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Resilience: A New Paradigm for Adaptation to Chronic Pain

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Abstract

Chronic pain is an affliction that affects a large proportion of the general population and is often accompanied by a myriad of negative emotional, cognitive, and physical effects. 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.

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References

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  1. Gatchel RJ, Peng YB, Peters ML, et al.: The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull 2007, 133:581–624.

    Article  PubMed  Google Scholar 

  2. Brown GK, Nicassio PM, Wallston KA: Pain coping strategies and depression in rheumatoid arthritis. J Consult Clin Psychol 1989, 57:652–657.

    Article  CAS  PubMed  Google Scholar 

  3. Marks R: Obesity profiles with knee osteoarthritis: correlation with pain, disability, disease progression. Obesity (Silver Spring) 2007, 15:1867–1874.

    Article  Google Scholar 

  4. Sullivan MJL, Bishop SR, Pivik J: The Pain Catastrophizing Scale: development and validation. Psychol Assess 1995, 7:524–532.

    Article  Google Scholar 

  5. Zautra AJ, Hamilton NA, Burke HM: Comparison of stress responses in women with two types of chronic pain: fibromyalgia and osteoarthritis. Cognit Ther Res 1999, 23:209–230.

    Article  Google Scholar 

  6. Zautra AJ, Yocum DC, Villanueva I, et al.: Immune activation and depression in women with rheumatoid arthritis. J Rheumatol 2004, 31:457–463.

    CAS  PubMed  Google Scholar 

  7. Carr DB, Goudas LC: Acute pain. Lancet 1999, 353:2051–2058.

    Article  CAS  PubMed  Google Scholar 

  8. Charney DS: Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am J Psychiatry 2004, 161:195–216.

    Article  PubMed  Google Scholar 

  9. McEwen BS, Stellar E: Stress and the individual: mechanisms leading to disease. Arch Intern Med 1993:2093–2101.

  10. Luthar SS, Cicchetti D, Becker B: The construct of resilience: a critical evaluation and guidelines for future work. Child Dev 2000, 71:543–562.

    Article  CAS  PubMed  Google Scholar 

  11. •• Handbook of Adult Resilience. Edited by Reich JW, Zautra AJ, Hall JS. New York: Guilford Press; 2010. This book provides an updated and comprehensive overview of the construct of resilience and proposes a 3-factor model of resilience, including recovery, sustainability, and growth.

  12. Rutter M: Psychosocial resilience and protective mechanisms. Amer J Orthopsychiatry 1987, 57:316–331.

    Article  CAS  Google Scholar 

  13. • Smith BW, Dalen J, Wiggins K, et al.: The brief resilience scale: assessing the ability to bounce back. Int J Behav Med 2008, 15:194–200. This article identifies recovery as a key concept related to, but still independent of, the construct of resilience. The implications of differences in individual resilience for health-related outcomes are also discussed.

    Article  PubMed  Google Scholar 

  14. •• Smith BW, Zautra AJ: Vulnerability and resilience in women with arthritis: test of a two-factor model. J Consult Clin Psychol 2008, 76:799–810. This article provides a delineation of the features of an affective health/resilience construct and tests resilience in a sample of chronic pain patients as a predictor of key social and emotional outcomes.

    Article  PubMed  Google Scholar 

  15. • Smith BW, Tooley EM, Montague EQ, et al.: The role of resilience and purpose in life in habituation to heat and cold pain. J Pain 2009, 10:493–500. This experimental article is among the first to test the utility of resilience as a coping mechanism to pain, and provides broader implications to the role of resilience in coping with both acute and chronic pain.

    Article  PubMed  Google Scholar 

  16. Scheier MF, Carver CS, Bridges MW: Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. J Pers Soc Psychol 1994, 67:1063–1078.

    Article  CAS  PubMed  Google Scholar 

  17. Steptoe A, Wright C, Kunz-Ebrecht SR, Iliffe S: Dispositional optimism and health behavior in community-dwelling older people: associations with healthy ageing. Br J Health Psychol 2006, 11:71–84.

