What Does CATS Have to Do With Cancer? The Cognitive Activation Theory of Stress (CATS) Forms the SURGE Model.., 2021, Monk et al

Full title: What Does CATS Have to Do With Cancer? The Cognitive Activation Theory of Stress (CATS) Forms the SURGE Model of Chronic Post-surgical Pain in Women With Breast Cancer

Chronic post-surgical pain (CPSP) represents a highly prevalent and significant clinical problem. Both major and minor surgeries entail risks of developing CPSP, and cancer-related surgery is no exception. As an example, more than 40% of women undergoing breast cancer surgery struggle with CPSP years after surgery.

While we do not fully understand the pathophysiology of CPSP, we know it is multifaceted with biological, social, and psychological factors contributing. The aim of this review is to advocate for the role of response outcome expectancies in the development of CPSP following breast cancer surgery.

We propose the Cognitive Activation Theory of Stress (CATS) as an applicable theoretical framework detailing the potential role of cortisol regulation, inflammation, and inflammatory-induced sickness behavior in CPSP. Drawing on learning theory and activation theory, CATS offers psychobiological explanations for the relationship between stress and health, where acquired expectancies are crucial in determining the stress response and health outcomes.

Based on existing knowledge about risk factors for CPSP, and in line with the CATS position, we propose the SURGEry outcome expectancy (SURGE) model of CPSP. According to SURGE, expectancies impact stress physiology, inflammation, and fear-based learning influencing the development and persistence of CPSP. SURGE further proposes that generalized response outcome expectancies drive adaptive or maladaptive stress responses in the time around surgery, where coping dampens the stress response, while helplessness and hopelessness sustains it. A sustained stress response may contribute to central sensitization, alterations in functional brain networks and excessive fear-based learning. This sets the stage for a prolonged state of inflammatory-induced sickness behavior – potentially driving and maintaining CPSP.

Finally, as psychological factors are modifiable, robust and potent predictors of CPSP, we suggest hypnosis as an effective intervention strategy targeting response outcome expectancies. We here argue that presurgical clinical hypnosis has the potential of preventing CPSP in women with breast cancer.
Paragraph breaks added for easier reading.

Open access, https://www.frontiersin.org/articles/10.3389/fpsyg.2021.630422/full

 

I remember when I had this major knee surgery at the age of around 20, that a few days afterwards I told one of the nurses that my knee hurt in certain positions (I used crutches to walk, so no real pressure was applied). And she told me it must be psychological. And that was just a few days after surgery, it wasn't even chronic. Now I understand I probably should've subjected myself to presurgical clinical hypnosis first. I learn a lot in this forum.

 

Oh wow even skimming most of the text, which is bad enough, I did not expect the ending. Wow. Just wow.

Seriously Marie Antoinette, or at least the popular account of the story, was far less oblivious to reality than this. Decades of complete lack of accountability has built a system that has turned full narcissist, with one certainty: we can't be wrong therefore you have to be and it must be psychological because it can't be falsified and claims require no evidence.

 

Have humans evolved out of getting adhesions and scarring now?

 

Why couldn't they have used men getting prostate cancer surgery as an example rather than women getting surgery for breast cancer?

 

How dare they demean cats by making such an acronym.

 

I spent a fair bit of time with cancer survivors practising yoga. On of the first things you notice with those who have had breast cancer surgery is the movement on that side is often limited. The range can be limited by quite a lot.

Hitting a range of movement limit repeatedly during the day, getting dressed, showering or if you use you arms and shoulders for your job is likely to cause pain.

Can't really see what's psychological about that.

 

No – or the radiology burns. Or having most of your chest muscle removed or rendered non-functional. Or having to lug around ridiculously heavy implants. Or the crumbling joints after all the steroids. Or the lymphoedema.

Makes you wonder why some halfwit thinks they need to come up with a theoretical framework, really, when the bleeding obvious does the job so admirably.

