Date of Completion


Embargo Period



Nursing, Chronic Pain, Biopsychosocial, Psychological Stress

Major Advisor

Angela Starkweather

Associate Advisor

Erin Young

Associate Advisor

Jessica Guite

Field of Study



Doctor of Philosophy

Open Access

Open Access


Persistent pain is a complex experience that can be difficult to treat if there is no obvious source. Nurses caring for patients with chronic pain may rely on pain severity to direct care, although this does not address the biopsychosocial factors that influence persistent pain states. Psychological stress is a potentially modifiable factor that has been proposed to influence the experience of pain, but the role of stress in developing persistent pain states remains undefined. The purpose of this dissertation was to examine stress-pain relationships by investigating how stress influences chronic pain trajectories. To address this query, three perspectives are discussed to elucidate instrumental factors. First, the experiences of childhood cancer survivors are explored to provide a foundation for understanding how stress, coping, and disease trajectories can influence present health and well-being. Next, a systematic literature review is presented which seeks to understand if stress-reduction strategies can influence persistent pain trajectories by modifying biological mechanisms. Finally, a secondary data analysis is presented, which sought to investigate the role of psychological stress, pain severity, and pain sensitivity as key factors in predicting pain trajectories. The results reveal that, although each of these factors of interest influence pain trajectories, the dominant predictor is household income. Together, the findings from this dissertation underscore the complex nature of stress-pain relationships and reflect the powerful impact of the social determinants of health. Psychological stress remains a critical factor in understanding pain trajectories and should be addressed throughout nursing practice.