Profiles of Risk and Resilience in Chronic Pain: Loneliness, Social Support, Mindfulness, and Optimism Coming out of the First Pandemic Year

Abstract

Objective: Individuals experience chronic pain differently, not only because of different clinical diagnoses, but also because of differing degrees of influence from biopsychosocial pain modulators. We aimed to cluster patients with chronic pain into distinct subgroups based on psychosocial characteristics and pain intensity, and we subsequently examined group differences in pain-related interference approximately 1 year later.

Methods: In this observational, longitudinal study, patients with chronic pain (n = 94) completed validated assessments of psychosocial characteristics and pain intensity at the beginning of COVID-19-related social distancing (April to June 2020). One year later (May to June 2021), patients completed a follow-up survey with assessments of pain interference, loneliness, social support, mindfulness, and optimism.

Results: A cluster analysis, using psychosocial factors and pain intensity, empirically produced three patient groups: 1) psychosocial predominant (PSP), characterized by high psychosocial distress and average pain intensity; 2) pain intensity predominant (PIP), characterized by average psychosocial distress and high pain intensity; and 3) less elevated symptoms (LES), characterized by low psychosocial distress and low pain intensity. At the 1-year follow-up, patients in the PSP and PIP clusters suffered greater pain interference than patients in the LES cluster, while patients in the PSP cluster also reported greater loneliness and lower mindfulness and optimism.

Conclusions: An empirical psychosocial-based clustering of patients identified three distinct groups that differed in pain interference. Patients with high psychosocial modulation of pain at the onset of social distancing (the PSP cluster) suffered not only greater pain interference but also greater loneliness and lower levels of mindfulness and optimism, which suggests some potential behavioral targets for this group in the future.

Keywords: Chronic Pain; Clustering; Loneliness; Mindfulness; Optimism; Pain Interference; Psychosocial.

Figure 1.

Factor z-scores of three empirically identified subgroups of patients.

Figure 2.

Differences in pain interference among the three patient clusters across time. (A) Patients in the LES cluster reported significantly lower pain interference at Time 1 (May 2020) than either the PSP cluster or the PIP cluster (LES mean = 20.23 ± 12.67 vs PSP mean = 42.09 ± 14.75 vs PIP mean = 39.16 ± 12.03, P < 0.001). (B) The LES cluster reported significantly lower pain interference than the PSP and PIP clusters at Time 2 (May 2021) (LES mean = 18.05 ± 15.19 vs PSP mean = 31.63 ± 16.51 vs PIP mean = 36.33 ± 17.62, P < 0.001). There were no significant differences in pain interference between the PSP and PIP clusters at either time point.

Figure 3.

Differences in psychosocial outcomes among clusters 1 year into social distancing. (A) There was a significant difference in loneliness between the clusters (F(2,91) = 5.66, P = 0.005, partial η² = 0.111), with patients in the PSP cluster reporting significantly greater loneliness than that reported by patients in the LES and PIP clusters (PSP mean = 48.97 ± 9.39 vs PIP mean = 42.31 ± 10.70 vs LES mean = 40.61 ± 10.49). There was no significant difference between the PIP and LES clusters. (B) There was no significant difference between any of the clusters with regard to perceived social support (F(2,91) = 2.75, P = 0.069, partial η² = 0.057). (C) There was a significant difference in mindfulness between the PSP and LES clusters (F(2,91) = 4.22, P = 0.018, partial η² = 0.085), with patients in the PSP cluster reporting significantly lower mindfulness than that reported by patients in the LES cluster (PSP mean = 2.42 ± 0.44 vs LES mean = 2.78 ± 0.51). There were no significant differences between the PIP and either the PSP or LES cluster (PIP mean = 2.70 ± 0.61). (D) Patients in the PSP cluster reported significantly lower optimism than that reported by either the PIP or LES cluster (F(2,91) = 12.65, P < 0.001, partial η² = 0.218; PSP mean = 10.04 ± 3.82 vs PIP mean = 13.72 ± 4.97 vs LES mean = 15.15 ± 3.73). There was no significant difference between the PIP and LES clusters.