It’s not the pain, it’s the mindset: How attitude outweighs pain

Boosting resilience could help people living with chronic pain to stay active and improve their wellbeing, new research reveals

2025-10-23

(Press-News.org) Pain resilience is the key factor linking chronic pain to physical activity levels

Individuals’ ability to stay active despite pain depends more on their pain resilience than on how much pain they feel

Efforts should centre on building resilience to pain, as well as reducing it

Pain affects activity levels, but how individuals understand and act in the face of pain can make a difference, a new study from the University of Portsmouth has found.

The paper, published in PLOS One identified that pain resilience - how well individuals cope with pain - affects physical activity independently of pain, and boosting resilience could enhance both pain management and overall health.

Led by Dr Nils Niederstrasser from the School of Psychology, Sport and Health Sciences at the University of Portsmouth, the study analysed data from 172 participants suffering from chronic pain, using statistical models to understand how pain resilience affects the relationship between pain and physical activity.

The study examined factors such as fear of movement, frailty, the number of painful areas, pain duration, and intensity, both individually and together - to identify which most influenced activity levels.

It found that high pain resilience was the key component associated with higher physical activity levels, while other aspects such as kinesiophobia - fear of movement - did not make a significant contribution.

The study suggests it’s not the pain itself, but how well people cope with it that largely determines activity levels. This underscores the central role of pain resilience, which continued to be a key predictor of activity even after accounting for pain intensity, emphasising the need to build resilience rather than focus solely on reducing pain.

Dr Niederstrasser, from the University’s Faculty of Science and Health, said: “What we found is that it's not how much pain you're in that determines whether you stay physically active - it's how you think about and respond to that pain, indicating that how individuals respond to and think about pain matters more than their actual pain sensitivity.

“We suspected resilience plays a major role, and this study helped confirm that.”

The researchers also concluded that treatments focusing on building resilience could help chronic pain patients become more active and improve their overall health.

Dr Niederstrasser added: “People with greater resilience can maintain a positive attitude and push through discomfort, and this psychological factor is a better predictor of physical activity than pain intensity itself.

“This is a significant shift from historically focusing on negative factors like fear of movement, to understanding the power of positive psychological resilience in managing chronic pain."

This research builds on a previous study by Dr Niederstrasser which showed that high levels of physical activity can lower the risk of developing chronic pain. The research detailed how pain prevention programs should include exercise, weight management, and support for social inequalities.

"Moving forward, further research could examine whether enhancing resilience in individuals with chronic pain leads to increased activity levels, potentially through targeted interventions”, added Dr Niederstrasser.

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