{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:56:48Z","timestamp":1781647008272,"version":"3.54.5"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":49,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Hubei Provincial Natural Science Foundation of China","award":["2021CFB588"],"award-info":[{"award-number":["2021CFB588"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Fear of pain (FOP) often leads to activity avoidance, hindering recovery after thoracic surgery. We proposed the concept of \u201cThreat Prioritization\u201d\u2014the cognitive weighing of activity-induced pain against inactivity-induced complications. This study investigated whether prioritizing complication risks over pain is associated with greater engagement in postoperative activities and a subsequent reduction in FOP. In this prospective cohort study, 121 patients undergoing thoracoscopic lung surgery were enrolled. FOP (Fear of Pain Questionnaire-9) and cough strength (Semi-Quantitative Cough Strength Score, SCSS) were assessed on postoperative days (POD) 1 and 3. Therapeutic ambulation episodes (POD1\u20133) were recorded. On POD3, patients were categorized as \u201cComplication-Focused\u201d or \u201cPain-Focused\u201d based on their self-reported primary concern during recovery. Multiple linear regression was used to identify predictors of FOP reduction. Complication-Focused patients (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200945) showed significantly stronger cough on POD3 (Median SCSS: 4.00 vs. 2.50,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and higher distribution of ambulation episodes (Median: 4.00 vs. 4.00,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.003) compared to Pain-Focused patients (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200976). Postoperative air leak rates were comparable between groups (20.0% vs. 19.7%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20091.000). Regression analysis (Adjusted R\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090.433) showed that greater FOP reduction was associated with higher ambulation counts (B = -1.25,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Conversely, activity-linked breakthrough pain was associated with attenuated fear reduction (B\u2009=\u20095.31,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Changes in physiological pain intensity were not significantly associated with FOP reduction (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.964). Age, sex, and surgical extent were included in the model a priori but were not significant predictors (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&gt;\u20090.05). A mindset prioritizing complication risks over pain is associated with increased engagement in essential recovery activities without increasing observed air leak rates. Postoperative FOP reduction appears to be driven by behavioral engagement rather than physiological pain relief alone. These findings suggest that perioperative interventions targeting threat prioritization may facilitate functional recovery.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-46036-5","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T13:34:06Z","timestamp":1775136846000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Threat prioritization and fear of pain dynamics are associated with engagement in postoperative activities after thoracoscopic lung surgery"],"prefix":"10.1038","volume":"16","author":[{"given":"Yang","family":"Luo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijuan","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihong","family":"Bao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"46036_CR1","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1016\/j.jopan.2021.02.003","volume":"37","author":"F Ustunel","year":"2022","unstructured":"Ustunel, F. & Erden, S. Evaluation of fear of pain among surgical patients in the preoperative period. J. Perianesthesia Nurs. Off J. Am. Soc. Perianesthesia Nurses. 37, 188\u2013193 (2022).","journal-title":"J. Perianesthesia Nurs. Off J. Am. Soc. Perianesthesia Nurses"},{"key":"46036_CR2","doi-asserted-by":"crossref","unstructured":"Luo, Y. et al. Fear of pain as a predictor for postoperative pain intensity among the patients undergoing thoracoscopic surgery. Pain Res. Manag. 2201501 (2022). (2022).","DOI":"10.1155\/2022\/2201501"},{"key":"46036_CR3","doi-asserted-by":"publisher","first-page":"4959","DOI":"10.1038\/s41598-025-87894-9","volume":"15","author":"S McIlroy","year":"2025","unstructured":"McIlroy, S., Bearne, L., Weinman, J. & Norton, S. Identifying modifiable factors that influence walking in patients undergoing surgery for neurogenic claudication: a prospective longitudinal study. Sci. Rep. 15, 4959 (2025).","journal-title":"Sci. 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All methods were carried out in accordance with relevant guidelines and regulations. Written informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"15799"}}