PhD.
• Research Foundation-Flanders (FWO), Brussels, Belgium.
• Pain Med. 2022 Jul 1; 23 (7): 1299-1310.

ObjectiveMultidimensional aspects of pain have raised awareness about cognitive appraisals, such as perceived injustice (PI) and pain catastrophizing (PC). It has been demonstrated that they play an important role in patients' pain experience. However, the mediating effect of these appraisals has not been investigated in breast cancer survivors (BCS), nor have they been related to fatigue and sleep.MethodsCross-sectional data from 128 BCS were analysed by structural path analysis with the aim to examine the mediating effect of PI and PC in the relationship of pain on fatigue and sleep.ResultsThe indirect mediating effects of PI on fatigue (CSI*PI = 0.21; P < .01 and VAS*PI = 1.19; P < .01) and sleep (CSI*PI = 0.31; P < .01 and VAS*PI = 1.74; P < .01) were found significant for both pain measures (Central Sensitization Inventory [CSI] and Visual Analogue Scale [VAS]). PC, on the other hand, only mediated the relationship between pain measured by VAS and fatigue (VAS*PC = 0.80; P = .03). Positive associations were found, indicating that higher pain levels are positively correlated with PI and PC, which go hand in hand with higher levels of fatigue and sleep problems.ConclusionsPI is an important mediator in the relationship of pain on fatigue and sleep, while PC is a mediator on fatigue after cancer treatment. These findings highlight that both appraisals are understudied and open new perspectives regarding treatment strategies in BCS.© The Author(s) 2022. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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