Psychological “resilience” and its correlates in chronic pain: Findings from a national community sample

More optimism, less pain! The influence of generalized and pain-specific expectations on experienced cold-pressor pain

Accumulating evidence suggests that dispositional optimism might be a protective factor against experiencing pain. The current paper presents two studies investigating the association between dispositional optimism and experimental pain. Moreover, the influence of pain-specific expectations on this association is investigated. In Study 1, mediation of pain-specific expectations in the relation between dispositional optimism and pain was hypothesized. Expected and experienced pain ratings were obtained from 66 healthy participants undergoing a cold pressor tolerance task. In Study 2, the moderating effect of dispositional optimism on the association between induced pain expectations and pain reports was studied in 60 healthy participants undergoing a 1-min cold pressor task. Both studies controlled for individual differences in fear of pain. Significant associations between dispositional optimism and pain ratings were found in both studies, although the exact time point of these associations differed. Subscale analyses revealed that only the pessimism subscale contributed significantly to these findings. We found no evidence for hypothesized mediation and moderation effects. Alternative explanations for the optimism-pain association are discussed.

Factor structure and psychometric properties of the resilience scale in a spanish chronic musculoskeletal pain sample

The concept of resilience is receiving increasing attention in the field of chronic pain. It has been shown to play a protective role in patients with osteoarthritis, fibromyalgia, and rheumatoid arthritis. Despite this finding, no resilience measurements have been validated in chronic pain populations. The Resilience Scale (RS) is a well-known instrument that has been used to assess resilience in studies conducted in the general population. When used in chronic pain samples, this scale presented the highest internal consistency compared to other resilience scales. The main aim of this study was to provide data on the factor structure, reliability, and validity of the RS in a sample of chronic musculoskeletal pain patients (n = 300). Factor analyses revealed a single-factor solution of 18 items (RS-18), which accounted for 52.43% of the total variance of this scale. The RS-18 shows good reliability (internal consistency and stability) and construct validity. This scale has the advantage of excluding items closely related to functional disability and impairment. Furthermore, the RS-18 significantly correlated with several pain-related variables (ie, catastrophizing, pain acceptance, active and passive pain coping, anxiety, depression, pain-related anxiety, disability, functioning, impairment, and pain intensity). Clinicians and researchers are thus provided with a valid and reliable instrument to assess resilience in chronic pain populations.

PERSPECTIVE

This article presents the first resilience questionnaire (RS-18) for chronic pain patients. The instrument obtained shows good reliability and validity. The results provide health-care professionals and researchers with a measure of resilience in chronic pain patients that excludes items related to functional disability.

The path to capacity: resilience and spinal chronic pain

STUDY DESIGN

A cross-sectional study.

OBJECTIVE

To analyze the relationship between resilience, acceptance, coping, and adjustment to spinal chronic pain.

SUMMARY OF BACKGROUND DATA

Several studies have concluded that resilience is relevant in predicting pain and physical functioning among patients with chronic pain. Although resilience may have a role in preventing or living with chronic pain, there is little research on the effects of resilience on adjustment among patients with chronic pain.

METHODS

Multivariate multiple regression by structural equation modeling was performed to simultaneously determine the influence of all the predictor variables on all the dependent variables. The sample was composed of 299 patients (138 men and 161 women) suffering from chronic spinal pain. : Higher levels of resilience were associated with higher levels of pain acceptance and active coping strategies. Active coping and acceptance were associated with higher levels of adjustment to pain.

CONCLUSION

Positive personality characteristics could play a crucial role in patient adjustment, and thus clinicians should take into account the positive path to capacity to better understand the chronic pain experience.

Beliefs and expectations for recovery, coping, and depression in whiplash-associated disorders: lessening the transition to chronicity

STUDY DESIGN

Literature review and discussion.

OBJECTIVE

To discuss the role played by beliefs, expectations, coping, and depression in the transition to chronicity in whiplash-associated disorders (WAD), and to discuss their clinical and research implications.

