The path to capacity: resilience and spinal chronic pain

Chronic Pain Resilience Across Clinical Populations: A Concept Analysis

BACKGROUND

Chronic pain resilience is a concept that is frequently used in research but lacks theoretical clarity. Understanding chronic pain resilience is germane to developing interventions to improve it and the overall quality of life among individuals with chronic pain.

AIMS

To uncover and clarify the unique characteristics of the concept of chronic pain resilience.

DESIGN

A concept analysis using Rodgers' evolutionary method.

METHODS

Full-text articles published after 2000 in English were used to inform the concept analysis. Scopus, PubMed, PsychINFO, Embase, and CINAHL Plus with Full Text were utilized for literature searches. Rodgers' evolutionary approach was used to clarify the attributes, antecedents, and consequences.

RESULTS

The search yielded 31 articles that were used in the analysis. The key attributes of chronic pain resilience included engagement in meaningful activities despite pain, maintaining positive psychological homeostasis, buffering against negative mental outcomes, seeking support, and self-empowerment. After considering surrogate terms, antecedents, attributes, and consequences, chronic pain resilience may be defined as the development of the capacity to successfully adapt to chronic pain. This adaptation results in a move toward optimal social, physical, mental, and behavioral functioning by balancing negative and positive psychosocial factors, despite the additional challenges brought about by living with chronic pain.

Cognitive-Affective-Behavioral Pathways Linking Adversity and Discrimination to Daily Pain in African-American Adults

The tendency to ruminate, magnify, and experience helplessness in the face of pain - known as pain catastrophizing - is a strong predictor of pain outcomes and is associated with adversity. The ability to maintain functioning despite adversity - referred to as resilience - also influences pain outcomes. Understanding the extent to which pain catastrophizing and resilience influence relations between adversity and daily pain in healthy African-American adults could improve pain risk assessment and mitigate racial disparities in the transition from acute to chronic pain. This study included 160 African-American adults (98 women). Outcome measures included daily pain intensity (sensory, affective) and pain impact on daily function (pain interference). Adversity measures included childhood trauma exposure, family adversity, chronic burden from recent stressors, and ongoing perceived stress. A measure of lifetime racial discrimination was also included. Composite scores were created to capture early-life adversity (childhood trauma, family adversity) versus recent-life adversity (perceived stress, chronic burden). Increased pain catastrophizing was correlated with increased adversity (early and recent), racial discrimination, pain intensity, and pain interference. Decreased pain resilience was correlated with increased recent-life adversity (not early-life adversity or racial discrimination) and correlated with increased pain intensity (not pain-related interference). Bootstrapped multiple mediation models revealed that relationships between all adversity/discrimination and pain outcomes were mediated by pain catastrophizing. Pain resilience, however, was not a significant mediator in these models. These findings highlight opportunities for early interventions to reduce cognitive-affective-behavioral risk factors for persisting daily pain among African-American adults with greater adversity exposure by targeting pain catastrophizing.

Pain Self-Efficacy (PSEQ) score of <22 is associated with daily opioid use, back pain, disability, and PROMIS scores in patients presenting for spine surgery

BACKGROUND CONTEXT

Pain self-efficacy, or the belief that one can carry out activities despite pain, has been shown to be associated with back and neck pain severity. However, the literature correlating psychosocial factors to opioid use, barriers to proper opioid use, and Patient-Reported Outcome Measurement Information System (PROMIS) scores is sparse.

PURPOSE

The primary aim of this study was to determine whether pain self-efficacy is associated with daily opioid use in patients presenting for spine surgery. The secondary aim was to determine whether there exists a threshold self-efficacy score that is predictive of daily preoperative opioid use and subsequently to correlate this threshold score with opioid beliefs, disability, resilience, patient activation, and PROMIS scores.

PATIENT SAMPLE

Five hundred seventy-eight elective spine surgery patients (286 females; mean age of 55 years) from a single institution were included in this study.

STUDY DESIGN/SETTING

Retrospective review of prospectively collected data.

OUTCOME MEASURES

PROMIS scores, daily opioid use, opioid beliefs, disability, patient activation, resilience.

METHODS

Elective spine surgery patients at a single institution completed questionnaires preoperatively. Pain self-efficacy was measured by the Pain Self-Efficacy Questionnaire (PSEQ). Threshold linear regression with Bayesian information criteria was utilized to identify the optimal threshold associated with daily opioid use. Multivariable analysis controlled for age, sex, education, income, and Oswestry Disability Index (ODI) and PROMIS-29, version 2 scores.

RESULTS

Of 578 patients, 100 (17.3%) reported daily opioid use. Threshold regression identified a PSEQ cutoff score of <22 as predictive of daily opioid use. On multivariable logistic regression, patients with a PSEQ score <22 had two times greater odds of being daily opioid users than those with a score ≥22. Further, PSEQ <22 was associated with lower patient activation; increased leg and back pain; higher ODI; higher PROMIS pain, fatigue, depression, and sleep scores; and lower PROMIS physical function and social satisfaction scores (p<.05 for all).

CONCLUSIONS

In patients presenting for elective spine surgery, a PSEQ score of <22 is associated with twice the odds of reporting daily opioid use. Further, this threshold is associated with greater pain, disability, fatigue, and depression. A PSEQ score <22 can identify patients at high risk for daily opioid use and can guide targeted rehabilitation to optimize postoperative quality of life.

Factors that influence the impact of Chronic Non-Cancer Pain on daily life: A partial least squares modelling approach

BACKGROUND

Chronic Non-Cancer Pain is pain of more than three months' duration and is not associated with an oncological condition. There is ample literature that recognises that Chronic Non-Cancer Pain impacts numerous areas of the life of the person who suffers from it. This impact is difficult to determine and quantify because Chronic Pain is a subjective experience.

OBJECTIVE

The objective of this study was to test a recursive model of hypothesised factors that comprise the concept of Chronic Non-Cancer Pain Impact on daily life using Partial Least Squares-Structural Equation Modelling.

DESIGN

A cross-sectional study was carried out. The sample size was calculated using G*Power V.3.1.9.4 with five parameters (two-tailed, large effect size (f² = 0.35), power of 0.95, statistical significance of 95% (α = 0.05) and 36 predictors). The minimum number of subjects was considered to be 137.

