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Pain and Resilience

We all respond to pain in different ways, with some individuals experiencing moderate discomfort and others feeling severe symptoms when presenting similar injuries. Describing pain is also a complex and nuanced exercise in communication. These differences in sensitivity and perception are often termed as resilience and a person’s level of resilience to pain can lead to adverse physical and psychological patient outcomes and dictate how successful pain management interventions are.

Resilience is both the process and outcome of our ability to successfully overcome and adapt to adversity. Whilst an individual may have some characteristics that make them more resilient than others, resilience can be built over time through developing behaviours, thoughts, and actions and utilising help from external resources.

Pain is physically and psychologically stressful and the level of resilience a person has impacts their ability to focus on positive outcomes instead of negative ones and presents a potential barrier to rehabilitation. The experience of catastrophic injuries such brain injury, spinal cord injury or limb loss does not diminish the positive influence resilience can have on pain management techniques and subsequent well-being.

Effective interventions

As with any long-term health problem, chronic pain creates complications beyond the physical symptoms and finding effective treatment is complex and uniquely personal, as your diagnosis, biology and personal history are all important factors.

Resilience-based therapy offers an integrative approach to trauma recovery combining physical and psychological treatments that allow a person to restore and sustain a fulfilling life. Emotional wellbeing can impact the experience of pain and a person’s ability to effectively cope with it.

Resilience to pain is a complex interaction between biological, psychological, and social influences and a biopsychosocial approach to understanding and managing pain allows for a broader range of treatment pathways.


Relationship between disease and bodily health, incorporating factors such as genetics, physiology, neurochemistry, tissue health, and gender


Focuses on interpersonal factors such as social interactions, family support, community, culture, and socioeconomic inputs


Aspects of mental and emotional wellness that relate to behaviour such as personality, mood, self-efficacy, somatisation, catastrophising, and coping skills.

Pharmacological treatments including medications such as opioids or non-steroidal anti-inflammatory drugs (NSAIDs) can be effective in providing relief from chronic pain by addressing pain messages in the brain or reducing inflammation and fever. Non-drug options such as acupuncture, biofeedback or meditation can also be introduced as elements of a coordinated treatment plan.

Interventional pain medicine uses injections and minimally invasive techniques to disrupt pain signals and can help chronic pain sufferers who have failed to find relief using other treatments. Examples include discography, pain pumps, or nerve blocks, which can be effective in treating pain caused by spinal cord injury, musculoskeletal pain, and arthritis as well as many other conditions and disorders.

Addressing the physical, emotional, and mental wellbeing of patients together is central to building resilience and developing the skills needed for successful pain management. Medications and physical therapy are effective treatments in alleviating pain, but psychological techniques and therapy are essential elements if an individual is to sustain an improved quality of life.

Resilience versus non-resilience-based people

The presence of certain risk factors is characteristic of people with low resilience. These might include catastrophic thoughts, perceived stress, or poor social support. Low resilience can present itself as the expectation of pain, which can contribute to anxiety and depression and result in greater intensity of pain.

Conversely, people with high resilience display protective factors that mean they typically have a lower fear of pain and instead display signs of optimism and strong levels of control.

The ability of a person to live an optimal emotional, psychological, and social life in the presence of pain is connected to their ability to recognise and focus on positive outcomes from their rehabilitation instead of only negative factors.

People living with chronic pain face different challenges and how they face those challenges and manage the different types of stressors relies on a combination of personal and social factors. There are several resilience resources and mechanisms that influence how a person exhibits resilience and these contribute to positive outcomes by increasing the ability to cope with pain. Vulnerability traits and mechanisms also influence a person’s ability to adapt and cope with pain but have an adverse effect on promoting recovery, sustainability, and growth.

The presence of pain

Pain perception and tolerance varies from person to person and so the effectiveness of treatment or therapies depends on a person’s sensitivity to pain and how their nerves communicate with their brain when pain is present. Pain is multidimensional and encompasses several aspects that must be evaluated to allow for appropriate pain management.

  • Physical – relates to how a person’s anatomic structure and physiological function influences their experience of pain. Previous injury or surgery might impact how a person perceives and reacts to pain.
  • Sensory – captures the location, quality, and intensity of pain. The use of common descriptors can help identify the type of pain and most suitable intervention.
  • Behavioural – refers to the verbal and non-verbal behaviours exhibited by a person in response to pain that can include obvious signs such as crying or tensing up, but also more subtle indicators such as confusion, insomnia, or depression.
  • Sociocultural – connects a person’s social and cultural background to their perception and response to pain. These can influence attitudes to treatment options or medications and pain management decisions.
  • Cognitive – highlights a person’s thoughts, beliefs, attitudes, and motivations related to pain and its management. Cognitive capacity and functioning can influence decision-making and impact engagement or participation in treatment.
  • Affective – examines how a person feels emotionally because of pain. Chronic pain can be draining and cause depression, which subsequently can lead to insomnia, withdrawal and lack of interest in treatment. Anger and frustration are other affective responses a person can present when in pain.
  • Spiritual relates to the meaning and purpose a person attributes to pain, self, and others. Religious and spiritual beliefs can affect the planning and delivery of pain management.

Certain positive characteristics displayed by a person can be seen as resilience resources that play an important role in effective coping with pain and can lead to better physical functioning and emotional wellbeing:

Personality – optimism, determination, conscientiousness, extroversion

Cognitive/Emotional – self-efficacy, hope, positive affect, psychological flexibility

Behavioural - sleep quality, physical activity, social engagement, genetics

Existential – acceptance, self-actualisation, life purpose, spirituality

Resilience in children and adults

Children can experience pain in similar ways to adults, but their brains are still developing, and they have fewer life markers to draw upon to help put pain into context. Their emotional capacity and communication abilities may lead them to display pain in different ways to an adult and their symptoms and verbal and non-verbal indicators can also differ. This can sometimes lead to pain in children being under-treated.

The involvement and perceptions of family members presents a further challenge in pain management for children, with parent pain catastrophising sometimes leading to increased child pain behaviours, anxiety, and pain-related fear.

Fundamental beliefs or associations of pain developed over a lifetime can be detrimental to effective pain management in adults, whereas children don’t have the same level of experience and therefore have yet to develop the same expectations of pain. Teaching young children about pain can help them understand and respond positively to pain as they grow.

A foundation of children’s resilience comes from strong relationships with parents, family members and caregivers, which help develop abilities in overcoming setbacks and building confidence. Children with high resilience are often good at solving problems and learning new skills and are likely to have good levels of physical and mental health.

Understanding the biological, social, and psychological factors contributing to a child’s pain and resilience are equally relevant in informing their treatment or therapy as they are in adults. Combining pharmacological treatments with psychotherapeutic techniques is therefore recommended for effective rehabilitation and delivering positive patient outcomes.

Case Management services from Bush & Co

Bush & Co case managers work with clients from the point of assessment through to active case management to support and develop resilience throughout their rehabilitation programme. Being aware of the client’s approach to pain, ability to manage that pain through the intervention that suits them, and the impact that may have on them is key to establishing a robust rehabilitation plan. Bush & Co case managers work to assess this on a regular basis, adapting goals and approaches as needed.

Case management services from Bush & Co support children from birth, young people, and adults who have suffered catastrophic injuries through personal injury or clinical negligence. Our work places clients at the centre and focuses on delivering effective care solutions that meet their needs.

The services we provide assist claimant and defendant parties access the expert professional care they need for their effective treatment and rehabilitation, helping them to achieve successful outcomes.