Resilience to Chronic Pain – Can It Be Predicted?

Resilience to Chronic Pain – Can It Be Predicted?

Stanford University has been conducting an online study of resilience in chronic pain.

stanford_medicine_logoA few weeks ago, Stanford researchers asked the National Pain Report if it would be ok to ask our readers to participate in the survey. We thought it was a good idea, and so apparently did our audience. The response to the surveys was swift.

“We received a remarkable number of responses and met our recruitment goal in less than two days,” said Dr. Drew Sturgeon, a post-doctoral fellow at the Stanford University School of Medicine. “In total, we received full responses from 336 participants in the first wave of our study (in January) and 346 participants in the second wave of our study (in April), which has provided us an excellent sample for our analysis.”

We checked in with Dr. Sturgeon recently to see what the results are saying about how those who suffer from pain deal with their condition.

The data are undergoing a rigorous review and Dr. Sturgeon said it may be several months until final conclusions are printed. But he indicated that there is valuable information that may guide not only future treatment models, but also may help predict how someone will react to a chronic pain condition.

Said Dr. Sturgeon:

Dr. Drew Sturgeon

Dr. Drew Sturgeon

“Though our analysis of the data is still ongoing, our results thus far broadly suggest that we have been able to develop a tool that effectively quantifies and studies resilience in chronic pain.  Our preliminary data suggest that resilience is related to other important aspects of the experience of chronic pain, such as physical function, fatigue, and mood, but is also something distinct from these measures.  We believe that this is an exciting finding, as it may suggest that resilience to pain is a useful target for future therapies.”

He reminded us in a phone conversation recently that resilience in chronic pain is understudied and its impact is underappreciated. In clinical practice, it is often noted that some individuals struggle with chronic pain, while others find effective means to cope.

Can this research ultimately lead to ways to help chronic pain sufferers to better endure their condition? Dr. Sturgeon hopes so.

“We intend to use our data to refine our measure of chronic pain resilience, and ultimately to develop an intervention that will help people develop greater resilience, which we believe will improve well-being and overall quality of life for people facing chronic or recurrent pain,” he said.

Stanford’s related work on the psychology of chronic pain suggests that pain can significantly disrupt a person’s physical abilities by increasing their level of fatigue (Sturgeon, Darnall, Kao, & Mackey, 2014), but can also decrease emotional well-being by affecting social relationships (Sturgeon, Zautra, & Arewasikporn, 2014) and how pain is perceived or interpreted (Sturgeon & Zautra, 2013a, 2013b).

“Our prior work (Sturgeon, Yeung, & Zautra, 2014; Sturgeon & Zautra, 2010, 2013a) also suggests that paying more attention to these areas, such as finding ways to change the interpretation or relationship of a person with his or her pain, increasing positive social interactions and positive mood, and addressing issues with fatigue may help us to increase resilience and ultimately improve quality of life in those people who are dealing with chronic pain,” he wrote. (The research references in this article are seen at the end of the story).

Dr. Sturgeon was grateful for the National Pain Report audience for the quick and in depth response.

“I would first like to offer my sincere thanks to everyone who participated,” he said. “We received responses from a variety of people who have had very different experiences with their chronic pain- this is what we hoped to achieve, as we wanted to ensure that our questionnaire is applicable to a wide range of experiences.”

Editor’s Note: Two columns written by Dr. Sturgeon on the Stanford research and its request to National Pain Report readers have been published. One was published on January 13th and the more recent one on April 1st.

As the research findings are reviewed and published, we will do additional stories on this work. We are glad to have helped Stanford and look forward to more work together in the future.

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Here are the research references Dr. Sturgeon cited in his response to National Pain Report.



Sturgeon, J. A., Darnall, B. D., Kao, M.-C. J., & Mackey, S. C. (2014). Physical and Psychological Correlates of Fatigue and Physical Function: A Stanford-NIH Open Source Pain Registry Study. The Journal of Pain.

Sturgeon, J. A., Yeung, E. W., & Zautra, A. J. (2014). Respiratory sinus arrhythmia: a marker of resilience to pain induction. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t]. International Journal of Behavioral Medicine, 21(6), 961-965. doi: 10.1007/s12529-014-9386-6

Sturgeon, J. A., & Zautra, A. J. (2010). Resilience: a new paradigm for adaptation to chronic pain. [Research Support, N.I.H., Extramural]. Current Pain and Headache Reports, 14(2), 105-112. doi: 10.1007/s11916-010-0095-9

Sturgeon, J. A., & Zautra, A. J. (2013a). Psychological resilience, pain catastrophizing, and positive emotions: perspectives on comprehensive modeling of individual pain adaptation. [Research Support, N.I.H., Extramural Review]. Current Pain and Headache Reports, 17(3), 317. doi: 10.1007/s11916-012-0317-4

Sturgeon, J. A., & Zautra, A. J. (2013b). State and trait pain catastrophizing and emotional health in rheumatoid arthritis. [Research Support, N.I.H., Extramural]. Annals of Behavioral Medicine, 45(1), 69-77. doi: 10.1007/s12160-012-9408-z

Sturgeon, J. A., Zautra, A. J., & Arewasikporn, A. (2014). A multilevel structural equation modeling analysis of vulnerabilities and resilience resources influencing affective adaptation to chronic pain. [Research Support, N.I.H., Extramural]. Pain, 155(2), 292-298. doi: 10.1016/j.pain.2013.10.007


Authored by: Ed Coghlan

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It’s great that behavioral interventions are out there for people to try, but they shouldn’t be the only option. We should have the choice of taking it or leaving it. I did not.

