Pain catastrophizing, pain acceptance, and pain intensity among patients with cancer in Oman and Lebanon: a comparative cross-sectional study

Despite advances in pharmacological management, cancer-related pain remains highly prevalent. Psychological processes such as pain catastrophizing and pain acceptance may shape pain perception, yet their independent and cross-national contributions remain underexamined. This study examined psychological, clinical, and contextual predictors of pain intensity among patients with cancer in Oman and Lebanon and explored the statistical mediating role of pain catastrophizing in the association between country and pain intensity. A comparative cross-sectional study of 200 adult oncology patients (100 per country). Participants completed the Numeric Rating Scale (NRS), the Chronic Pain Acceptance Questionnaire (CPAQ), and the Pain Catastrophizing Scale (PCS). Descriptive statistics, Pearson correlations, multiple linear regression, and mediation analysis using PROCESS were performed. Lebanese participants reported significantly higher pain intensity and catastrophizing scores, whereas Omani participants reported higher pain acceptance. Pain intensity was positively correlated with catastrophizing ( r = 0.53, p < 0.001) and negatively correlated with acceptance ( r = −0.35, p < 0.001). In multivariable regression, pain catastrophizing ( B = 0.05, p = 0.002), country ( B = 1.29, p = 0.04), and analgesic use ( B = 2.37, p < 0.001) independently predicted pain intensity (adjusted R 2 = 0.44). Pain acceptance did not remain independently significant. Exploratory mediation analysis indicated that pain catastrophizing statistically partially mediated the association between country and pain intensity (indirect effect B = 1.23, p < 0.001). Pain catastrophizing emerged as the most salient psychological predictor of cancer pain intensity and partially explained cross-national differences. Integrating culturally informed cognitive interventions with pharmacological treatment may improve pain outcomes in oncology settings.