Chng Zanna, Yeo Jerry Jay, Joshi Ashutosh
Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, Singapore.
Khoo Teck Puat Hospital, National Healthcare Group, 90 Yishun Central, Singapore, Singapore.
Scand J Pain. 2022 Aug 11;23(2):228-250. doi: 10.1515/sjpain-2021-0190. Print 2023 Apr 25.
Patients suffering from chronic pain experience significant disability and disease burden. Resilience has been understood to be a protective factor in face of adversity, eventually contributing to positive outcomes. As such, the current review sought to summarize the existing literature focusing on the roles of resilience in relation to pain phenomenology, pain outcomes (including function and mental health), amongst relevant clinical correlates in a bid to promote holistic management of debilitating chronic pain conditions from a resilience-oriented psychotherapeutic approach as an adjunct to pharmacological treatment.
A scoping review was conducted on empirical studies surrounding the theme of resilience in adult chronic pain populations published before 9th May 2021. The following main inclusion criteria was applied; (a) adults diagnosed with chronic pain disorders, (b) use of quantifiable pain measures, (c) use of quantifiable resilience measures. A total of 32 studies were then selected for the review.
First, higher levels of resilience were associated with a reduced likelihood of experiencing any chronic pain, fewer pain sites, better psychological response towards nociception and reduced need for analgesia. Second, higher levels of resilience correlated with better daily and physical function, quality of life, psychosocial functioning and lower likelihood of co-morbid mental health disorders. Third, resilience was an intermediary variable in the pathways from pain phenomenology leading to pain interference, depression and post-traumatic growth.
The findings were contextualized using pain-disability and resilience frameworks (The Pain and Disability Drivers Model, O'Leary's Resilience models) with suggestions to enhance resilience and contextual factors in the holistic management of adult chronic pain conditions. Future research should examine the differences in resilience between pain types as well as evaluate the efficacy of streamlined resilience-oriented interventions.
患有慢性疼痛的患者会经历严重的残疾和疾病负担。韧性被认为是面对逆境时的一种保护因素，最终有助于产生积极的结果。因此，本综述旨在总结现有文献，重点关注韧性在疼痛现象学、疼痛结果（包括功能和心理健康）以及相关临床关联中的作用，以便从以韧性为导向的心理治疗方法作为药物治疗的辅助手段，促进对使人衰弱的慢性疼痛状况进行整体管理。
对2021年5月9日前发表的关于成年慢性疼痛人群韧性主题的实证研究进行了范围综述。采用了以下主要纳入标准：(a) 被诊断患有慢性疼痛障碍的成年人，(b) 使用可量化的疼痛测量方法，(c) 使用可量化的韧性测量方法。然后共选择了32项研究进行综述。
第一，较高水平的韧性与经历任何慢性疼痛的可能性降低、疼痛部位减少、对伤害感受的更好心理反应以及镇痛需求减少相关。第二，较高水平的韧性与更好的日常和身体功能、生活质量、心理社会功能以及共病心理健康障碍的可能性降低相关。第三，韧性是从疼痛现象学到疼痛干扰、抑郁和创伤后成长的途径中的一个中介变量。
研究结果在疼痛 - 残疾和韧性框架（疼痛与残疾驱动模型、奥利里韧性模型）的背景下进行了阐述，并提出了在成人慢性疼痛状况的整体管理中增强韧性和背景因素的建议。未来的研究应检查不同疼痛类型之间韧性的差异，并评估简化的以韧性为导向的干预措施的效果。