METHODS

A recursive model was built based on data from a sample of 395 people over 18 years of age with Chronic Non-Cancer Pain. Data collection was conducted between January and March 2020 at Pain Units and Primary Healthcare Centres belonging to the Spanish Public Health System in the province of Seville (Spain). Analyses were based on Partial Least Squares-Structural Equation Modelling. The internal consistency, convergent validity and discriminant validity of the internal measurement model were assessed. For the external measurement model, global model adjustment and structural validity were assessed. The predictive capacity of the final model was also evaluated. All analyses were performed using SmartPLS version 3.3.2 in consistent mode.

RESULTS

Findings showed an adequate validity of the proposed model, which comprised nine factors: pain catastrophising, hopelessness due to pain, support network, proactivity, treatment compliance, self-care, mobility, resilience, and sleep. The internal validity of the model (Cronbach's alpha and rho_A > 0.70; Average Variance Extracted>0.50; standardised outer loadings>0.60; Heterotrait-Monotrait-Ratio < 0.85), goodness of fit (Standardised Root Mean Square Residuals<0.08; Geodesic and Euclidean distance p-value<0.05) and predictive power with out-of-sample values (Stone-Geisser test>0.5) were adequate. The hypothesised structure of the instrument has also been confirmed (path coefficients>0.3; R² > 0.1; f² > 0.2).

CONCLUSIONS

The results have shown an adequate internal consistency, convergent validity and discriminant validity of the model. Likewise, the model has shown an adequate goodness of fit, and the validity of its structure and the hypothesis have been confirmed. However, more research is needed in this regard as the possible interaction between the different factors evaluated in the model with the confounding or moderating variables that may exist.

Resilience as a protective factor in face of pain symptomatology, disability and psychological outcomes in adult chronic pain populations: a scoping review

OBJECTIVES

Patients suffering from chronic pain experience significant disability and disease burden. Resilience has been understood to be a protective factor in face of adversity, eventually contributing to positive outcomes. As such, the current review sought to summarize the existing literature focusing on the roles of resilience in relation to pain phenomenology, pain outcomes (including function and mental health), amongst relevant clinical correlates in a bid to promote holistic management of debilitating chronic pain conditions from a resilience-oriented psychotherapeutic approach as an adjunct to pharmacological treatment.

METHODS

A scoping review was conducted on empirical studies surrounding the theme of resilience in adult chronic pain populations published before 9th May 2021. The following main inclusion criteria was applied; (a) adults diagnosed with chronic pain disorders, (b) use of quantifiable pain measures, (c) use of quantifiable resilience measures. A total of 32 studies were then selected for the review.

RESULTS

First, higher levels of resilience were associated with a reduced likelihood of experiencing any chronic pain, fewer pain sites, better psychological response towards nociception and reduced need for analgesia. Second, higher levels of resilience correlated with better daily and physical function, quality of life, psychosocial functioning and lower likelihood of co-morbid mental health disorders. Third, resilience was an intermediary variable in the pathways from pain phenomenology leading to pain interference, depression and post-traumatic growth.

CONCLUSIONS

The findings were contextualized using pain-disability and resilience frameworks (The Pain and Disability Drivers Model, O'Leary's Resilience models) with suggestions to enhance resilience and contextual factors in the holistic management of adult chronic pain conditions. Future research should examine the differences in resilience between pain types as well as evaluate the efficacy of streamlined resilience-oriented interventions.

"If You Don't Keep Going, You're Gonna Die": Helplessness and Perseverance Among Older Adults Living With Chronic Low Back Pain

BACKGROUND AND OBJECTIVES

Chronic low back pain (CLBP) is the leading cause of disability worldwide and the most common pain complaint among the rapidly growing older adult population. As part of a larger qualitative study examining the lived experience of CLBP among older adults, the objective of the present study is to understand how older pain clinic patients experience helplessness and also how they foster perseverance amid treatment-resistant CLBP.

RESEARCH DESIGN AND METHODS

Using van Manen's phenomenological method, semistructured, in-depth, one-on-one interviews were conducted with 21 older pain clinic patients (aged 66-83) living with CLBP. Data were iteratively analyzed via line-by-line thematic coding.

RESULTS

Findings dually illustrate how participants were living a battle between helplessness and perseverance; the final thematic structure revealed 5 subthemes: (a) Feeling helpless because nothing works; (b) Feeling down and depressed; (c) Distantly wishing for an end; (d) Accepting the reality of my pain; and (e) The pain stays, I keep going.

DISCUSSION AND IMPLICATIONS

This study contributes a vivid illustration of older adults' CLBP illness experiences that are substantially underpinned by helplessness, depression, and a drive to continue thriving in old age. Practice implications include the need for clinic-based mood and suicide assessment.

Individual variability and sex differences in conditioned pain modulation and the impact of resilience, and conditioning stimulus pain unpleasantness and salience

Distinct pain experiences are shaped both by personal attributes and characteristics of noxious stimuli. An Individual's capacity for endogenous pain inhibition (reflected by conditioned pain modulation [CPM]), their resilience, and the pain unpleasantness and salience of painful stimuli can impact their pain perception. Here, we aimed to determine how individual variability in CPM relates to sex and resilience as personal attributes, and pain unpleasantness and salience of the CPM conditioning stimulus (CS). We evaluated CPM in 106 healthy participants (51 female and 55 male) based on the change in test stimulus pain applied concurrently with a painful CS, both delivered by painful heat. The CS reduced test stimulus pain in only half of the participants (CPM subgroup), but did not do so for the other half (no-CPM subgroup), many who exhibited pain facilitation. A regression model explained CPM effects after accounting for sex, resilience, CS pain unpleasantness and salience. In the CPM subgroup regression model, the CPM effect was positively related to CS pain unpleasantness, while the CPM effect was not related to any variable in the no-CPM subgroup model. Correlation analyses revealed that the CPM effect was anticorrelated with resilience in males with no-CPM. The CPM effect was correlated with CS pain unpleasantness in males with CPM and in females with no-CPM. The CPM effect and CS salience were correlated in the whole group more strongly than in the subgroups. These data reveal that the complexity of contributors to CPM variability include both personal attributes and attributes of the CS.

Beyond pain intensity and catastrophizing: The association between self-enhancing humour style and the adaptation of individuals with chronic pain

BACKGROUND

Many questions regarding the process by which self-enhancing humour style has an effect on chronic pain individuals' adjustment remain unanswered. The aim of the present study was to analyse the association of self-enhancing humour style with adjustment in a sample of individuals with chronic pain, over and above the role of catastrophizing and pain intensity. Adjustment was assessed using measures of depression, pain interference and flourishing. We also examined the indirect association between self-enhancing humour style and adjustment via pain acceptance.

METHODS

The study included 427 patients with heterogeneous chronic pain conditions. The study hypotheses were tested using three multiple linear regression analyses, one for each of the criterion variables.

