Resilience and Vulnerability in Individuals With Chronic Pain and Physical Disability

Objective: To examine the independent contributions of vulnerability and resilience factors to pain interference, self-efficacy for managing pain, global mental health, and global physical health. Research Method/Design: Secondary analysis of baseline data from individuals with a spinal cord injury (n = 73), amputation (n = 33), or multiple sclerosis (n = 82) and chronic pain who participated in a randomized controlled trial comparing 2 chronic pain interventions. Participants completed a comprehensive battery of pain-related outcomes that assessed for both psychosocial assets and maladaptive cognitions and behaviors. Results: Results suggested that vulnerability and resilience factors together account for a considerable amount of variance in the physical outcomes, but that neither set of factors was able to make a substantial contribution above and beyond the other. In contrast, for mental health related outcomes, results indicated that resilience factors did make a meaningful contribution above and beyond vulnerability factors, suggesting the important contribution of resilience factors to the psychological experience of chronic pain. Conclusions: The present study suggested a valuable contribution of both resilience and vulnerability factors to pain outcomes, with the additional caveat that resilience factors uniquely impact specific outcomes-particularly those that are more psychosocially focused-above and beyond vulnerability factors. Taken together, this highlights the importance of considering resilience factors in addition to vulnerability factors for individuals with chronic pain. Additional research is needed to explore other factors that could be considered representative of the resilience construct and more attention should be focused on evaluating the effects of interventions that seek to build an individual's assets. Impact and Implications This is the first study to simultaneously examine the independent contributions of vulnerability and resilience factors to pain-related outcomes, including how resilience factors relate to adaptive coping and buffer against negative consequences for those living with chronic pain and physical disability. Results suggested that both vulnerability and resilience factors account for a substantial amount of variance in physical outcomes, but that neither set of factors was able to make a meaningful contribution above and beyond the other. In contrast, for mental health oriented outcomes, results indicated that resilience factors did make a meaningful contribution above and beyond vulnerability factors, suggesting the important contribution of resilience factors to the psychological experience of chronic pain. Given that resilience factors make a unique contribution to pain-related outcomes, it is important for future research to examine how best to address these psychosocial assets in addition to maladaptive cognitions and behaviors.