 

Exactly. The women I saw were finished treatment but before the long term effects were felt.

I was frankly shocked how limited the range of movement was. Some of them with otherwise decent muscle tone.

The school of yoga I learned from was oriented towards people with disabilities - the yoga adapts to suit the person rather than the other way around. Even some of the simple warm up exercises on the floor needed to be adapted.

Getting them to understand that it is better to use an adapted pose to make full use of the range of motion you have rather than struggle & cause pain and tension by insisting on trying to force your body to do something that's not right for it (& so you end up achieving less) was quite the challenge.

The last thing they'd need is to be ignoring and trying to push through. Like with the yoga pose that will only hold them back and prevent exploring other far less painful & potentially a lot more successful tactics.

The rigidity of mindset is, as usual, in the heads of the so called psych experts.

 

Maybe they don't believe it anymore, but I remember the analogy being that if a nerve is cut it often grows back where instead of being like the arm, a single strong thread, you get nervelets like the fingers which are fragile but each strand carries a full pain signal so pain is increased.

More recently, I read a description which was quite scientifically written but seemed to say that if a nerve is damaged the cells produce a chemical signal to heal the joint. They were talking about eyes and said that before the damage nerve signals are strong from the eye to the brain, not so much the other way but the growth factor spreads both ways from the break so signals travel in both directions equally which can cause pain and other problems.

In any surgery a chunk of tissue is removed so what is left needs to fill the space. That must put all sorts of strain on the rest of the body. It takes over a year for all the tissues to knit back together as well. There is no need to invoke psychology to explain things.

Hyperbaric oxygen is almost miraculous at healing tissues and makes much more sense than hypnosis if the welfare of the patient is the goal.

 

It sees to me that the goal is "stop bothering us you pesky patients. We cut the cancer out of you now stop bothering us with your 'post op issues', you're like mosquitoes you're so annoying, we want to get on with things that we enjoy, like cutting, and being thought of as gods. Your pesky pain is just in the way".

 

What Do Ducks Have to Do With Cancer? The QUACK model...

(you always know research is of poor quality when cortisol is the central pillar of the hypothesis)

Why even bother doing empirical science, when you can just publish hypothetical models like this?

 

Target the women first, because they are more gullible to alternative therapies and more accepting of the BPS BS.

Let’s try the same scenario with male physicians who have long-covid and see how that goes.

 

That would need to be tested in research. I believe that women fall for it more then men and in fact it has been my experience (professional and as patient)

 

N=1 experience. Part of the reason why I find online dating hard is that it is full of men who are into alternative medicine, psychobabble (or conspiracy theories or esotericism or horoscopes or...). These are absolute dealbreakers for me because I'm just so much the opposite. Yet when I share this experience, a lot of men seem to be genuinely surprised, thinking it is something that is more characteristic of women and they listen to me in disbelief. My experience shows that it is more of a people thing than a gender thing and I'm not sure why they have such a different experience.

 

Well, that’s interesting. Thank you for sharing. It is getting me curious. I assure you i have plenty of experience! I accept that you have yours!

 

In my experience, women and men can be equally adept at spotting bullshit when they see it. Same with conspiracy theories. A lot depends on age and experience.

Much of this crap is targeted at women, for sure, because the institutional sexism in medicine means their health needs have never been taken as seriously as men's; ingrained racism makes this even worse for women of colour. This history, along with a frequent tendency to share experience with and learn from other women, means they're often particularly robust about offering a middle finger when they're being gaslit.

There's no need to increase the burden of sexism by making assumptions. As @Wyva says, it's better to regard people as individuals.

 

When people talk about a relationship between alternative medicine and women I always think that women are more likely to be interested out of desperation. After all, if you get no medical help, are frequently insulted, and are always gaslit by members of any profession involving health, and yet nobody actually helps you or believes your symptoms, and claims all your symptoms are in your head then if you are in enough pain and life is shitty enough you might become desperate enough to try anything.