    Article  PubMed  Google Scholar 

  18. Ferreira VM, Sherman AM: The relationship of optimism, pain and social support to well-being in older adults with osteoarthritis. Aging Ment Health 2007, 11:89–98.

    Article  CAS  PubMed  Google Scholar 

  19. Treharne GJ, Kitas GD, Lyons AC, et al.: Well-being in rheumatoid arthritis: the effects of disease duration and psychosocial factors. J Health Psychol 2005, 10:457–474.

    Article  PubMed  Google Scholar 

  20. Lightsey OR: Resilience, meaning, and well-being. Couns Psychol 2006, 34:96–107.

    Article  Google Scholar 

  21. Ryff CD: Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989, 57:1069–1081.

    Article  Google Scholar 

  22. Smith BW, Zautra AJ: The role of purpose in life in recovery from knee surgery. Int J Behav Med 2004, 11:197–202.

    Article  PubMed  Google Scholar 

  23. McCracken LM, Eccleston C: A prospective study of acceptance of pain and patient functioning with chronic pain. Pain 2005, 118:164–169.

    Article  PubMed  Google Scholar 

  24. McCracken LM: Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain 1998, 74:21–27.

    Article  CAS  PubMed  Google Scholar 

  25. Esteve R, Ramirez-Maestre C, Lopez-Martinez AE: Adjustment to chronic pain: the role of pain acceptance, coping strategies, and pain-related cognitions. Ann Behav Med 2007, 33:179–188.

    Article  PubMed  Google Scholar 

  26. Elander J, Robinson G, Mitchell K, et al.: An assessment of the relative influence of pain coping, negative thoughts about pain, and pain acceptance on health-related quality of life among people with hemophilia. Pain 2009, 145:169–175.

    Article  PubMed  Google Scholar 

  27. Kratz AL, Davis MC, Zautra AJ: Pain acceptance moderates the relation between pain and negative affect in osteoarthritis and fibromyalgia patients. Ann Behav Med 2007, 33:291–301.

    Article  PubMed  Google Scholar 

  28. Zautra AJ, Johnson LM, Davis MC: Positive affect as a source of resilience for women in chronic pain. J Consult Clin Psychol 2005, 73:212–220.

    Article  PubMed  Google Scholar 

  29. Stone AA, Neale JM, Cox DS, et al.: Daily events are associated with a secretory immune response to an oral antigen in men. Health Psychol 1994, 13:440–446.

    Article  CAS  PubMed  Google Scholar 

  30. Cohen S, Alper CM, Doyle WJ, et al.: Positive emotional style predicts resistance to illness after experimental exposure to rhinovirus or influenza A virus. Psychosom Med 2006, 68:809–815.

    Article  PubMed  Google Scholar 

  31. Fredrickson BL: What good are positive emotions? Rev Gen Psychol 1998, 2:300–319.

    Article  Google Scholar 

  32. Davis MC, Zautra AJ, Smith BW: Chronic pain, stress, and the dynamics of affective differentiation. J Pers 2004, 72:1133–1159.

    Article  PubMed  Google Scholar 

  33. Ong AD, Zautra AJ, Reid MC: Psychological resilience predicts decreases in pain catastrophizing through positive emotions. Psychol Aging 2010 (under editorial review).

  34. Ong AD, Bergeman CS, Bisconti TL, Wallace KA: Psychological resilience, positive emotions, and successful adaptation to stress in later life. J Pers Soc Psychol 2006, 91:730–749.

    Article  PubMed  Google Scholar 

  35. Strand EB, Zautra AJ, Thoresen M, et al.: Positive affect as a factor of resilience in the pain-negative affect relationship in patients with rheumatoid arthritis. J Psychosom Res 2006, 60:477–484.

    Article  PubMed  Google Scholar 

  36. Feldman-Barrett L, Gross J, Conner-Christensen T, et al.: Knowing what you’re feeling and knowing what to do about it: mapping the relation between emotion differentiation and emotion regulation. Cogn Emot 2001, 15:713–724.

    Article  Google Scholar 

  37. McFarland C, Buehler R: The impact of negative affect on autobiographical memory: the role of self-focused attention to moods. J Pers Soc Psychol 1998, 75:1424–1440.