RESULTS

Consistent with the study hypothesis, both direct and indirect associations were found between self-enhancing humour style and depressive symptoms, pain interference and flourishing via pain acceptance.

CONCLUSIONS

Self-enhancing humour style could potentially help individuals with chronic pain to gain perspective and distance themselves from the situation through the acceptance of pain-related negative emotions.

SIGNIFICANCE

Very few studies have investigated the relationship between humour styles and adjustment in chronic pain samples. The results of the current study support the idea that adaptive dispositional traits, such as patient's self- enhancing humour style, play a role in the adaptation of individuals with chronic pain. Given that the association between self-enhancing humour style and adjustment evidenced an indirect association through pain acceptance, training in the use of humour, as individuals with self-enhancing humour style do, might be a useful addition to ACT treatment.

Pain-Specific Resilience in People Living With HIV and Chronic Pain: Beneficial Associations With Coping Strategies and Catastrophizing

Objective

Chronic pain is increasingly recognized as a common and disabling problem for people living with HIV (PLWH). In a recent systematic review of psychosocial factors associated with chronic pain in PLWH, it was reported that very few studies to date have examined protective psychological factors that might help mitigate chronic pain for PLWH. The current study examined pain-specific resilience in relation to clinical and experimental pain, as well as pain coping in PLWH and chronic pain. Pain-specific resilience specifically refers to the ability to maintain relatively stable, healthy levels of psychological and physical functioning in the face of ongoing and persistent pain.

Methods

A total of 85 PLWH (mean CD4 = 643; 13% detectable viral load ≥200; 99% on antiretroviral therapy) who met criteria for chronic pain (>3 consecutive month’s duration) were enrolled. Medical records were reviewed to confirm clinical data. All participants provided sociodemographic information prior to completing the following validated measures: Pain Resilience Scale (PRS), Coping Strategies Questionnaire-Revised (CSQ-R), Center for Epidemiologic Studies – Depression Scale (CES-D), and the Brief Pain Inventory – Short Form (BPI-SF). They then completed a quantitative sensory testing battery designed to assess tolerance for painful heat and cold stimuli.

Results

In adjusted multiple regression models controlling for covariates, greater pain-specific resilience was significantly associated with less pain interference (p = 0.022) on the BPI-SF, less pain catastrophizing (p = 0.002), greater use of distraction (p = 0.027) and coping self-statements (p = 0.039) on the CSQ-R, as well as significantly greater heat pain tolerance (p = 0.009). Finally, results of a parallel multiple mediation model demonstrated that the effect of pain-specific resilience on heat pain tolerance was indirectly transmitted through less pain catastrophizing (95% confidence interval:0.0042 to 0.0354), but not use of distraction (95% confidence interval: −0.0140 to 0.0137) or coping self-statements (95% confidence interval: −0.0075 to 0.0255).

Conclusion

The findings suggest that pain-specific resilience may promote adaptation and positive coping in PLWH and chronic pain.

High Resiliency Linked to Short-Term Patient Reported Outcomes and Return to Duty Following Arthroscopic Knee Surgery

Introduction

Resilience is a psychometric construct of a patient’s ability to recover from adversity and has been used to predict outcomes but its use in orthopedics has been limited. The purpose of this study was to examine the association between resilience and outcomes.

Materials and Methods

We performed a retrospective analysis of prospectively collected data of patient who underwent sports knee surgery at a single institution performed by 6 orthopedic surgeons from January 2017 to December 2017. We included active-duty patients with complete preoperative outcomes and a minimum of 6 month follow-up. All patients completed the Brief Resilience Scale (BRS), Veteran’s Rand-12 (VR-12), Patient-Reported Outcomes Measurement Information System 43 (PROMIS-43), International Knee Documentation Committee function score (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Patients were divided into low resilience (LR) and high resilience (HR) groups based on a score of less than 24 for low and greater than or equal to 24 according to BRS. Outcomes were then compared.

Results

We identified 50 active-duty patients who had complete preoperative and postoperative outcomes at a minimum of 6 months. Mean preoperative and postoperative BRS were significantly different (25.8 HR v 18.6 LR, p < 0.001). We found a difference in postop KOOS in pain, sports, and short form (pain 70.9 HR v 55.7 LR, p = 0.03; sports 50.3 HR v 32.2 LR, p = 0.03; short form (72.1 HR v 62.5 LR, p = 0.04). Similarly, there was a significant difference in postoperative IKDC score (58.0 HR v 44.0 LR, p = 0.03). Similarly we found significant differences in postoperative PROMIS-43 (anxiety 44.4 HR v 60.3 LR, p = 0.004; depression 41.6 HR v 58.1 LR, p = 0.004; fatigue 45.1 HR v 58.6 LR, p = 0.001; sleep 52.6 HR v 62.5 LR, p = 0.02; social participation 36.2 HR v 47.6 LR, p < 0.001). Postoperative VR-12 mental was also statistically different between the two groups (53.5 HR v 41.6 LR; p = 0.01). In addition, 2.3% of the HR group changed MOS as a result of their sports knee surgery compared to 22.2% of the LR group.

Conclusions

Active-military patients with high preoperative resilience appear to have significantly better early postoperative outcomes following sports knee surgery in terms of PROMIS-43, KOOS, and IKDC. There was also a lower rate of changing MOS secondary to sports knee surgery in patients with high resilience.

Does resiliency mediate the association of psychological adaptability with disability and pain in patients with an upper extremity injury or illness?

OBJECTIVE

Symptom intensity and magnitude of limitations are highly variable for a given nociception and pathophysiology. As psychological determinants are of great influence to physical wellbeing, we assessed the influence of the protective factor measured and labelled as resilience in upper extremity illness.

METHODS

One hundred and six patients completed a survey of demographics, the Brief Resilience Scale (BRS), the Psychological Adaptation Scale (PAS), an 11-point ordinal measure of pain intensity, and the PROMIS Physical Function (PROMIS PF) Computer Adaptive Test (CAT). Measures of pain intensity and PROMIS PF were repeated 3 months later. We created mediation models using structural equation modeling (SEM) to assess the mediation effect of BRS on the association of PAS and other confounding variables with disability and pain at initial assessment and 3 months later.

RESULTS

Resiliency does not mediate the association of psychological adaptability with physical limitations and pain intensity at baseline (P = .89 and .82 respectively) or 3 months after enrollment (P = .65 and .72 respectively).

