Abstract
Current treatments for chronic pain have limited benefit. We describe a resilience intervention for individuals with chronic pain which is based on a model of viewing chronic pain as dysregulated homeostasis and which seeks to restore homeostatic self-regulation using strategies exemplified by survivors of extreme environments. The intervention is expected to have broad effects on well-being and positive emotional health, to improve cognitive functions, and to reduce pain symptoms thus helping to transform the suffering of pain into self-growth. A total of 88 Veterans completed the pre-assessment and were randomly assigned to either the treatment intervention (n = 38) or control (n = 37). Fifty-eight Veterans completed pre- and post-testing (intervention n = 31, control = 27). The intervention covered resilience strengths organized into four modules: (1) engagement, (2) social relatedness, (3) transformation of pain and (4) building a good life. A broad set of standardized, well validated measures were used to assess three domains of functioning: health and well-being, symptoms, and cognitive functions. Two-way Analysis of Variance was used to detect group and time differences. Broadly, results indicated significant intervention and time effects across multiple domains: (1) Pain decreased in present severity [F(1, 56) = 5.02, p < 0.05, η2p = 0.08], total pain over six domains [F(1, 56) = 14.52, p < 0.01, η2p = 0.21], and pain interference [F(1, 56) = 6.82, p < 0.05, η2p = 0.11]; (2) Affect improved in pain-related negative affect [F(1, 56) = 7.44, p < 0.01, η2p = 0.12], fear [F(1, 56) = 7.70, p < 0.01, η2p = 0.12], and distress [F(1, 56) = 10.87, p < 0.01, η2p = 0.16]; (3) Well-being increased in pain mobility [F(1, 56) = 5.45, p < 0.05, η2p = 0.09], vitality [F(1, 56) = 4.54, p < 0.05, η2p = 0.07], and emotional well-being [F(1, 56) = 5.53, p < 0.05, η2p = 0.09] Mental health symptoms and the cognitive functioning domain did not reveal significant effects. This resilience intervention based on homeostatic self-regulation and survival strategies of survivors of extreme external environments may provide additional sociopsychobiological tools for treating individuals with chronic pain that may extend beyond treating pain symptoms to improving emotional well-being and self-growth.Clinical Trial Registration: Registered with ClinicalTrials.gov (NCT04693728).
Highlights
Current treatments for chronic pain provide limited benefit, focus on pathology, and often ignore the resources of the person who experiences chronic pain (Institute of Medicine, 2011; Mardian et al, 2020)
We propose resilient intrinsic selfregulation in extremes (RISE) as a suitable therapeutic opponent for chronic pain; one that is resilient as part of the opponent process of homeostatic regulation (Craig, 2015), that is intrinsic in originating from within the person rather than from external sources, and that follows gradients rather than aimed at end states
RISE differs from self-regulation for achieving extrinsic goals through willpower proposed by Baumeister and Alquist (2009, p. 21–33) and Baumeister and Tierney (2011) or the regulation of emotions through common sense strategies of Gross (2014) that involve the activation of a goal and changing its emotional trajectory at five points: the trajectory, the situation, attention, appraisal, and the response
Summary
Current treatments for chronic pain provide limited benefit, focus on pathology, and often ignore the resources of the person who experiences chronic pain (Institute of Medicine, 2011; Mardian et al, 2020). This study will examine chronic pain as a derailed homeostatic process that threatens stability, is aversive and unpredictable, and that shares these characteristics with external extreme environments. Our key questions concern how individuals survive well in deeply aversive, unpredictable environments such as chronic pain; their strategies and characteristics of adaptive survival; and how such strategies can inform this resilience intervention for chronic pain. By situating chronic pain within homeostatic regulation, this study joins the growing interest in interoception and emerging directions in clinical thought and practice An integrated resilient intrinsic selfregulation in extremes (RISE) model for chronic pain
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