Resilience in Chronic Pain Management

The following article features coverage from PAINWeek 2017 in Las Vegas, Nevada. Click here to read more of Clinical Pain Advisor‘s conference coverage.

LAS VEGAS — Most conventional psychological interventions for pain strive to reduce negative symptoms, missing opportunities to bolster resilience, a process that can help individuals better cope with their pain and its negative effects, according to a presentation by Kimberly Sibille, PhD, assistant professor, department of aging and geriatric research at the University of Florida (UF) College of Medicine in Jacksonville, and Emily J. Bartley, PhD, research assistant professor at the UF College of Dentistry in Gainesville, at PainWeek 2017, held September 5-9.¹

“Importantly, resilience is not a fixed trait that we are born with, but rather we each have the innate capacity to grow and become more resilient. Subsequently, pain clinicians have the unique opportunity to promote the development of an array of resilience skills in their patients,” noted Drs Sibille and Bartley in an interview with Clinical Pain Advisor.

A variety of resilience factors in chronic pain have been identified, including trait positive affect, dispositional optimism, active coping, self-efficacy, acceptance, social support, and purpose in life. Although affective traits are dispositional in nature, research suggests that affective patterns are modifiable through experience, learning, and exposure. Thus, positive affect appears to be a promising clinical target.

“Evidence indicates that strategies such as encouraging benefit-finding activities, developing mindfulness skills, capitalizing on personal strengths, initiating and increasing attention to positive affect moments, and cultivating a stronger social support system can be effective,” the presenters pointed out. Both researchers are currently investigating techniques that would help bolster resilience in individuals living with chronic pain.

Noninvasive strategies aiming to promote neuroplasticity as a way to enhance an individual’s responsiveness to treatment interventions have not yet been explored in chronic pain management. In a recently published review article, Dr Sibille and colleagues explored the utility of two such strategies: intermittent fasting and targeted glucose administration.² Dr Sibille is also leading a pilot study (OPTIMIZE; ClinicalTrials.gov identifier NCT02681081), investigating whether intermittent fasting or glucose administration in conjunction with positive affect-focused relaxation/guided imagery exercise results in neurophysiological changes and functional improvements compared with relaxation/guided imagery exercise alone in older (50 to 80) adults with chronic knee pain.³ Preliminary findings are encouraging, but data are still being collected. Results are anticipated in early 2018.

Dr Bartley recently completed a pilot study titled ORION (ClinicalTrials.gov identifier: NCT02164630), a 2-armed randomized trial assessing a hope-based intervention vs pain education to optimize resilience in patients age 18 to 65 with chronic pain from temporomandibular disorder (TMD).⁴ The hope-based intervention focused on effective goal-setting, mobilization of internal resources to reach goals, identification of resilience factors to formulate hopeful thinking, and enhancement of maintenance of future goal development, while patients receiving pain education learned about TMD symptomatology and etiology, the relationship between pain and stress, and lifestyle management of pain. Patients in the “hope” group showed significant improvements in several psychological outcomes, including increased hope, self-efficacy, and pain acceptance, and a reduction in catastrophizing. They also had lower heat pain sensitivity and higher pain thresholds following application of mechanical pressure to their temporomandibular joints and legs. The study is pending publication. Dr Bartley has extended this research with a new study exploring resilience factors that have an impact on pain and physiological functioning in older adults with chronic low back pain.

“There is good evidence of the importance of expanding the focus of pain treatments to include interventions and strategies targeting protective processes that may buffer, bolster, and possibly inhibit some of the negative effects of living with chronic pain. Integrating both a risk and resilience model into current therapies appears to be a promising approach for broadening the impact of our existing pain management interventions,” concluded Drs Sibille and Bartley.

Read more of Clinical Pain Advisor‘s coverage of PAINWeek 2017 by visiting the conference page.

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References

1. Sibille K, Bartley EJ. Ramping up resilience in chronic pain: strategies for reducing pain and improving function. Presented at: PainWeek 2017, September 5-9, 2017, Las Vegas, Nevada.
2. Sibille KT, Bartsch F, Reddy D, Fillingim RB, Keil A. Increasing neuroplasticity to bolster chronic pain treatment: a role for intermittent fasting and glucose administration? J Pain. 2016;17:275-281.
3. ClinicalTrials.gov. Optimizing Chronic Pain Treatment With Enhanced Neuroplastic Responsiveness (OPTIMIZE) [NCT0281081]. https://clinicaltrials.gov/ct2/show/NCT02681081. Verified March 2017. Accessed August 30, 2017.
4. ClinicalTrials.gov. Optimizing Resilience In Orofacial Pain and Nociception (ORION) [NCT02164630]. Verified August 2016. Accessed August 30, 2017.