Resilience among adults with chronic urologic pelvic pain syndrome: A flexible self-regulation perspective

While coping with the heavy patient demands of chronic pain requires psychological resilience, its core mechanisms have not been systematically studied in high-impact pain disorders like Urologic Chronic Pelvic Pain Syndrome (UCPPS). Applying a flexible self-regulation (FSR) model of resilience, we sought to characterize how flexibility deficits in the abilities to read, decode, and respond appropriately to contextual cues (context sensitivity) and coping flexibility relative to known protective (e.g., pain-specific resilience, social support) and vulnerability factors (e.g., catastrophizing), correspond with symptom severity and quality of life (QoL) impairment in patients with refractory UCPPS symptoms. Participants included 113 (Mean age = 43.56, SD = 14.79, 81.4% female) formally diagnosed UCPPS (Interstitial Cystitis/Bladder Pain Syndrome or Chronic Prostatitis/Chronic Pelvic Pain Syndrome) patients with refractory pelvic pain. Baseline data, completed as part of an NIH clinical trial, included FSR components, Pain Resilience Scale, social support, Positive and Negative Affect Schedule, Coping Strategies Questionnaire - Catastrophizing, pelvic pain, and urinary severity indices, and QoL (CDC Healthy Days, PROMIS physical and mental health). Regression analyses, using a Bayesian variable selection method, examined how protective and vulnerability factors were associated with symptom and QoL outcomes. As predicted, context sensitivity and coping flexibility corresponded with higher QoL. The pattern of results was more consistent for components of FSR than for dispositional psychological factors including pain resilience, negative affectivity, and pain catastrophizing. Data demonstrates the importance of resilience rooted in a theory-informed, empirically grounded flexible self-regulation conceptual model. Perspective: Flexible self-regulation, a cognitive-affective construct critical to the development of resilience, is important for understanding adaptation to nociplastic pain disorders like UCPPS. Contextual-based coping based on situational flexibility corresponds with quality of life, which may may be a novel therapeutic target for optimizing behavioral pain treatments for high-impact pain disorders.