Resilience is a relatively new area of study in chronic pain and is premised on the concept that positive psychological traits contribute to positive states, which lead to better pain outcomes.1
Resilience strategies for patients with chronic pain are designed to help them adapt to adverse situations, allowing them to recover from an initial functional decline, maintain their functional ability, and even flourish despite ongoing adversity.1 In a symposium titled “Enhancing Resilience in Chronic Pain: Exploring Factors and Interventions That Promote Resilient Functioning” at the 35th Annual Scientific Meeting of the American Pain Society in Austin, Texas, speakers discussed data from studies of resilience in patients with chronic pain from temporomandibular disorder (TMD) and fibromyalgia.
Emily Bartley, PhD, from the University of Florida, presented findings from a pilot study assessing the efficacy of a resilience-oriented intervention (ROI) aimed at improving pain and psychological outcomes. The investigators recruited 29 people with TMD who underwent laboratory and quantitative sensory pain testing and completed psychosocial questionnaires at baseline. Participants were then randomly assigned to the ROI, which promoted hopeful thinking, or to an educational intervention about pain and stress. Both interventions consisted in 3 sessions. After the third session, the investigators re-administered the laboratory and pain tests and the questionnaires.
The psychosocial questionnaires revealed greater improvement in measures of hope, self-efficacy, pain acceptance, and pain catastrophizing in the ROI group than in the control group. Dr Bartley described hope as a “strength-based motivational state consisting of one’s belief in [his or her] ability to generate routes to achieve goals (pathways) and initiate directional activity toward attaining goals (agency).” Sensory pain testing showed the ROI increased tolerance for pain caused by heat or mechanical pressure and decreased the perception of heat pain intensity more than the educational intervention. Also, ROI participants had lower levels of stress-induced activation of salivary alpha-amylase after the intervention. Dr Bartley said preliminary results show ROIs may decrease negative affect (NA) and improve pain outcomes.
Mary Davis, PhD of Arizona State University presented results of a single-arm study examining the relationship between positive affect (PA), NA, pain flares, and function in 220 fibromyalgia patients. For 3 weeks, participants completed daily diaries at 11 am, 4 pm, and 7 pm. In the diaries, they rated adjectives from the Positive and Negative Affect Schedule (PANAS) using a Likert scale; these were scored to determine trait levels. Participants also recorded their perceptions about pain and function. In an interview, Dr Davis said participants completed 83% of the diary assessments.
Analyses showed having high-trait PA and getting a boost in PA were independent predictors of reduced NA and pain catastrophizing during morning pain episodes. Both parameters also significantly moderated end-of-day disability and depression following morning pain. Although the study did not administer interventions to boost PA Dr Davis said, “There are data that mindfulness-based interventions boost daily PA…loving kindness also raises daily PA and improves an individual’s sense of positive social connection.” She explained the importance of PA as “a resource that helps us break out of the narrow perspective that accompanies stress—including the stress of chronic pain and other chronic pain conditions.” She added that PA may make people less likely to “think and feel in ‘black and white.’”
Dr Davis said the findings “add to the growing body of evidence suggesting that paying attention to the positive side of the equation is worthwhile as we try to help individuals live well with chronic pain.” Results from resilience studies are promising, but more research is needed to develop and identify targeted ROIs for patients with chronic pain and to quantify their effect on pain outcomes.1
- Hassett AL, Finan PH. The role of resilience in the clinical management of chronic pain. Curr Pain Headache Rep. 2016;20:39.