CONCLUSIONS

Positive and protective factors promote beneficial resilience mechanisms that strengthen coping responses to pain and disability. In future studies we should either include more patients to improve power and provide more information about the health benefits of resilience or focus more on mood and self-efficacy on symptoms and limitations in patients with musculoskeletal illness.

LEVEL OF EVIDENCE

Prospective, longitudinal cohort study; Level II.

The effect of psychosocial measures of resilience and self-efficacy in patients with neck and lower back pain

BACKGROUND CONTEXT

Psychosocial risk factors may predispose to progression of back and neck pain to chronic pain or disability. Resilience (the ability to recover from stress) and pain self-efficacy (confidence that one can perform daily activities despite pain) are important psychometric properties shown to affect health and illness.

PURPOSE

To examine the relationships among resilience, pain self-efficacy, and disability in spine patients.

DESIGN/SETTING

Prospective, single-center orthopedic spine clinic.

PATIENT SAMPLE

One hundred and ninety five patients in a tertiary spine practice recruited between December 2016 and March 2017.

OUTCOME MEASURES

Self-reported measures: Brief Resilience Scale (BRS), Pain Self-Efficacy Questionnaire 2 (PSEQ-2) Short Form, Neck Disability Index (NDI), and Oswestry Disability Index (ODI).

METHODS

A prospective study was conducted of new patients visiting an orthopedic spine clinic complaining of neck pain or low back pain, with or without radiculopathy. Enrolled patients completed a survey of demographic information, the six-question BRS, the two-question PSEQ-2 Short Form, and NDI or ODI for neck or back pain, respectively. The relationship between BRS and NDI or ODI was examined, and the relationship between PSEQ-2 and NDI or ODI was also examined.

RESULTS

A total of 195 patients were evaluated. After excluding those with incomplete NDI or ODI, 180 patients were included in the analysis (46.1% men [83/180]; mean age 53 [standard deviation: 17] years). 139 (77.2%) subjects complained of low back pain and 41 (22.8%) subjects complained of neck pain. BRS was strongly negatively correlated with NDI (r=-0.61, p<.0001) and moderately negatively correlated with ODI (r=-0.34, p<.0001). PSEQ-2 was strongly negatively correlated with NDI (r=-0.69, p<.0001) and strongly negatively correlated with ODI (r=-0.62, p<.0001). BRS was moderately positively correlated with PSEQ-2 (r=0.36, p<.0001). For the low back pain cohort, the correlation between PSEQ-2 and ODI was significantly greater than the correlation between BRS and ODI (p=.0003); this difference was not noted in the neck pain cohort (p=.34).

CONCLUSIONS

Low resilience and low pain self-efficacy are both independently associated with greater functional disability in neck and low back pain patients. Spine surgeons may find it useful to incorporate the BRS and PSEQ-2 into preoperative assessment. Future studies should examine the utility of these simple validated questionnaires in predicting response to treatments, including surgical intervention.

Resilience, depression, and quality of life in elderly individuals with chronic pain followed up in an outpatient clinic in the city of São Paulo, Brazil

PURPOSE

In this study, we assessed resilience, depression, and quality of life in a group of elderly individuals with or without chronic pain.

PATIENTS AND METHODS

A cross-sectional study assessing elderly individuals followed up at a geriatrics outpatient clinic and divided into two groups: 54 elderly patients with chronic pain and 54 elderly with no chronic pain.

RESULTS

The sample comprised mainly women (67.6%), with mean age 79.9 years. The mean resilience index in the group with pain was 69.4 and, in the group with no pain, 80.1 (P<0.001). Depression was observed in 35.2% of patients with chronic pain; there was no case of depression in those without chronic pain. Quality of life of the elderly with chronic pain was worse in all the domains assessed: physical, mental, emotional, social, vitality, and pain.

CONCLUSION

In the study sample, resilience was lower, depression was more frequent, and quality of life was worse in the group of elderly with chronic pain.

The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain

PURPOSE

This study investigated the role of anxiety sensitivity, resilience, pain catastrophizing, depression, pain fear-avoidance beliefs, and pain intensity in patients with acute back pain-related disability.

METHOD

Two hundred and thirty-two patients with acute back pain completed questionnaires on anxiety sensitivity, resilience, pain catastrophizing, fear-avoidance beliefs, depression, pain intensity, and disability.

RESULTS

A structural equation modelling analysis revealed that anxiety sensitivity was associated with pain catastrophizing, and resilience was associated with lower levels of depression. Pain catastrophizing was positively associated with fear-avoidance beliefs and pain intensity. Depression was associated with fear-avoidance beliefs, but was not associated with pain intensity. Finally, catastrophizing, fear-avoidance beliefs, and pain intensity were positively and significantly associated with acute back pain-related disability.

CONCLUSION

Although fear-avoidance beliefs and pain intensity were associated with disability, the results showed that pain catastrophizing was a central variable in the pain experience and had significant direct associations with disability when pain was acute. Anxiety sensitivity appeared to be an important antecedent of catastrophizing, whereas the influence of resilience on the acute back pain experience was limited to its relationship with depression.

Resilience and Vulnerability Factors When Pain is Acute as Predictors of Disability: Findings From a Two-Year Longitudinal Study

OBJECTIVE

To investigate the predictive power of resilience and vulnerability factors in relation to pain-related disability.

DESIGN

A two-year prospective study investigated whether back pain-related disability was predicted by the following variables, measured when pain was acute: 1) pain-related disability, 2) pain intensity, 3) depression, 4) fear avoidance beliefs, 5) anxiety sensitivity, and 6) resilience.

METHODS

Two hundred thirty-two patients treated in five primary care centers participated in this study. They were assessed at baseline during an acute back pain episode and at six, 12, 18, and 24 months. Ninety-nine patients completed all the assessment sessions. Linear mixed models were used to examine the trajectory of disability across the measurement occasions and its association with the predictors.

RESULTS

Individuals who had higher scores of disability and pain intensity when pain was acute also had higher scores of disability six months later; moreover, the increase in disability was greater over time in comparison with individuals with lower scores in disability and pain intensity when pain was acute. Individuals who had reported greater levels of fear avoidance beliefs when pain was acute also reported greater scores of disability six months later; however, no differences were found in the rate of change in disability. No associations were found between initial disability or rate of change and resilience, anxiety sensitivity, or depression.

CONCLUSIONS

Patients with acute back pain who show high levels of pain-related disability, pain intensity, and fear avoidance beliefs are at risk of developing back pain-related disability and should be the target of a preventive intervention.