SUMMARY OF BACKGROUND DATA

Psychological factors are important in musculoskeletal pain problems. Recently, there has been attention paid to their role in the transition from acute to chronic WAD. However, most of this attention has focused on identifying and addressing the personal and behavioral aspects of psychological factors, and little focus on the social and societal influences shaping these factors in WAD patients.

METHODS

A literature review was conducted to describe the evidence regarding the roles of beliefs, expectations, pain coping, and depression in WAD recovery. These psychological constructs and research findings were discussed in the context of efforts to improve beliefs, coping, and psychological well-being in WAD.

RESULTS

There is consistent evidence negative beliefs about WAD are common in the general population and that poor expectations for recovery are associated with poor recovery. Pain coping and depression also appear to predict WAD recovery. The conceptual frameworks (such as social learning theory) for understanding these psychological constructs highlight the roles of interpersonal and societal factors. However, most research and clinical interventions related to these factors focuses on the individual, rather than also addressing the social context.

CONCLUSION

Beliefs, expectations, coping, and depression all predict WAD recovery. Efforts to address these factors should take a broad-based approach. These psychological constructs should be viewed as being developed and maintained within the broader social context of family, social networks, employment, and societal processes in general. There is need for a research and clinical paradigm, which acknowledges the interrelationships between internal processes and the social context in attempts to optimize recovery and functioning in those with WAD.

Family resilience: towards a new model of chronic pain management

This paper presents a critical appraisal of the potential of family resilience as a new model of care for chronic pain. For nurses, this model offers new strategies for working with families where a member experiences chronic pain. Chronic pain is characterised by one or more of the following: pain that lasts more than six months, from a non-life-threatening cause; and/or which is not responsive to available treatment. Chronic pain has the potential to be longstanding and difficult to treat and may result in negative outcomes for individuals and their families. However, a family resilience model of care moves the nurse from a traditional deficit base or problem-focused model of care to one which addresses the individual's and family's strengths. Strengths based models of care such as family resilience offer a fresh approach within Australia's developing agenda of primary health care. A family resilience or strengths based model of chronic pain has the potential to facilitate transformation and growth within families that will enable them to be more resourceful when facing immediate and long-term challenges. Further research into the effectiveness of this approach to nursing care is required to develop specific implementation strategies for working with families experiencing chronic health conditions such as chronic pain.

Psychological resilience predicts decreases in pain catastrophizing through positive emotions

The study used a daily process design to examine the role of psychological resilience and positive emotions in the day-to-day experience of pain catastrophizing. A sample of 95 men and women with chronic pain completed initial assessments of neuroticism, psychological resilience, and demographic data, and then completed short diaries regarding pain intensity, pain catastrophizing, and positive and negative emotions every day for 14 consecutive days. Multilevel modeling analyses indicated that independent of level of neuroticism, negative emotions, pain intensity, income, and age, high-resilient individuals reported greater positive emotions and exhibited lower day-to-day pain catastrophizing compared with low-resilient individuals. Mediation analyses revealed that psychologically resilient individuals rebound from daily pain catastrophizing through experiences of positive emotion. Implications for research on psychological resilience, pain catastrophizing, and positive emotions are discussed.

The Resilience Scale: psychometric properties and clinical applicability in older adults

Resilience is described as the ability to achieve, retain, or regain a level of physical or emotional health after illness or loss. The Resilience Scale was specifically developed to measure personality characteristics of resilience in older adults. The purposes of this article are to provide additional support for the psychometric properties of the Resilience Scale and to consider the clinical applicability of this tool. Data from two independent samples of older adults were used. Most of the participants were Caucasian women, between 80 and 90 years of age, widowed, single, or divorced, and they had on average approximately three comorbid medical problems. Psychometric testing included confirmatory factor analysis, Rasch analysis, and test criterion relationships for validity testing, and internal consistency and estimates of R(2) for reliability testing. Although there was some support for the reliability and validity of the 25-item Resilience Scale, there was a poor fit of Items 3-6, 9, 11, 20, and 22 in the 25-item measure. Overall, participants in both samples scored high in resilience, and item mapping indicated that additional items are needed on the measure to differentiate those who are particularly resilient. Although revisions are recommended, use of the Resilience Scale can help identify older adults low in resilience and expose these individuals to interventions to improve resilience and facilitate successful aging.

