PAINFUL RESILIENCE

The literature on pain and adaptation has centered on the qualities of the person to define those who are most likely to be resilient. Equal weight needs to be given to the person's social world in identifying factors that promote resilience. Environments that reward efforts aimed at recovery, sustainability, and growth foster resilience in important ways, and individuals differ in the resourcefulness of the environments in which they live.

Although the patient is at the center of attention in clinical work, there is much benefit when the social environment is also examined for its responsiveness to the patient's capacities for positive adaptation, and the patient is guided to favor interactions in those social realms most likely to reinforce resilient action. Both localized pain such as lower back pain and widespread bodily pain may be part of the clinical picture.

Thus, the subjective experience of pain may be qualitatively different, both across disorders and across individuals. For instance, it appears that individuals suffering from fibromyalgia seem to experience a greater degree of emotional distress than those individuals who suffer from osteoarthritis, although both disorders involve a similar degree of widespread bodily pain.

These differences may be borne out through differential neurophysiological processes, or it may be manifested in a difference in a behavior, coping, or cognitive reaction to the pain itself. These considerations can have far-reaching implications toward the direction of future research on a given disorder, as well as on the development of a syndrome-or disease-specific treatment for pain.

Similarly, consideration should be given to demographic factors that may impact the overall nature of an individual's chronic pain experience and their subsequent reaction to it. The same can be said of socioeconomic status SES , because those individuals who report a lower SES may have fewer material or personal resources to contribute to maintaining or increasing healthy behavior.

Another consideration that is closely related with SES is that of race and ethnicity. Despite evidence of fewer health care resources and the presence of risk factors such as discrimination and acculturation, there is evidence of better physical and emotional outcomes among the African-American [ 48 ] and Latin American communities [ 49 ] than Caucasians. What may explain this difference? As a result, it cannot be assumed that the nature of pain and pain coping are the same for different ethnicities.

There may also be significant gender differences to consider when examining the process of resilience to pain. Evidence suggests that there are significant psychosocial differences in how men and women respond to the same type of pain [ 50 ]. These differences may lead to differential rates of disability, activity level, and social interactions [ 50 ], all of which may impact the overall health status of an individual with chronic pain.

Future research should serve to illuminate the influences of gender, race, ethnicity, culture, and socioeconomic differences. Instead of focusing on deficits and vulnerabilities exclusively, this paper encourages that researchers and clinicians give more attention to how chronic pain patients may be resilient. One useful way of conceptualizing resilience to pain is to change one's perspective from looking for vulnerabilities to identifying one or more strengths that can foster resilient outcomes for people in pain.

It is important to note that both stable personal characteristics resilience resources and more dynamic processes resilience mechanisms can play a prominent role in determining the effectiveness of individual pain adaptation. Resilient individuals possess greater emotional knowledge and direct more attention within in order to evaluate their current emotional state, and thus may seek to bolster their own positive affect as a means of reducing the control that their current pain has over their emotions.

They may demonstrate a more optimistic outlook on their lives, express a greater belief that their lives have meaning, and demonstrate a willingness to accept pain and its consequences as a means of fostering a greater sense of engagement in their lives overall. When they do experience pain and associated negative emotions, resilient individuals demonstrate more emotional complexity and, in the case of negative emotions, may also use information associated with these emotions in order to return to their normal levels of positive affect more quickly, thus aiding in the process of recovery from pain.

It is important to keep in mind the different ways that a person in pain may show resilience. The effect of resilience may be manifested in quicker recovery from the negative effects of pain, through the effective sustaining of positive functioning despite the presence of pain, and even through the realization of personal growth due to the presence of pain. It should be noted that individual differences are unquestionably present in the process of resilience to pain, both in recovery of homeostasis following upset and sustainability of positive engagements.

The nature of an individual's experience of pain may vary across different disorders and based on demographic variables such as age and gender. The responsiveness of the person's social world is a key factor in activation of resilient resources. In the absence of social interactions that reinforce resilient ways of thinking and behaving, the capacity that many people have to resolve their difficulties with chronic pain might otherwise remain dormant. Future research is needed to further illuminate the degree of the many forms that resilience can take. Nevertheless, the adoption of a strength-based view of those coping with chronic pain promises to greatly enhance our understanding of how people can adapt successfully, and provide important guidance to pain management programs.

The two authors contributed equally to this work. The members of the RSG, in addition to the authors of this article, are, in alphabetical order: In addition, the authors are grateful to St.

Disclosure No potential conflicts of interest relevant to this article were reported. National Center for Biotechnology Information , U. Curr Pain Headache Rep. Author manuscript; available in PMC Jun 9. Sturgeon and Alex J. Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at Curr Pain Headache Rep. See other articles in PMC that cite the published article. Abstract Chronic pain is an affliction that affects a large proportion of the general population and is often accompanied by a myriad of negative emotional, cognitive, and physical effects.