From acute to chronic back pain: Using linear mixed models to explore changes in pain intensity, disability, and depression

Background/aims

This longitudinal study investigated the pattern of change in pain intensity, disability, and depression in 232 chronic pain patients who were followed up for 2 years since pain onset. Most studies that have investigated changes in these variables over time have used participants who had already been in pain for more than 3 months. Few studies have followed up individuals from the acute phase onward and such studies used traditional statistical methods that cannot identify transition points over time or measure inter-individual variability.

Methods

We followed up individuals with chronic pain from pain onset up to 18 months and we examined their pain intensity, disability and depression trajectories using a modelling approach that allows to account for between and within-individual variability. We compared three patterns of change based on theoretical criterions: a simple linear growth model; a spline model with a 3-month transition point; and a spline model with a 6-month transition point. Time with pain was selected as time metric to characterise the change in these variables in the transition from acute to chronic pain. Sex and age differences were also examined.

Results

The results showed that the pain intensity trajectory was best represented by the spline model with a 3-month transition point, whereas disability and depression were best explained by linear growth models. There were sex differences at intercept level in all the models. There were age differences at baseline for pain intensity. No sex or age differences were found for the slope.

Conclusions

Pain intensity decreased in the first 3 months but underwent no further change. Disability and depression slightly but constantly decreased over time. Although women and older individuals are more likely to report higher pain intensity or pain-related disability in the first three months with pain, no differences by sex or age appear to be associated with the changes in pain intensity, depression and disability through the process of chronification.

Implications

Our findings suggest that pain chronification could be considered a continuous process and contribute to the ongoing discussion on the utility of standard classifications of pain as acute or chronic from a clinical point of view. Clinical and intervention decisions based in these standard classifications should consider the differences in the trajectories of pain related variables over time. In addition, this article illustrates a statistical procedure that can be of utility to pain researchers.

Towards a science and practice of resilience in the face of pain

The primary objective of this paper is to discuss how a resilience approach to (chronic) pain may advance our current understanding of (mal)adaptation to pain. Different resilience perspectives are described, and future challenges for research, prevention and treatment of (chronic) pain are discussed. Literature searches were performed in Web of Science and PubMed to identify relevant literature on risk and resilience in the context of pain. Resilience can be best defined as the ability to restore and sustain living a fulfilling life in the presence of pain. The Psychological Flexibility Model, the Broaden-and-Build Theory, and Self-Determination Theory are described as theories that may provide insight into resilience within the context of (chronic) pain. We describe how a resilience paradigm shifts the outcomes to pursue in pain research and intervention and argue the need for including positive outcomes in addition to negative outcomes. Psychological flexibility, positive affect and basic psychological needs satisfaction are described as potentially important resilience mechanisms with the potential to target both sustainability and recovery from pain. A resilience approach to chronic pain may have important implications for the prevention and treatment of chronic pain problems, as it may give specific indications on how to empower patients to continue living a fulfilling life (in the presence of pain).

SIGNIFICANCE

The resilience approach put forward in this review spotlights sustainability of positive outcomes (e.g. engagement in meaningful activities) in the presence of pain as an outcome to pursue beyond recovery of negative outcomes. We illuminate the evidence-base and practical application of promising resilience mechanisms (positive emotions, psychological flexibility, needs satisfaction). For this article, a commentary is available at the Wiley Online Library.

Psychological risk and protective factors for disability in chronic low back pain - a longitudinal analysis in primary care

Background

Utilizing psychological resources when dealing with chronic low back pain might aid the prevention of disability. The observational study at hand examined the longitudinal impact of resilience and coping resources on disability in addition to established risk factors.

Methods

Four hundred eighty four patients with chronic low back pain (>3 months) were recruited in primary care practices and followed up for one year. Resilience, coping, depression, somatization, pain and demographic variables were measured at baseline. At follow-up (participation rate 89%), data on disability was collected. We first calculated bivariate correlations of all the predictors with each other and with follow-up disability. We then used a multiple regression to evaluate the impact of all the predictors on disability together.

Results

More than half of the followed up sample showed a high degree of disability at baseline (53.7%) and had suffered for more than 10 years from pain (50.4%). Besides gender all of the predictors were bivariately associated with follow-up disability. However in the main analysis (multiple regression), disability at follow up was only predicted by baseline disability, age and somatization. There was no relationship between resilience and disability, nor between coping resources and disability.

Conclusions

Although it is known that there are cross-sectional relationships between resilience/coping resources and disability we were not able to replicate it in the multiple regression. This can have several reasons: a) the majority of patients in our sample were much more disabled and suffered for a longer time than in other studies. Therefore our results might be limited to this specific population and resilience and coping resources might still have a protective influence in acute or subacute populations. b) We used a rather broad operationalization of resilience. There is emerging evidence that focusing on more concrete sub facets like (pain) self-efficacy and acceptance might be more beneficial.

Trial registration

German Clinical Trial Register, DRKS00003123 (June 28th 2011).

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-017-1482-8) contains supplementary material, which is available to authorized users.

Psychological factors as risk factors for poor hip function after total hip arthroplasty

Recovery after total hip arthroplasty (THA) is influenced by several psychological aspects, such as depression, anxiety, resilience, and personality traits. We hypothesized that preoperative depression impedes early functional outcome after THA (primary outcome measure). Additional objectives were perioperative changes in the psychological status and their influence on perioperative outcome. This observational study analyzed depression, anxiety, resilience, and personality traits in 50 patients after primary unilateral THA. Hip functionality was measured by means of the Harris Hip Score. Depression, state anxiety, and resilience were evaluated preoperatively as well as 1 and 5 weeks postoperatively. Trait anxiety and personality traits were measured once preoperatively. Patients with low depression and anxiety levels had significantly better outcomes with respect to early hip functionality. Resilience and personality traits did not relate to hip functionality. Depression and state anxiety levels significantly decreased within the 5-week stay in the acute and rehabilitation clinic, whereas resilience remained at the same level. Our study suggests that low depression and anxiety levels are positively related to early functionality after THA. Therefore, perioperative measurements of these factors seem to be useful to provide the best support for patients with risk factors.

Resilience profile of patients with chronic pain

The aim of this study was to identify resilience profiles of patients with chronic pain. Using latent class analysis in a sample of 414 patients with chronic musculoskeletal pain, three profiles were identified: primary resilience (40%), consisting of individuals 40 years or younger with high education, who seek medical care, are not working, and without symptoms of psychological stress; secondary resilience (30%), consisting of women over 54 years of age with low schooling, who seek medical care, are not working, and with low likelihood of symptoms of psychological stress; tertiary resilience (29%), women with medium schooling, 40 to 54 years old, working, who do not seek medical care, and with a high likelihood of symptoms of psychological stress. The three profiles display different paths of resilience in chronic pain that are relevant to clinical practice, highlighting the importance of multidisciplinary care for patients with chronic pain.