I wanted to get Cognitive Behavioral Therapy (CBT) for an anxiety disorder, which responds well to it. I knew that the road ahead wouldn’t be easy. The sessions can be long, granular and somewhat boring. Furthermore, most therapists don’t take insurance, so it is prohibitively expensive. Luckily I found a place that accepted, and actually billed my insurance, but it meant working with a trainee.

At first my therapist was friendly enough, but she didn’t have a lot of real-world experience. She had been in school most of her life. It showed. I mentioned my pain condition once, and the therapist insisted I try CBT. She accused me of catastrophizing when on one occasion I sought emergency care. It was offensive and hurtful. My psychiatrist thought I was being reasonable and he was board certified in neurology. She congratulated me when I engaged in risky behavior i.e. driving on a demanding road for an extended period of time, while experiencing an attack.

I tried to focus the therapy sessions on my anxiety disorder, but She had other ideas. She wanted to treat the pain. I told her what I needed to happen. I begged her. I tried to convince her. It was no use. Her mind was made up. With therapy, I could learn to just “suck it up”. I was already trying my hardest go on with the pain. I was working. I was driving. I was dating. I asked the psychiatrist to intervene on my behalf. He tried to talk her out of treating the pain. She told him where to go. I had to pack up my marbles and go home, missing out on a major opportunity. It sucked.

Behavior therapy is not a substitute for pain management, or medication.


If there is an existing way to keep a patient out of pain – even if that existing thing happens to be opiates – why is in in any way necessary to encourage people with chronic pain to try to do something other than take medication and then go on with their day? Even if this supposed “resilience” is possible, is in necessary? I can’t imagine that someone with un- or under-medicated pain will be as functional in day-to-day life, work and play, as someone whose pain is fully treated.

The very idea of depriving people with pain of medications that fully work, and trying to convince them that it is in some way better to struggle through life while in unnecessary pain is cruel.


If some chronic pain patients were more willing to make life style changes instead of continuing to seek higher doses of pain meds, they would realize that they can get by with less meds. It seems that the majority of those who are having problems finding treatment and getting their rxs filled are those on high doses of the stronger pain meds.


PAita is right- the concept of resilience stems from Mackey and others from the AAPM and APS wo view all people in pain as catastrophizers-and so they think the pain, the disability, the fatigue from pain is due to some mental defect of people in pain that can be fixed by making the person in pain resilient. Its kind of a pick yourself up by your bootstraps mentality and shows that pain experts project their biases on to people in pain.It really suggests that pain experts when they talk of resilience are saying “pain is in your head- get over it and be resilient.”


Stanford is part of the problem in pain care- as they wish to impose top down instittionalized medicocentric solutions to people in pain. If Stanford truly cared about people in pain they would have people in pain in positions of power deciding what research monies to seek and use. But just like other institutions Stanford doesnt wish to include the voice of people in pain. Instead they see people in pain as just subjects of their research And what chronic pain condition has Stanford researchers cured? What is their success with regard to helping people in pain?
Instead of exploiting people in pain Stanford should ask people in pain what research they want done or more broadly what Stanford can do to help people in pain.


psss,,,look at his 2013 report at the bottom of the article,,,”psychological resilience,”,,,,hmmm the more I think on this the more is proves they want to prove its in our heads,,,,even if they have to trick us on surveys,,,,thus no medicine ,,,yea,,,u ,,,”will”’ that chronic physical pain away,,,,the reality to us,,that statement means,,”non-medical” treatment,,,,if we don’t stop these guys,,,we are all going to end up w/no medicines and it will be legal in the eyes of ,”our” government cause some doctor is going to us this doctors ,so-called ,”survey” as proof,,,we don’t need medicines to stop our physical pain,,,u all know its true,,,


Wow,,my first impression,,,”endure MORE,,then we already are,,,i make no qualms about this,,,these people are trying to prove,,,,,physical pain is on our heads,,361,,,people really,,,when I emailed this guy and said,,I think a lot of people ,me included,,thought it was ,”with” medicines,,,,,,I trust NOTHING with this survey,,,jmo,,it is about making us ENDURE MORE PHYSICAL PAIN, plain and simple,,