Measuring life quality, physical function and psychological well-being in neurological illness

There is little in the literature comparing experiences of patients with disabling and uniformly terminal illness (e.g. amyotrophic lateral sclerosis) and illness characterized by episodic disability and prognostic uncertainty (e.g. multiple sclerosis). This study aimed to compare experiences of disability, quality of life (QoL) and psychological well-being in ALS and MS. One hundred patients with ALS and MS were interviewed at baseline and at six months. Variables measured included function, health related QoL, individualized QoL and psychological distress. Despite the divergent illness experiences of ALS and MS patients, groups did not differ on individualized QoL or mental well-being, and distress was in the normal range. Despite marked deterioration in ALS patients' health, there was no change in mental well-being and QoL. Psychological well-being appeared more important in maintaining QoL (individualized QoL and mental aspects of health related QoL) than physical factors. At the individual level, there was evidence of psychological adaptation to deteriorating function, which underlined the role of specific illness related challenges in determining perceived life quality and emotional well-being. In conclusion, the complex interplay between psychosocial and illness specific factors such as certainty with regard to prognosis has considerable implications for well-being and life quality. Recognizing such factors is essential when designing clinical interventions to promote adjustment and self-management among patients with neurological conditions.

Catastrophic appraisal of acute and chronic pain in a population sample of new jersey national guard troops

OBJECTIVES

Catastrophic appraisal has been implicated as a possible cause of psychiatric morbidity, psychological distress, and physical impairment in individuals with chronic pain. At issue in this study was whether catastrophizing was associated with psychiatric morbidity in a population sample of National Guard members. In addition, we sought to determine whether it could account for individual differences in psychological distress and impaired physical function in the presence of acute and chronic pain.

METHODS

We performed a secondary analysis of an existing survey database. The original survey was designed to assess combat readiness in a population sample of 2995 National Guard troops about to deploy overseas. The database included screening instruments for psychiatric illness as well as continuous measures of psychological distress, pain perception, pain catastrophizing, and perceived physical function.

RESULTS

Among Guard members reporting a problem with pain, frequent catastrophizing was associated with higher rates of depression, posttraumatic stress, alcohol dependence, and somatization-like illness. Higher rates were also associated with chronic as opposed to acute pain (except for alcohol dependence). Pain-related catastrophizing accounted for substantial variance in measures of psychological distress and physical impairment regardless of pain duration.

DISCUSSION

Although catastrophizing beliefs are common in clinical settings, this study suggests that the phenomenon may be prevalent in the population at large and likely to influence the outcome of acute as well as chronic pain.

Envelhecer atuando: bem-estar subjetivo, apoio social e resiliência em participantes de grupo de teatro

Essa pesquisa, realizada com participantes do grupo de teatro Os Mais Vividos, objetivou: a) investigar o bem-estar subjetivo; b) averiguar a resiliência; c) levantar a percepção de suporte social; d) correlacionar bem-estar subjetivo, resiliência e percepção de suporte social. Participaram 12 idosos (idade média 68 anos ± 10,57). Os Resultados indicaram que os participantes relatam bemestar subjetivo positivo, apresentam níveis de adaptação psicossocial positiva frente a eventos de vida importantes, avaliada pela resiliência e percebem suporte social nos aspectos emocional e prático. As correlações indicaram que quanto maior a idade, maior a resiliência apresentada por idéias de independência e determinação; quanto maior o tempo no grupo, maior a vitalidade; quanto maior a percepção de suporte social, maior o número de afetos positivos experimentados; quanto mais sentimentos positivos apresentam, maior o nível de satisfação com a vida; a medida que experienciam afetos negativos, tornam-se mais resilientes

Resilience: a new paradigm for adaptation to chronic pain

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. However, current pain adaptation paradigms do not account for the many chronic pain patients who demonstrate little or no noticeable impairment due to the effects of chronic pain. This paper offers resilience as an integrative perspective that can illuminate the traits and mechanisms underlying the sustainability of a good life and recovery from distress for individuals with chronic pain.