Pain expectations in neuropathic pain: Is it best to be optimistic?

BACKGROUND

Pain expectancy may be an important variable that has been found to influence the effectiveness of treatments for pain. Much of the literature supports a self-fulfilment perspective where expectations for pain relief predict the actual pain experienced. However, in conditions such as neuropathic pain (NeP) where pain relief is difficult to attain, expectations for pain relief could be unrealistic. The objective of this study was to investigate the relationship between realistic/unrealistic expectations and 6-month, post-treatment outcomes.

METHODS

We performed a retrospective analysis of a large cohort of patients with NeP (n = 789) attending tertiary care centres to determine the association between unrealistic (both positive and negative) and realistic expectations with outcomes after multidisciplinary treatment. An expectation variable with three categories was calculated: realistic expectations were those whose expected reduction in pain was similar to the observed mean group reduction in pain, while optimistic and pessimistic expectations were those who over- or under-estimated the expected response to treatment, respectively. The association between baseline realistic/unrealistic expectations and 6-month pain-related disability, catastrophizing and psychological distress was assessed.

RESULTS

Univariable analyses suggested that realistic expectations were associated with lower levels of disability, catastrophizing and psychological distress, compared to unrealistic expectations. However, after adjustment for baseline symptom severity, multivariable analysis revealed that patients with optimistic expectations had lower levels of disability, than those with realistic expectations. Those with pessimistic expectations had higher levels of catastrophizing and psychological distress at follow-up.

CONCLUSIONS

These findings are largely congruent with the self-fulfilment perspective to expectations.

SIGNIFICANCE

This study defined realistic pain expectations with patient data. Examining the relationship between expectations between pain and disability in a large cohort of patients with neuropathic pain.

Resilience does not explain the dissociation between chronic pain and physical activity in South Africans living with HIV

Pain burden is high in people living with HIV (PLWH), but the effect of this pain on functionality is equivocal. Resilience, the ability to cope with adversity, may promote adaptation to pain, so we hypothesised that higher resilience would correlate with less pain-related impairment of activity. We recruited 197 black South African PLWH, 99 with chronic pain (CP) and 98 patients without. We measured pain intensity and interference using the Brief Pain Inventory, and resilience using the Resilience Scale. Participants were generally highly resilient. Greater resilience correlated with better health-related quality of life, but not with pain intensity or interference. We also measured physical activity objectively, by actigraphy, in a subset of patients (37 with chronic pain and 31 without chronic pain), who wore accelerometers for two weeks. There was no difference in duration or intensity of activity between those with and without pain, and activity was not associated with resilience. In this sample, pain was not associated with altered physical activity. Resilience did not explain differences in pain intensity or pain interference but was associated with improved quality of life. Financial stresses and the fear of HIV stigma may have driven patients to conceal pain and to suppress its expected impairment of activity.

Demoralization, Patient Activation, and the Outcome of Spine Surgery

It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified “risk” factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients. However, there are indications that the adverse impact of risk factors such as demoralization can be mitigated by psychosocial “maximizing” factors—characteristics that propel the patient towards positive surgical results. One of these maximizing factors, patient activation, is discussed in depth. The patient activation measure (PAM), an inventory assessing the extent to which patients are active and engaged in their health care, is associated not only with improved spine surgery results, but with better outcomes across a broad range of medical conditions. Other maximizing factors are discussed in this article. The author concludes that the past research focus on psychosocial risk factors has limited the value of presurgical psychological screening, and that future research, as well as clinical assessment, should recognize that the importance of evaluating patients’ strengths as well as their vulnerabilities.

Chronic Pain in Irish Prison Officers: Profile and Predictors of Pain-Related Disability and Depression

OBJECTIVE

International research has consistently found increased risk for physical health and psychological difficulties among prison officers including elevated risk of assault resulting in acute pain. This study represented an exploratory examination of the experience of chronic pain conditions among Irish prison officers with particular reference to the psychosocial predictors of pain severity, pain interference, and depression.

DESIGN

A questionnaire battery was completed by 152 Irish prison officers. The questionnaires measured pain severity and interference, anxiety, depression, social support, coping strategies, and resilience.

RESULTS

Results showed that 48% of participants reported chronic pain based on the International Association for the Study of Pain definition. Psychological distress was high among respondents reporting chronic pain, with 38% of participants meeting the criteria for "probable depression" while 51% met the criteria for "probable anxiety disorder." In regression analyses, depression emerged as a significant predictor of both pain severity and pain interference while anxiety and pain interference emerged as significant predictors of depression.

CONCLUSION

Chronic pain appears to be prevalent in prison officers and is associated with both physical and psychological impairment. Health care staff in correctional facilities should be aware that these health difficulties are prevalent in the prison work environment.

Psychometric properties of the Haitian Creole version of the Resilience Scale with a sample of adult survivors of the 2010 earthquake

BACKGROUND

Resilience is defined as the ability of people to cope with disasters and significant life adversities. The present paper aims to investigate the underlying structure of the Creole version of the Resilience Scale and its psychometric properties using a sample of adult survivors of the 2010 earthquake.

METHODS

A parallel analysis was conducted to determine the number of factors to extract and confirmatory factor analysis was performed using a sample of 1355 adult survivors of the 2010 earthquake from people of specific places where earthquake occurred with an average age of 31.57 (SD=14.42). All participants completed the Creole version of Resilience Scale (RS), the Impact of Event Scale Revised (IES-R), the Beck Depression Inventory (BDI) and the Social Support Questionnaire (SQQ-6). To facilitate exploratory (EFA) and confirmatory factor analysis (CFA), the sample was divided into two subsamples (subsample 1 for EFA and subsample 2 for CFA).

RESULTS

Parallel analysis and confirmatory factor analysis results showed a good-fit 3-factor structure. The Cronbach α coefficient was .79, .74 and .72 respectively for the factor 1, 2 and 3 and correlated to each other. Construct validity of the Resilience scale was provided by significant correlation with measures of depression and social support satisfaction, but no correlation was found with posttraumatic stress disorder measure, except for factor 2.

CONCLUSIONS

The results reveal a different factorial structure including 25 items of the RS. However, the Haitian Creole version of RS is a valid and reliable measure for assessing resilience for adults in Haiti.

