Summary: A new study shows that how people think about and handle chronic pain — their pain resilience — is a stronger predictor of physical activity than the intensity of the pain itself. Participants with higher pain resilience remained significantly more active than those with lower resilience, while factors such as pain intensity and fear of movement had little independent effect once resilience was considered.
The findings, published in PLOS ONE by researchers at the University of Portsmouth, suggest that therapies designed to build psychological resilience could improve activity levels and overall health for people living with chronic pain.
Key Facts:
- Pain resilience predicts activity: People with higher pain resilience reported greater physical activity regardless of pain intensity.
- Mindset matters: Fear of movement and pain sensitivity contributed little to activity levels after accounting for resilience.
- Treatment implications: Interventions that strengthen resilience may help patients stay active and support broader health benefits.
Source: University of Portsmouth
Pain affects activity levels, but how individuals interpret and respond to pain can be decisive, according to a new study from the University of Portsmouth.
The study, published in PLOS ONE, examined the role of pain resilience — the psychological capacity to continue functioning and stay positive despite pain — and found it independently associated with higher physical activity. The research suggests that improving resilience could be a valuable component of chronic pain care, complementing symptom management.
Led by Dr Nils Niederstrasser of the School of Psychology, Sport and Health Sciences, the research analysed data from 172 adults living with chronic musculoskeletal pain. The team used statistical path models and regression analyses to evaluate how pain resilience and kinesiophobia (fear of movement) influenced the link between pain and activity.
Participants completed measures capturing pain intensity, pain duration, the number of painful sites, fear of movement, frailty, and pain resilience. The models tested whether resilience and kinesiophobia acted as indirect pathways between pain and physical activity, both separately and together.
Results showed that both resilience and kinesiophobia could account for portions of the association between musculoskeletal pain and activity when examined individually. However, when both factors were modelled together, only the pathway through pain resilience remained significant. In regression models that adjusted for pain characteristics, higher pain resilience — and male gender in this sample — were associated with greater physical activity, while kinesiophobia was not a significant predictor.
In practical terms, the study indicates that many people maintain activity not because they experience less pain but because they have developed psychological strategies and attitudes that help them continue moving despite discomfort. This shifts attention from symptom-focused strategies alone toward approaches that build adaptive coping and sustained engagement in activity.
Dr Niederstrasser commented that the findings highlight the importance of psychological response: “It isn’t only the intensity of pain that predicts activity — it’s how people think about and respond to that pain. Resilient individuals are better able to preserve activity and positive functioning despite ongoing discomfort.”
The authors suggest clinical practice could benefit from incorporating resilience-building elements into rehabilitation programs. Such approaches might include psychological skills training, motivational support, and tailored activity planning to help people gradually increase and maintain movement. The study’s cross-sectional design, however, means that longitudinal and experimental work is needed to confirm whether deliberately increasing resilience leads to sustained gains in activity.
Key Questions Answered:
A: Pain resilience is the psychological capacity to keep functioning and stay positive despite persistent pain. It helps people remain active and maintain daily routines even when discomfort continues.
A: The study found that activity levels were more closely tied to how well participants coped with pain than to the amount of pain they reported. In other words, mindset and coping mattered more than pain intensity itself.
A: The findings support adding resilience-focused strategies to treatment plans — psychological training, motivation, and practical support intended to help patients remain physically active alongside conventional pain management.
About this pain research news
Author: Lauren Harrison
Source: University of Portsmouth
Contact: Lauren Harrison – University of Portsmouth
Image: The image is credited to Neuroscience News
Original Research: Open access. “Indirect associations of pain resilience and kinesiophobia with the relationship between physical activity and chronic pain” by Nils Niederstrasser et al. Published in PLOS ONE.
Abstract
Indirect associations of pain resilience and kinesiophobia with the relationship between physical activity and chronic pain
Background
Chronic pain is commonly linked with reduced physical activity, yet some people maintain active lives despite persistent pain. Psychological factors — especially pain resilience and fear of movement — may explain these differences. This study tested direct and indirect associations involving pain resilience and kinesiophobia in the relationship between pain and activity.
Methods
In this cross-sectional study, 172 adults with chronic musculoskeletal pain provided data on pain intensity, duration, spread, kinesiophobia, frailty, and pain resilience. Researchers fitted three path models to assess indirect associations of resilience and kinesiophobia with the link between pain and physical activity, both separately and together, and used linear regression to identify psychological predictors of activity while controlling for pain characteristics.
Results
Both pain resilience and kinesiophobia accounted for portions of the association between pain and activity when considered alone. When modelled simultaneously, however, only the pathway via pain resilience remained statistically significant. Regression analysis showed that higher pain resilience — and male gender in this sample — were associated with greater physical activity; kinesiophobia did not independently predict activity levels.
Conclusions
The study highlights pain resilience as a central factor in maintaining physical activity despite chronic pain. Pain resilience predicted activity over and above pain intensity, kinesiophobia, pain duration, and pain spread. These results suggest potential benefits from exploring ways to boost resilience among people with chronic pain to improve activity levels and overall well-being. Because the data are cross-sectional, future longitudinal and experimental studies are needed to establish causal relationships.