Resilience and mental health

The relationship between disease and good health has received relatively little attention in mental health. Resilience can be viewed as a defence mechanism, which enables people to thrive in the face of adversity and improving resilience may be an important target for treatment and prophylaxis. Though resilience is a widely-used concept, studies vary substantially in their definition, and measurement. Above all, there is no common underlying theoretical construct to this very heterogeneous research which makes the evaluation and comparison of findings extremely difficult. Furthermore, the varying multi-disciplinary approaches preclude meta-analysis, so that clarification of research in this area must proceed firstly by conceptual unification. We attempt to collate and classify the available research around a multi-level biopsychosocial model, theoretically and semiotically comparable to that used in describing the complex chain of events related to host resistance in infectious disease. Using this underlying construct we attempt to reorganize current knowledge around a unitary concept in order to clarify and indicate potential intervention points for increasing resilience and positive mental health.

The role of resilience and purpose in life in habituation to heat and cold pain

This study examined the role of resilience in habituation to heat and cold pain in healthy women (n = 47). Heat and cold pain thresholds were each assessed across 5 equally spaced trials. Resilience, purpose in life, optimism, social support, and neuroticism were assessed using self-report measures. The hypothesis was that the resilience and the associated resilience factors would be positively related to habituation to heat and cold pain while controlling for neuroticism. Multilevel modeling was used to test the hypothesis. When considering each characteristic separately, resilience and purpose in life predicted greater habituation to heat pain while resilience, purpose in life, optimism, and social support predicted greater habituation to cold pain. When controlling for the other characteristics, both resilience and purpose in life predicted greater habituation to heat and cold pain. Resilience and associated characteristics such as a sense of purpose in life may be related to enhanced habituation to painful stimuli. Future research should further examine the relationship between resilience, purpose in life, and habituation to pain and determine whether psychosocial interventions that target resilience and purpose in life improve habituation and reduce vulnerability to chronic pain.

PERSPECTIVE

This article showed that resilience and a sense of purpose in life were both related to the ability to habituate to heat and cold pain in healthy women. These personal characteristics may enhance habituation to pain by providing the confidence and motivation to persist in the face of painful stimuli.

Predictors of psychological distress and well-being in women with chronic musculoskeletal pain: two sides of the same coin?

OBJECTIVE

To date, few results on well-being in chronic-pain patients have been published, while several studies in patients without pain have indicated that well-being may not be equivalent to absence of psychological distress. The aim of the present study was to investigate the relationship between psychological distress and well-being and to identify the predictors of each in patients with chronic nonmalignant pain.

METHODS

Sixty-nine women with chronic multiregional musculoskeletal pain, 41 of whom met American College of Rheumatology criteria for fibromyalgia, completed questionnaires on pain, fatigue, stiffness, physical disability (Fibromyalgia Impact Questionnaire), psychological distress [Multidimensional Affect and Pain Survey (MAPS), Symptom Check List-90 (SCL-90), State-Trait Anxiety Inventory Form Y2 (STAI-Y2)], and hedonic and eudaimonic well-being (MAPS).

RESULTS

Patients reported increased amounts of psychological distress (STAI-Y2 and SCL-90) compared to healthy people. Multiple regression analysis of patient data demonstrated that higher psychological distress was related to higher age, more intense pain, a higher positive tender point count, and more physical disability. Well-being (both hedonic and eudaimonic aspects) decreased with higher disability, but was independent of age, pain intensity, and number of positive tender points. Bivariate correlations showed that psychological distress was moderately related to eudaimonic well-being and strongly related to positive affect, an aspect of hedonic well-being.

CONCLUSION

In patients with chronic musculoskeletal pain, self-reports of well-being and low psychological distress only partially overlap with each other and are differently related to major patient symptoms, supporting the relevance of the concept of well-being to chronic-pain research and a need for further studies in this field.