    Article  CAS  PubMed  Google Scholar 

  38. Snow-Turek AL, Norris MP, Tan G: Active and passive coping strategies in chronic pain patients. Pain 1996, 64:455–462.

    Article  CAS  PubMed  Google Scholar 

  39. Strahl C, Kleinknecht RA, Dinnel DL: The role of pain anxiety, coping, and pain self-efficacy in rheumatoid arthritis patient functioning. Behav Res Ther 2000, 38:863–873.

    Article  CAS  PubMed  Google Scholar 

  40. Karoly P, Ruehlman LS: Psychological “resilience” and its correlates in chronic pain: findings from a national community sample. Pain 2006, 123:90–97.

    Article  PubMed  Google Scholar 

  41. Mikolajczak M, Roy E, Luminet O, de Timary P: Resilience and hypothalamic-pituitary-adrenal axis reactivity under acute stress in young men. Stress 2008, 11:477–482.

    Article  PubMed  Google Scholar 

  42. Jensen MP, Turner JA, Romano JM: Self-efficacy and outcome expectancies: relationship to chronic pain coping strategies and adjustment. Pain 1991, 44:263–269.

    Article  CAS  PubMed  Google Scholar 

  43. Bower JE, Moskowitz JT, Epel E: Is benefit finding good for your health? Pathways linking positive life changes after stress and physical health outcomes. Curr Dir Psychol Sci 2009, 18:337–341.

    Article  Google Scholar 

  44. Cacioppo J, Reis H, Zautra AJ: Social resilience. Am Psychol 2010 (under editorial review).

  45. Davis MC, Zautra AJ, Reich JW: Vulnerability to stress among women in chronic pain from fibromyalgia and osteoarthritis. Ann Behav Med 2001, 23:215–226.

    Article  CAS  PubMed  Google Scholar 

  46. Wright LJ, Zautra AJ, Going S: Adaptation to early knee osteoarthritis: the role of risk, resilience, and disease severity on pain and physical functioning. Ann Behav Med 2008, 36:70–80.

    Article  PubMed  Google Scholar 

  47. Davis MC, Affleck G, Zautra AJ, Tennen H: Daily interpersonal events in pain patients: applying action theory to chronic illness. J Clin Psychol 2006, 62:1097–1113.

    Article  PubMed  Google Scholar 

  48. Keyes CL: The black-white paradox in health: flourishing in the face of social inequality and discrimination. J Pers 2009, 77:1677–1706.

    Article  PubMed  Google Scholar 

  49. Gallo LC, Penedo FJ, Espinosa de los Monteros K, Arguelles W: Resilience in the face of disadvantage: do Hispanic cultural characteristics protect health outcomes? J Pers 2009, 77:1707–1746.

    Article  PubMed  Google Scholar 

  50. Sheffer CE, Cassisi JE, Ferraresi LM, et al.: Sex differences in the presentation of chronic low back pain. Psychol Women Q 2002, 26:329–340.

    Article  Google Scholar 

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Acknowledgments

The two authors contributed equally to this work. They wish to thank Billie Sandberg and members of the Resilience Solutions Group (RSG). The members of the RSG, in addition to the authors of this article, are, in alphabetical order: Leona Aiken, Felipe Castro, Mary Davis, John Hall, Roger Hughes, Martha Kent, Rick Knopf, Kathy Lemery, Linda Luecken, Kate Murray, Morris Okun, and John Reich. This work is supported in part by a grant from the National Institute on Aging (R01 AG 026006), Alex Zautra (PI), John Hall (Co-PI). In addition, the authors are grateful to St. Luke’s Charitable Trust and the Arizona State University Office of the Vice President for Research for invaluable support of the RSG.

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Correspondence to Alex J. Zautra.

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Sturgeon, J.A., Zautra, A.J. Resilience: A New Paradigm for Adaptation to Chronic Pain. Curr Pain Headache Rep 14, 105–112 (2010). https://doi.org/10.1007/s11916-010-0095-9

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