Psychosocial Risk Factors, Interventions, and Comorbidity in Patients with Non-Specific Low Back Pain in Primary Care: Need for Comprehensive and Patient-Centered Care

Non-specific low back pain (LBP) affects many people and has major socio-economic consequences. Traditional therapeutic strategies, mainly focused on biomechanical factors, have had moderate and short-term impact. Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP. Primary health care providers (HCPs) are involved in most of the management of people with LBP and they are skilled in providing comprehensive care, including consideration of psychosocial dimensions. This review aims to discuss three pieces of recent research focusing on psychosocial issues in LBP patients in primary care. In the first systematic review, the patients' or HCPs' overall judgment about the likely evolution of LBP was the factor most strongly linked to poor outcome, with predictive validity similar to that of multidimensional scales. This result may be explained by the implicit aggregation of many prognostic factors underlying this judgment and suggests the relevance of considering the patients from biopsychosocial and longitudinal points of view. The second review showed that most of the interventions targeting psychosocial factors in LBP in primary care have to date focused on the cognitive-behavioral factors, resulting in little impact. It is unlikely that any intervention focusing on a single factor would ever fit the needs of most patients; interventions targeting determinants from several fields (mainly psychosocial, biomechanical, and occupational) may be more relevant. Should multiple stakeholders be involved in such interventions, enhanced interprofessional collaboration would be critical to ensure the delivery of coordinated care. Finally, in the third study, the prevalence of psychosocial comorbidity in chronic LBP patients was not found to be significantly higher than in other patients consulting in primary care. Rather than specifically screening for psychosocial conditions, this suggests taking into account any potential comorbidity in patients with chronic LBP, as in other patients. All these results support the adoption of a more comprehensive and patient-centered approach when dealing with patients with LBP in primary care. As this condition is illustrative of many situations encountered in primary care, the strategies proposed here may benefit most patients consulting in this setting.

Even Worse - Risk Factors and Protective Factors for Transition from Chronic Localized Low Back Pain to Chronic Widespread Pain in General Practice: A Cohort Study

STUDY DESIGN

Prospective cohort study with patients with chronic low back pain (CLBP) at primary care setting.

OBJECTIVE

The aim of our study was to identify predictors for transition from localized CLBP to chronic widespread pain in general practice. In contrast to the typically investigated risk factors, this study also focuses intensively on protective factors, which decrease the probability of chronic widespread pain. For this, we investigated the resources resilience and coping strategies, which are suspected as potential protective factors for incident chronic pain syndromes.

SUMMARY OF BACKGROUND DATA

In primary care, about a quarter of patients with CLBP experience chronic widespread pain (CWP).

METHODS

Patients experiencing localized CLBP were included and evaluated after a 6- and 12-month follow-up period regarding the development of CWP. Potential risk factors (sociodemographic data, pain characteristics, depression, anxiety, somatization), protective factors (resilience, coping strategies), and sample characteristics were assessed at baseline. Predictor identification was done by multivariate logistic regression analysis.

RESULTS

The 1-year incidence for the onset of CWP among patients with CLBP was 23.8%. We identified the 3 risk factors, female sex, long duration of back pain, and a high rate of psychosomatic symptoms, for the onset of CWP among patients with CLBP. Coping resources and resilience had no impact on the transition from CLBP to CWP.

CONCLUSION

The results suggest that CWP is no independent entity but rather a particularly negative occurrence on a continuum of chronic pain. Processes of somatization play a major role in the development of this extreme.

LEVEL OF EVIDENCE

2.

[Coping resources in a sample of chronic low back pain patients. Evaluation of the questionnaire for back pain]

BACKGROUND

The coping resources questionnaire for back pain (FBR) uses 12 items to measure the perceived helpfulness of different coping resources (CRs, social emotional support, practical help, knowledge, movement and relaxation, leisure and pleasure, spirituality and cognitive strategies). The aim of the study was to evaluate the instrument in a clinical patient sample assessed in a primary care setting.

SAMPLE AND METHODS

The study was a secondary evaluation of empirical data from a large cohort study in general practices. The 58 participating primary care practices recruited patients who reported chronic back pain in the consultation. Besides the FBR and a pain sketch, the patients completed scales measuring depression, anxiety, resilience, sociodemographic factors and pain characteristics. To allow computing of retested parameters the FBR was sent to some of the original participants again after 6 months (90% response rate). We calculated consistency and retest reliability coefficients as well as correlations between the FBR subscales and depression, anxiety and resilience scores to account for validity. By means of a cluster analysis groups with different resource profiles were formed. Results.

RESULTS

For the study 609 complete FBR baseline data sets could be used for statistical analysis. The internal consistency scores ranged fromα=0.58 to α=0.78 and retest reliability scores were between rTT=0.41 and rTT=0.63. Correlation with depression, fear and resilience ranged from r=-0.38 to r=0.42. The cluster analysis resulted in four groups with relatively homogenous intragroup profiles (high CRs, low spirituality, medium CRs, low CRs). The four groups differed significantly in fear and depression (the more inefficient the resources the higher the difference) as well as in resilience (the more inefficient the lower the difference). The group with low CRs also reported permanent pain with no relief. The groups did not otherwise differ.

CONCLUSIONS

The FBR is an economic instrument that is suitable for practical use e.g. in primary care practices to identify strengths and deficits in the CRs of chronic pain patients that can then be specified in face to face consultation. However, due to the rather low reliability, the use of subscales for profile differentiation and follow-up measurement in individual diagnoses is limited.

A confirmatory factor analysis of the Resilience Scale adapted to chronic pain (RS-18): new empirical evidence of the protective role of resilience on pain adjustment

PURPOSE

Recent attention has focused on resilience as an important process in the experience and management of chronic pain. In this context, resilience is considered as a psychological factor that promotes adaptive responses to pain and pain-related life adversities. Current research suggests that it is a relevant variable in the prediction of pain adjustment among chronic pain patients. Recently, it was adapted the Resilience Scale to patients suffering chronic musculoskeletal pain (RS-18). The aims of this study were to confirm the internal structure of the RS-18 and to present new empirical evidence regarding its validity.

METHODS

A sample of 592 patients with chronic musculoskeletal back pain completed a battery of instruments to assess resilience, anxiety sensitivity, catastrophizing, fear-avoidance beliefs, hypervigilance, pain acceptance, and pain adjustment variables (pain intensity, emotional distress, functional impairment, and daily functioning).

RESULTS

Confirmatory factor analysis supported the validity of the RS-18 and a single-factor solution. A series of moderated multiple regression analysis showed that resilience is a relevant psychological variable that not only independently predicts better pain adjustment, but also moderates the relationships between several psychological pain-related variables and pain adjustment variables.

