The Role Of Psychological Resilience And Pain-Related Beliefs In Pain Responses Among Chinese Adults—Evidence From Laboratory Induced Pain And Chronic Pain

We assessed the factor structure,correlates,and incremental validity of the Pain Appraisal Inventory(PAI)in two Chinese adult chronic pain samples.In an exploratory factor analysis sample(N=301),the original two-component(threat,challenge)structure and a 10-item short form(PAI-SF)were supported(Study 1).In Study 2,within a confirmatory factor analysis sample(N=285),uniformly acceptable fits were observed only for the PAI-SF.Furthermore,PAI-SF threat and challenge subscales had significant correlations with conceptually-related measures and added to the prediction of pain coping capacities and outcomes independent of other pain belief indices.Together results indicate the PAI-SF has utility in Chinese chronic pain samples.Chronic back pain is widespread and potentially disabling yet a substantial percentage of those affected maintain a high quality of life despite ongoing discomfort.Presumably,more resilient persons view pain and their capacities to manage it in a manner that mitigates pain-related dysfunction.To test this premise,Study 3 was examined,307 mainland Chinese adults with chronic back pain(189 women,118 men)completed self-report measures of psychologicalresilience,pain beliefs(challenge appraisals of pain,pain self-efficacy,pain catastrophizing)and pain-related dysfunction(pain intensity,disability,affective distress,depression).Structural equation modeling indicated resilient cohorts reported more challenge appraisals of pain,higher pain self-efficacy levels,and less frequent catastrophizing about their capacities to manage pain.In turn,resilience,pain self-efficacy,and pain catastrophizing were linked to pain-related dysfunction while challenge appraisals were not.After controlling for demographics(i.e.,age and education)related to pain-related dysfunction,results underscored specific pain beliefs underlying the pathway of general psychological resilience with reduced dysfunction from chronic back pain.Numerous studies have found appraisals of pain as a source of potential threat or tissue damage influence coping response and pain perception.Conversely,causal effects of primary appraisals(threat appraisal and challenge appraisal)and secondary appraisal(e.g.,self-efficacy)have received little attention.Study 4 was designed to elucidate effects of appraising laboratory pain on pain perception and coping.Causal effects of a 2(Resilience level: higher resilience vs.lower resilience)x 3(Appraisal condition: challenge vs.higher threat vs.lower threat)design was assessed in relation to task specific self-efficacy changes(before and after reading the orienting passages),coping,and pain perception reported during CPT.Before engaging in a cold pressor test(CPT),young adult women(N = 147)and men(N = 88)with higher or lower trait resilience were recruited,and then they were randomly assigned to one of three conditions: a higher threat group in which participants read an orienting passage describing symptoms and consequences of frostbite(pain as a signal for nociception),a lower threat group in which participants read about CPT safety(pain independent of nociception)or a challenge appraisal group in which participants read a passage describing how persistence in the face of discomfort predicts future life success and satisfaction.The higher threat group had decreased in the task-specific self-efficacy changes and more reported use of catastrophizing and less use of cognitive coping(ignoring,diverting attention,coping self-statements),resulting in shorter pain tolerance,whereas pattern of exposure to higher levels of challenge orienting information was in the opposite.Besides,less resilient participants reported higher subjective threat appraisals.In SEM,task-specific self-efficacy changes and coping fully mediated the association between subjective appraisals of pain and pain tolerance.More specifically,higher challenge appraisal levels were related to increased self-efficacy and more reported use of cognitive coping,which corresponded,in turn,with increased tolerance for cold pressor pain;whereas higher threat appraisal levels were related to decreased cognitive coping and increased catastrophizing,leading to decreased tolerance duration.In sum,findings underscore the role of psychological resilience and pain appraisals on coping responses and pain perception in laboratory induced pain and chronic pain context within Chinese mainland adults.