Chronic pain, Resilience psychological , Coping behavior, Stress. Introduction Pain is an essential process that can signal injury or illness and can attract attention to areas of the body that require immediate care. Issues in Defining Resilience to Pain Themes of resilience arose in the field of child development, based on observations of many children who sustained positive functioning and development despite the presence of significant risk factors such as abuse or low socioeconomic status [ 10 ].

Open in a separate window. Pathways to resilience for those in chronic pain.

All items listed below the pathways are examples. Emotional Aspects of Resilience to Pain One key resource that aids individuals in resisting the deleterious effects of pain in their everyday functioning, as well as in the recovery from pain-related deficits in functioning, is high average levels of positive emotion, usually measured as elevations in positive affect.

Cognitive-Behavioral Aspects of Resilience to Pain Another key variable that plays a prominent role in resilience to pain is active coping. Social Resilience Resources and Mechanisms Resilience has also been used to refer to a capacity by families, work teams, neighborhoods, and communities when interactions between individuals serve to bolster personal and community resources in the face of adversity [ 44 ].

Conclusions Instead of focusing on deficits and vulnerabilities exclusively, this paper encourages that researchers and clinicians give more attention to how chronic pain patients may be resilient. Acknowledgments The two authors contributed equally to this work. Footnotes Disclosure No potential conflicts of interest relevant to this article were reported.

References Papers of particular interest, published recently, have been highlighted as: The biopsychosocial approach to chronic pain: Pain coping strategies and depression in rheumatoid arthritis. J Consult Clin Psychol.

Obesity profiles with knee osteoarthritis: Obesity Silver Spring ; The Pain Catastrophizing Scale: Comparison of stress responses in women with two types of chronic pain: Immune activation and depression in women with rheumatoid arthritis. Psychobiological mechanisms of resilience and vulnerability: Stress and the individual: The construct of resilience: Handbook of Adult Resilience.

This book provides an updated and comprehensive overview of the construct of resilience and proposes a 3-factor model of resilience, including recovery, sustainability, and growth. Psychosocial resilience and protective mechanisms. The brief resilience scale: Int J Behav Med. This article identifies recovery as a key concept related to, but still independent of, the construct of resilience.

The implications of differences in individual resilience for health-related outcomes are also discussed.

Scientists identify method to study resilience to pain

Vulnerability and resilience in women with arthritis: The role of resilience and purpose in life in habituation to heat and cold pain. This experimental article is among the first to test the utility of resilience as a coping mechanism to pain, and provides broader implications to the role of resilience in coping with both acute and chronic pain. Distinguishing optimism from neuroticism and trait anxiety, self-mastery, and self-esteem: J Pers Soc Psychol. Dispositional optimism and health behavior in community-dwelling older people: Br J Health Psychol. The relationship of optimism, pain and social support to well-being in older adults with osteoarthritis.

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Well-being in rheumatoid arthritis: Resilience, meaning, and well-being. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. The role of purpose in life in recovery from knee surgery. A prospective study of acceptance of pain and patient functioning with chronic pain. Learning to live with the pain: Adjustment to chronic pain: An assessment of the relative influence of pain coping, negative thoughts about pain, and pain acceptance on health-related quality of life among people with hemophilia.

Pain acceptance moderates the relation between pain and negative affect in osteoarthritis and fibromyalgia patients. Positive affect as a source of resilience for women in chronic pain. Daily events are associated with a secretory immune response to an oral antigen in men.

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Positive emotional style predicts resistance to illness after experimental exposure to rhinovirus or influenza A virus. What good are positive emotions? Chronic pain, stress, and the dynamics of affective differentiation. Psychological resilience predicts decreases in pain catastrophizing through positive emotions. Psychological resilience, positive emotions, and successful adaptation to stress in later life. Positive affect as a factor of resilience in the pain-negative affect relationship in patients with rheumatoid arthritis.

Knowing what you're feeling and knowing what to do about it: McFarland C, Buehler R.

Resilience: A New Paradigm for Adaptation to Chronic Pain

The impact of negative affect on autobiographical memory: Active and passive coping strategies in chronic pain patients. For example, a study published in the Journal of Consulting and Clinical Psychology looked at women with RA and found that those who scored high on resilience questionnaires reported less RA-related pain than those with lower scores. A study published in the Annals of Behavioral Medicine looked at patients with knee OA and found that those who exhibited the most resilience-related characteristics were also the most likely to show self-efficacy — for example, taking the initiative to see a physician or to exercise regularly.

They also reported less pain and an increased ability to perform everyday activities compared with less resilient study participants. What can I do to get moving again? Further, resilience requires tapping into a set of coping skills that reduce stress levels and the stress hormones that are known to exacerbate arthritis pain. Experts agree that some people seem to be naturally resilient, but a wealth of research shows others can develop it and bolster their buoyancy. Focus on the upside.

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Ask yourself three questions, he says: Can I look at this differently? Is there any good to come out of it? What worked, and which strategies should I skip this time? Control as well as resourcefulness give you the confidence to move forward in the face of adversity. Make time to find and do things you love. Support systems are a linchpin of resilience.