Understanding pain as threat or challenge: predictive roles of resilience, attachment, and sensory sensitivity

OBJECTIVE: Appraisals of pain as threatening or as a challenge are important for chronic pain patients' quality of life. The aim of this study was to examine the role of psychosocial factors (attachment, resilience, and self-esteem), as well as pain characteristics (pain intensity and generalized sensory sensitivity) in shaping pain appraisals among individuals with chronic pain from a single medical center in the Midwestern United States. METHODS: A cross-sectional survey study was conducted with 278 participants from Michigan Medicine who reported chronic pain. Participants completed measures assessing psychosocial factors (attachment orientation, resilience, self-esteem), pain characteristics (pain intensity, generalized sensory sensitivity), and pain appraisals (threat and challenge). Gamma regression models were used to analyze the predictors of threat and challenge appraisals. RESULTS: Higher pain intensity (β = 1.11, P < .001), generalized sensory sensitivity (β = 1.03, P = .005), anxious attachment (β = 1.04, P = .002), and lower resilience (β = 0.99, P < .001) were significantly associated with higher threat appraisals. Challenge appraisals were seldom endorsed and were significantly associated with higher resilience (β = 1.02, P = .001) and pain intensity (β = 1.05, P = .003). CONCLUSIONS: Pain characteristics, anxious attachment, and resilience were associated with pain appraisals. Identifying the potential antecedents of pain appraisals will provide a more comprehensive view of this important cognitive process linked to quality of life among individuals with chronic pain. Additionally, it may guide clinicians in identifying and applying appropriate pain interventions that best fit clients' needs.