CONCLUSIONS

These findings give empirical support to the consideration of resilience as a protective variable in chronic pain adjustment and highlight the consideration that improving resilient behaviour could be an important target for the treatment of pain patients.

The role of experiential avoidance, resilience and pain acceptance in the adjustment of chronic back pain patients who have experienced a traumatic event: a path analysis

BACKGROUND

The degree to which shared vulnerability and protective factors for chronic pain and trauma-related symptoms contribute to pain adjustment in chronic pain patients who have experienced a traumatic event remains unclear.

PURPOSE

The purpose is to test a hypothetical model of the contribution of experiential avoidance, resilience and pain acceptance to pain adjustment in a sample of 229 chronic back pain patients who experienced a traumatic event before the onset of pain.

METHODS

Structural equation modelling was used to test the linear relationships between the variables.

RESULTS

The empirical model shows significant relationships between the variables: resilience on pain acceptance and trauma-related symptoms, experiential avoidance on trauma-related symptoms and experiential avoidance, pain acceptance and trauma-related symptoms on pain adjustment.

CONCLUSIONS

This study demonstrates the role of a vulnerability pathway (i.e. experiential avoidance) and a protective pathway (i.e. resilience and pain acceptance) in adaptation to pain after a traumatic event.

Validity and reliability of the Spanish version of the 10-item CD-RISC in patients with fibromyalgia

Background

No resilience scale has been validated in Spanish patients with fibromyalgia. The aim of this study was to evaluate the validity and reliability of the 10-item CD-RISC in a sample of Spanish patients with fibromyalgia.

Methods

Design: Observational prospective multicenter study. Sample: Patients with diagnoses of fibromyalgia recruited from primary care settings (N = 208). Instruments: In addition to sociodemographic data, the following questionnaires were administered: Pain Visual Analogue Scale (PVAS), the 10-item Connor-Davidson Resilience scale (10-item CD-RISC), the Fibromyalgia Impact Questionnaire (FIQ), the Hospital Anxiety and Depression Scale (HADS), the Pain Catastrophizing Scale (PCS), the Chronic Pain Acceptance Questionnaire (CPAQ), and the Mindful Attention Awareness Scale (MAAS).

Results

Regarding construct validity, the factor solution in the Principal Component Analysis (PCA) was considered adequate, so the KMO test had a value of 0.91, and the Barlett’s test of sphericity was significant (χ2 = 852.8; gl = 45; p < 0.001). Only one factor showed an eigenvalue greater than 1, and it explained 50.4% of the variance. PCA and Confirmatory Factor Analysis (CFA) results did not show significant differences between groups. The 10-item CD-RISC scale demonstrated good internal consistency (Cronbach’s alpha = 0.88) and test-retest reliability (r = 0.89 for a six-week interval). The 10-item CD-RISC score was significantly correlated with all of the other psychometric instruments in the expected direction, except for the PVAS (−0.115; p = 0.113).

Conclusions

Our study confirms that the Spanish version of the 10-item CD-RISC shows, in patients with fibromyalgia, acceptable psychometric properties, with a high level of reliability and validity.

Resilience does matter: evidence from a 10-year cohort record linkage study

OBJECTIVES

To examine 10-year mortality and hospital use among individuals categorised as resilient and vulnerable to the impact of chronic pain.

DESIGN

A cohort record linkage study.

SETTING

Grampian, Scotland.

PARTICIPANTS

5858 individuals from the Grampian Pain Cohort, established in 1996, were linked, by probability matching, with national routinely collected datasets.

MAIN OUTCOME MEASURES

HRs for subsequent 10-year mortality and ORs/incidence rate ratios for subsequent 10-year hospital use, each with adjustment for potential confounding variables.

RESULTS

36.5% of those with high pain intensity reported a low pain-related disability (categorised resilient) and 7.1% of those reporting low pain intensity reported a high pain-related disability (categorised vulnerable). Sex, age, housing, employment and long-term limiting illness were independently associated with being vulnerable or resilient. After adjustment for these variables, individuals in the resilient group were 25% less likely to die within 10 years of the survey compared with non-resilient individuals: HR 0.75, 95% CI 0.62 to 0.91 and vulnerable individuals were 45% more likely to die than non-vulnerable individuals: HR 1.45, 95% CI 1.01 to 2.11. Resilient individuals were less likely to have had an outpatient or day-case visit for anaesthetics: OR 0.46, 95% CI 0.27 to 0.79, but no other clinical specialities. Vulnerable individuals were significantly less likely to have had any outpatient or day-case visit (OR 0.43, 0.25 to 0.75); but more likely to have had a psychiatric visit (OR 1.96, 1.06 to 3.61). No significant differences in likelihood of any inpatient visits were found.

CONCLUSIONS

Resilient individuals have a better 10-year survival than non-resilient individuals indicating that resilience is a phenomenon worth researching. Further research is needed to explore who is likely to become resilient, why and how, as well as to tease out the internal and external factors that influence resilience.

Disposition and adjustment to chronic pain

Several empirical studies have shown that personal characteristics act as differential variables, which determine how pain is experienced and how the chronic pain patient adjusts to pain. The main aim of the present research is to review the relationships between some dispositional characteristics and pain adjustment. Taking into account the empirical literature, 6 personality traits that are relevant to the pain experience have been selected: neuroticism, anxiety sensitivity, and experiential avoidance as risk factors that increase the probability of patients experiencing a disability; and extraversion, optimism, and resilience as personal resources that increase their capacity to manage pain effectively. The results suggest that it would be useful to include an assessment of normal personality structure during the multi-dimensional evaluation of a person with chronic pain. Understanding these individual personality characteristics will aid in designing pain intervention programs and help predict possible treatment outcomes.

Variability Over Time-Since- Diagnosis in the Protective Effect of Psychological Resilience Against Depression in Australian Prostate Cancer Patients

Although there is some evidence that psychological resilience may “buffer” against depression following major stressors, no data have been reported on the nature and variability of this buffering effect among prostate cancer patients during the 5 years following their initial diagnosis. Patients from two sites in Australia and who had received their initial diagnosis within 5 years ( n = 255) were surveyed, and the results indicated that there was a significant inverse relationship between resilience and depression in the overall data, but that was mostly accounted for by a single factor of the resilience scale (“Confidence to cope with change”). Variability in that buffering effect was noted over time since diagnosis, with peaks during the first 6 months, at 24 and 60 months. These findings support the argument to develop focused psychiatric interventions at various periods following a diagnosis of prostate cancer.

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.