Rose Marie Pignataro

Background: Chronic low back pain (CLBP) is associated with psychological risk and resilience factors that drive pain, distress, and disability. Pain Resilience Therapy (PRT) is a novel strengths-based approach; however, its risk and resilience outcomes compared with recognized approaches remain unclear. Objective: To examine the effectiveness of PRT compared to Pain Neuroscience Education (PNE) on psychological risk and resilience factors in adults with CLBP. Design: Secondary data analysis from a randomized controlled trial. Methods: This secondary analysis included data from 60 adults with CLBP randomized to eight telehealth sessions of PRT or PNE delivered over four weeks. Psychological risk and resilience factors were assessed at baseline and at the 90-day follow-up using the OSPRO-YF, which estimates scores of 11 validated questionnaires across three domains: negative mood, negative/maladaptive coping, and positive affect/coping. Between-group differences were examined using ANCOVA with baseline adjustment. Treatment response was quantified using relative risk, absolute risk reduction, and number needed to treat. Results: PRT produced significantly greater improvements than PNE across eight of eleven outcomes, including anxiety, fear avoidance, pain catastrophizing, kinesiophobia, pain-related anxiety, self-efficacy for rehabilitation, and pain acceptance, with medium-to-large effect sizes (ηp² = 0.088–0.316). Both groups improved in depressive symptoms and pain self-efficacy. Trait anger did not significantly change in either group. The number needed to treat for PRT was 2 for self-efficacy for rehabilitation and 3 for pain catastrophizing, kinesiophobia, and pain acceptance. Conclusions: PRT demonstrated greater effectiveness across eight psychological risk and resilience factors than PNE, warranting further investigation in larger trials.

The prevalence of chronic wounds and their impact on physical, psychological, and social well-being continues to escalate. Optimal outcomes rely on the ability of clinicians to work collaboratively with patients and care partners to plan and implement holistic, individualized treatments. Physical health is heavily impacted by wound status and the patients' capacity to engage in usual daily activities. Functional limitations carry a host of consequences, including adverse effects on patients’ sense of meaning and purpose in life, self-esteem, and body image. Negative emotions, fear, and loss of autonomy can create challenges to mental well-being, with higher rates of depression and anxiety reported in people with chronic wounds as compared with the general population. These challenges are exacerbated by stigma, patients’ reluctance to disclose psychological symptoms, and clinicians’ lack of preparation in assessing and addressing mental, as well as physical health. Psychological stress carries physiological consequences that can contribute to healing delays. These consequences can be offset by cognitive behavioral interventions, a strong therapeutic alliance, and peer support. Integrative, individualized plans of care are improved by shared decision-making and the application of social and behavioral theory to provide insight regarding patients’ abilities and willingness to actively engage in collaborative wound management. Resilience, or the ability to productively cope with adversity, mediates the psychological burden associated with chronic wounds. The purpose of this targeted, narrative review of the literature is to assist clinicians in assessing the physiological consequences of delayed healing and promoting resilience in people with chronic wounds. GENERAL PURPOSE: To describe how wound care clinicians can improve treatment outcomes by promoting resilience in people with chronic wounds. JOURNAL/aswca/04.03/00129334-202510000-00004/figure1/v/2025-09-15T111045Z/r/image-jpeg TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will: Explain the impact of psychological stressors on wound healing. Identify interventions to assess and promote resilience in individuals with chronic wounds. Describe the impact of chronic wounds on psychological health.

ObjectivePain is a multifaceted phenomenon; therefore, innovative, multisystem approaches are recommended as a path to pain recovery. Pain Resilience Therapy (PRT) was developed as a novel, resilience-focused approach to pain management. MethodsThree people with chronic pain received tele-physical therapy using PRT. The primary aim of PRT was to facilitate the development of pain resilience. Addressing vulnerability was a secondary aim. Treatment results were assessed using validated self-report measures for pain intensity, resilience, vulnerability, interference, patient outcome expectations, expectancies, and perspectives. ResultsAll patients demonstrated a reduction in pain intensity and pain interference (PROMIS®) with associated improvements in activity, sleep, mood, and stress measured by the Defense and Veterans Pain Rating Scale (DVPRS 2.0). Resilience (positive affect/coping) and self-efficacy increased, as measured by the Pain Self-Efficacy Questionnaire (PSEQ), Self-Efficacy for Rehabilitation (SER), Chronic Pain Acceptance Questionnaire (CPAQ), and the Pain Resilience Scale (PRS). Certain measures related to vulnerability (negative mood and fear avoidance) also improved. The PRT intervention was safely delivered and patients reported their health as very much improved measured by the Patient Global Impression of Change (PGIC) survey. ConclusionThis case series supports the application of PRT’s resilience-focused approach to attenuate pain and vulnerability while improving physical and psychological well-being. Although there is a need for research elucidating change mechanisms, assisting patients/clients in accessing resources that facilitate resilience is a valid pathway to pain recovery. This case series is a step toward integrating an understanding of resilience within the broader context of pain and disability.