The amount of physical activity someone with chronic pain does depends far more on how well they cope with pain (their resilience) than how much pain they’re actually in.
A study of 172 adults with long-term musculoskeletal pain found that higher pain resilience predicted more activity — while fear of movement (“kinesiophobia”) mattered much less when resilience was taken into account.
The findings suggest that for managing chronic pain, building resilience (attitudes, coping) may be as important — or more so — than simply reducing pain intensity.
When you’re dealing with persistent pain, it’s easy (and logical) to assume the more it hurts, the less you’ll move.
But fresh research out of the University of Portsmouth suggests that your mindset might play a much bigger role. Their work reveals that it isn't strictly how much it hurts, but how you deal with it — your resilience — that makes the biggest difference in staying active.
In plain terms: two people might have similar pain levels — but the one who thinks, “I can still keep going,” is far more likely to stay physically active than the one whose pain bursts their motivation.
“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,” researcher Dr. Nils Niederstrasser said in a news release.
“We suspected resilience plays a major role, and this study helped confirm that.”
The study
The study enrolled 172 adults who had experienced musculoskeletal pain for more than three months. Participants completed validated questionnaires that measured:
Their average and worst pain over the past week using a visual analogue scale.
Their level of pain resilience (how well they maintain emotional and physical functioning despite pain) via the Pain Resilience Scale.
Their degree of kinesiophobia (fear of movement because it might cause pain or injury) with the Tampa Scale.
Their physical activity levels by using the Recent Physical Activity Questionnaire, converting responses into energy expenditure (kJ/kg/day).
Statistical models probed how pain related to activity, and whether resilience or fear of movement served as “bridges” in that relationship.
The results: Resilience in the driver’s seat
The headline finding: while pain was negatively associated with activity (i.e., more pain → less movement), a large portion of that link ran through resilience. Specifically:
Approximately 42.8 % of the association between pain and lower activity was explained by lower pain resilience.
When both resilience and fear-of-movement were included, only resilience remained a significant indirect pathway. Fear alone explained just about 6.4 % of the link.
In a regression model including pain intensity, number of painful areas, pain duration, frailty and the psychological measures, only higher pain resilience (and being male, in this sample) significantly predicted greater activity. Fear of movement dropped out.
“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," Dr. Niederstrasser said.
“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."
Consumer takeaway
If you’re managing chronic pain, this study suggests a shift in focus might help.
Rather than only asking “How much does it hurt”, you might also ask “How do I respond when it hurts?”
Building resilience — the mindset of I can still move, even though I’m in pain — could be a game-changer in staying active and improving wellbeing. Of course, the study was cross-sectional (a snapshot in time), so it doesn’t prove resilience causes more activity. But it strongly points to the idea that how you think about pain matters.