Introduction
Readers of this blogpost are all aware of the huge impact that chronic pain has on both personal lives and society as a whole. The numbers speak for themselves and point to the urgent need for improvements in the ways we conceptualize pain in our theoretical frameworks and how this works out in clinical practice. Although we are catching up on pain and definitely know much more than a few decades ago, we still need new ideas an so we need to explore more or less un-(der)explored areas and ideas.
One of such ‘areas to explore’ has recently been reviewed very nicely by Goubert and Trompetter (Goubert and Trompetter 2017) who summarize in their article the literature about ‘the science and practice of resilience in pain’. Not only consists this review of a comprehensive and insightful exploration of the field, the authors also make a convincing plea to add these insights to our current thinking and doing within the field of pain rehabilitation.
Goubert and Trompetter depart from the observation that in the population of people with chronic pain there seems to be a subgroup that combines high pain intensity with relative low disability levels. These people seem to be able to ‘deal’ with their pain rather well and show some ‘resilience’ that other people in pain can’t. People with high resilience have typically lower pain related fear, lesser catastrophizing beliefs about their pain and lower self-reported disability. Besides that, they seem more often to be optimists, experience high levels of control and are enjoying strong social support. Out of these observations, the authors take the reader on a way to the definition of resilience, its characteristics and its role in (chronic) pain theory and its consequences for pain rehabilitation.
In this blogpost, I will summarize the common thread of the article and hope that it will facilitate readers to go for the real thing!
Resilience
Resilience (in pain) is defined as ‘the ability to restore and sustain living a fulfilling life in the presence of pain’. People living with pain can be more or less ‘resilient’ and can, as a consequence, have better abilities to cope with their pain. At first sight, this seems to be something that we already know and it seems that nothing ‘new’ is put forward by the term ‘resilience’. However, Goubert and trompetter make in their definition a difference between ‘restoration’ and ‘sustainability’. ‘Restoration’ is about the process that ultimately leads to recovery after a traumatic or stressful event. The term ‘sustainability’ stands for the ‘ability of a person to move towards long-term positive outcomes in life in the presence of adversity’. Resilience is about living an optimal emotional, psychological and social life in the presence of pain and involves much more than the absence of negative outcomes like disability and distress.
Although both terms seem to be just two different sides of the same coin, the authors show that the two terms are related, but not each others opposite. Sustainability is more than recovery and is for this reason an important addition to pain theory.
This leads to the conclusion that in thinking about pain not only ‘negative outcomes’, factors that stand in the way, on a road to recovery, but that also ‘positive outcomes’, factors that facilitate flourishing and positive life goals, should be brought to the pain ‘rehabilitation-table’. Examples of such positive outcomes that are mentioned in the text are for instance: engagement in value-based activities, psychological well-being, vitality and contribution to society.
Resources and mechanisms
Goubert and Trompetter discuss three psychological theories that bear close relationships with the term ‘resilience’. These are 1) the psychological flexibility model, 2) the broaden-and-build theory (about the role of affect) and 3) The self determination theory (about the role of psychological needs satisfaction). All these models show how aspects of resilience are constructed and how these can be translated into the practice of pain rehabilitation. Both risk and resilience mechanisms should be considered in pain treatment and current treatment philosophies should be further enriched with resilience resources.
To illustrate this, the authors take the Fear-Avoidance Model as an example of an important theory underlying many treatment regimes for people with chronic pain. Within this theory there is a strong emphasis on emotional (fear), cognitive (catastrophizing) and behavioural (avoidance) factors that are all risks for creating disability. Influencing these risk factors and minimizing their role in disability processes leads to restoration and are of course important. Emphasizing the role of acceptance, optimism, psychological need satisfaction, positive affect, personal values and social support would however enrich current rehabilitation practice and can lead to engagement in values-based activities and optimal emotional, psychological and social well-being.
Relevance
The article of Goubert and Trompetter is – in my opinion – important as it points to the need to broaden current thinking and doing in the field of chronic pain rehabilitation. The authors show that there is already a firm theoretical framework about resilience build on empirical studies. In the future this framework should be enriched and its practical consequences should be further explored in clinical research.
Lennard Voogt
2017 Pain in Motion
References and further reading:
Goubert, L., & Trompetter, H. (2017). Towards a science and practice of resilience in the face of pain. Eur J Pain, 21(8), 1301-1315.
