Association between pain intensity and perceived cognitive impairment in non-central nervous system cancer survivors: a cross-sectional study

While pain is known to pose a significant risk for cognitive outcomes in non-central nervous system cancer survivors, the impact of pain intensity remains unclear. This study aims to explore the association between pain intensity and perceived cognitive impairment and to examine the moderating role of sleep quality between them among non-central nervous system cancer survivors. Data collection was conducted in 14 wards across grade-A tertiary hospitals in China between 2024 and 2025.

The data of demographics, disease-related, and treatment-related factors, pain intensity, perceived cognitive impairment were included in the analyses. Pain intensity included least, worst and average pain, as measured by the Brief Pain Inventory-Short Form. Least, worst and average pain are defined as the lowest, highest and average levels of pain intensity experienced in the past 24 h, respectively.

Perceived cognitive impairment was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire cognitive functioning subscale. Data were analyzed using generalized linear mixed-effects models to account for ward-level clustering while testing the main effects of pain intensity and Johnson-Neyman method to test the moderating role of sleep quality on cognitive outcomes. A total of 692 non-central nervous system cancer survivors were included (mean age: 58.09 ± 11.45 years; 78.90% male; 57.08% primary education or below, 61.42% digestive system cancer participants.

According to the results of the fixed-slope model, after controlling for demographic, disease-related, and treatment-related factors, the least, worst, and average pain were positively associated with attention complaints (β = 0.288–0.395, all P