Cultivate Key Character Strengths to Combat Chronic Pain

Chronic pain, authors (Graziosi et al., 2021) note in their recent study in The Journal of Positive Psychology, takes a massive toll on people and healthcare systems. Unlike acute pain, which typically signals the need for attention to an immediate concern, chronic pain does not necessarily point to an obvious conventional medical problem, and it's often too easily dismissed.

Chronic pain is quite real, nonetheless, even when the causes may be elusive or intangible. Neuroimaging of fibromyalgia (Richard, et al., 2019), for instance, shows changes in brain activity around pain even when there is no identifiable problem at the site of the pain in the body.

Chronic pain loses its function as a survival mechanism

If there is an underlying physical problem, the pain is amplified, lasting beyond the point where it serves as an alarm. This can make it hard to live with, as chronic pain saps energy and distracts, taking us away from engagement in more satisfying and joyful pursuits.

Considering that an estimated 100 million Americans experience chronic pain with a price tag to the healthcare system of up to 300 billion dollars, it’s important to identify ways to alleviate chronic pain and the dysfunction which goes along both to free up individual as well as systemic resources.

What drives chronic pain?

Unlike acute pain, while there may be a localized problem like joint inflammation causing pain receptors to fire and send a signal to the brain (nocioceptive pain), with chronic pain the pain information is interpreted differently (neuropathic pain) by the nerves and spinal cord, as well as within the brain, leading to a "central pain syndrome" (Brenner and Rathmell, 2021).

So, chronic pain—by definition lasting at least three months with some regularity of symptoms—has a strong central component, making chronic pain significantly a function of coping and psychological state. Chronic pain is also associated with a higher burden of psychiatric illness, including depression, anxiety and personality-related difficulties, as well as greater risk for prescription drug overuse. For instance, depression and anxiety worsen pain conditions and vice versa. Personality traits including higher levels of neurosis, associated with emotional instability, make it harder to cope effectively.

This means that maladaptive responses to pain such as excessive worry and focus on pain, and neutral responses (which while they don’t make things worse also don’t make them better), perpetuate chronic pain. Approaches like Cognitive Behavioral Therapy (CBT), which reduces catastrophic pain thinking and supports mood and stress response, alleviates chronic pain—as do mind-body approaches which help people learn to reflect on pain without being consumed.

Is it possible to intentionally train signature character strengths to achieve desired outcomes?

Positive psychology offers additional avenues by which people can learn to live more fully in spite of chronic pain. In addition to tracking the intensity, frequency and character of pain, and the impact of chronic pain on day-to-day loss of function, the concept of “pain self-efficacy” is key.

Graziosi and colleagues note that greater pain self-efficacy goes hand in hand with lower rates of depression and anxiety, reduced impact of pain on daily living, and less medication use. Self-efficacy generally is associated with better outcomes in all areas of life, both personally, at work and in relationships. For example, specific self-efficacy can lessen the impact of trauma, and couples can practice esteem support to increase relationship self-efficacy.

In order to understand how leveraging positive psychology could help people with chronic pain live better, the study authors first looked at which strengths have the highest associations with pain self-efficacy in order to identify targets for intervention. For example, if a particular strength were associated with the capacity to better live with chronic pain, then training up that strength might be therapeutic.

Chronic Pain Essential Reads

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Four hundred ninety-one participants with chronic pain rated pain severity and impact on function, pain self-efficacy (the ability to engage in regular daily activities in spite of pain), and completed a global self-assessment of character strengths. According to prior research, there are 24 different character strengths:

1. Creativity
2. Curiosity
3. Judgment
4. Love of learning
5. Perspective
6. Bravery
7. Perseverance
8. Honest
9. Zest
10. Love
11. Kindness
12. Social Intelligence
13. Teamwork
14. Fairness
15. Leadership
16. Forgiveness
17. Humility
18. Prudence
19. Self-regulation
20. Appreciation
21. Gratitude
22. Hope
23. Humor
24. Spirituality

Many of the character traits were associated with greater pain self-efficacy in the face of higher pain severity and functional loss, with zest, perseverance, and hope among the highest and leadership, creativity and appreciation among the lowest. Spirituality, interestingly, had an inverse relationship in which greater pain severity and functional impact was associated with lower pain self-efficacy, a finding of note for future investigation.

Can zesting it up help with chronic pain?

Because zest was most strongly correlated with pain self-efficacy, researchers choose to target this character strength in a follow-up interventional study. Zest, they write, “is characterized by a sense of vitality and ‘aliveness’ in their own individual lives, as well as having the ability to invigorate and energize the people around them.”

During a two-week intervention, eighty-one participants were assigned to either cultivate their zest for life, or to a neutral control condition. Participants in the zest condition were given instructions to write daily on their use of zest: “You are enthusiastic toward life; you are highly energetic and activated; you use your energy to the fullest degree.’ Those in the control group wrote about how their day went and their daily routines. See below¹ for examples of responses in the zest and control conditions.

Participants in the zest and control conditions had similar reported pain levels at the beginning of the two weeks, and both groups reported less pain by the end of the study. People who wrote about zest reported better function in spite of pain, and enjoyed greater pain self-efficacy. Both groups showed improvements in pain severity and function over the course of the study, while only the zest group showed increasing pain self-efficacy.

Using intention and practice to catalyze constructive changes

This work, although preliminary, is important because it shows that identifying and training signature character strengths can empower people with chronic pain to not only reduce pain and functional impact, but to increase their sense of self-efficacy.

It's important to recognize the role of depression, anxiety, posttraumatic stress, personality and other factors that can impact basic self-care and motivation, however, so as not to put people in an impossible position and instead set things up for success. If basic self-relationship is compromised, active techniques may do more harm than good if they reinforce identities of failure until basic self-regard is established and conditions like depression are treated.

As in this study in which people were able to intentionally cultivate zest, research (2015) has shown that similar approaches can change personality traits for the better with only a few months of concerted effort, journaling as well as deliberate practice. Imagine designing individual strength-based programs to help with chronic pain and other treatment-resistant issues. For example, one could complete an assessment of character strengths and personality traits to develop a personalized treatment plan.

Using tools like journaling, ongoing self-assessment and specific behavioral changes, it may be possible to see significant improvements in a relatively short time—potentially setting the stage for long-term transformation. In addition to helping people to live which chronic physical pain, strength-oriented approaches may help with resilience to emotional pain and other chronic problems.

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