Unseen Wounds: The Association Between Past Trauma, Emotional Well-Being and Pain in Cancer Patients —2024–2025. a Multi-Site Cross-Sectional Study, Iraq Publisher



Alseleet DK ; Saber AF ; Ali SS ; Ali AN ; Abdullah KS ; Hussein SS ; Hussein HS ; Rasool AA ; Omar AA ; Sabah RS ; Tofiq MS ; Majeed AM ; Hussein S ; Qurbani K Show All Authors
Source: European Journal of Oncology Nursing Published:2026

Abstract

Background and aim Cancer patients frequently experience both physical pain and emotional distress, often intensified by exposure to past traumatic events. These psychological and physiological burdens can adversely affect treatment outcomes and quality of life. This study aimed to examine the relationship between past trauma, emotional well-being, and pain among cancer patients undergoing chemotherapy across Iraq. Method This cross-sectional study was conducted from September 1st, 2024, to February 13th, 2025, across four major hospitals in Iraq, using convenience sampling. Data were collected using three standardized instruments: the Trauma History Questionnaire (THQ), the Pain Assessment Numerical Rating Scale (NRS), and the Hospital Anxiety and Depression Scale (HADS), along with a sociodemographic form. Statistical analyses were performed using SPSS version 26.0 and PROCESS Macro version 4.2. Descriptive statistics, Pearson's correlation, multivariable and hierarchical regression, and mediation analysis with 5000 bootstrap samples were employed. Results A total of 409 patients participated in the study. The Findings revealed significant positive correlations between trauma exposure and pain (r = 0.26–0.31), anxiety (r = 0.33–0.41), and depression (r = 0.29–0.38) (p < .05). Regression models indicated that trauma and emotional well-being significantly predicted pain (Adjusted R2 = 0.39, p < .001). Mediation analysis demonstrated that anxiety and depression partially mediated the trauma–pain relationship, accounting for 38–46% of the total effect. Conclusions Past trauma was significantly associated with both emotional well-being and pain severity among cancer patients. Integrating trauma-informed psychological care into oncology settings may help reduce pain and enhance emotional resilience among patients. © 2026 Elsevier Ltd.