Fostering Resilience in Adolescents with Chronic Musculoskeletal Pain

Statement of Problem

Pediatric chronic musculoskeletal pain (CMP)—chronic pain affecting the bones, joints, muscles or connective tissues for three months or longer—is extremely prevalent, affecting up to 40% of children, primarily adolescents. Despite current treatment practices, long-term outcomes for youth with CMP remain poor, with affected teens experiencing greater anxiety, depression, and overutilization of health care and a greater risk of opioid misuse as adults. While cognitive behavioral therapy (CBT) can effectively treat adolescent CMP, access to a psychologist can be challenging for some families, and CBT alone does not result in improved physical activity among affected teens.

Resilience-training interventions serve as potential alternative psychosocial skills-based interventions for the treatment of adolescent CMP. While routed in traditional CBT, resilience-training interventions are distinct in that they are brief and target specific stress management skills. More youth can access these interventions since providers, including bachelors-level, non-clinical personnel, can deliver them remotely via telephone or Skype.

Our long-term goal is to test the efficacy of a resilience-training intervention (Promoting Resilience in Stress Management [PRISM])—which researchers in the Palliative Care and Resilience Research Program at Seattle Children’s Hospital originally designed for adolescents and young adults with serious illness—among a population of youth with CMP. However, prior to doing so, we need more research to understand the role of patient and parental resilience in disease management among youth with CMP.


Fostering Resilience in Adolescents with Chronic Musculoskeletal Pain

Findings from this study will support future studies evaluating the efficacy of resilience training interventions for adolescents with chronic musculoskeletal pain.

Our prior research demonstrates low resilience among youth ages 12-17 with CMP, as well as a link between resilience and measures of disease burden (i.e. pain level and widespreadness of pain). The goal of this body of research is to contribute unique knowledge regarding risk factors associated with long term outcomes in adolescent CMP and identify ways to support adolescents with CMP. First, we will conduct longitudinal risk factor study to assess resilience and patient-reported outcomes at time of initial clinic visit and again approximately 6 months later for adolescents diagnosed with CMP and one of their parents.

Patients and proxies will complete the Connor Davidson Resilience Scale 10-item (CD-RISC-10) and patient-reported outcome measures to assess resilience and treatment adherence. We will link our findings to information from the electronic medical record. We will also assess whether changes in resilience, and other psychosocial risk factors (i.e. pain catastrophizing, mindfulness, optimism, etc.), are associated with a number of symptoms and factors important to patients with CMP including pain intensity, physical disability, health-related quality of life, symptom severity, widespreadness of pain and parental resilience.

Findings from this study will complement the execution of a pilot trial of PRISM among adolescents with CMP that will examine the feasibility and acceptability (e.g. appropriateness) of the intervention and identify any possible adaptations to the intervention specific to this patient population. The team will administer the intervention via in-person, telehealth, or telephone, dependent on the subjects’ preferences. The team will also interview subjects upon completion to gain additional feedback to help reformat the intervention as needed.

Next Steps

Understanding how resilience relates to symptom severity and treatment adherence among youth with CMP as well as further determining whether resilience changes over time with current treatment regimens will inform the design of a future randomized controlled trial of a resilience training intervention in this vulnerable patient population. Long-term, we hope this research will result in improved access to and efficacy of non-pharmacologic psychosocial interventions for adolescent CMP.

In our Research in Motion video series, Dr. Sabrina Gmuca explains more about her work in fostering resilience in youth with chronic, including her aims to utilize PRISM to help reduce suicidal thoughts among these youth. 

This project page was last updated in June 2020.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Fostering Resilience in Adolescents with Chronic Musculoskeletal Pain [online]. Available at: [Accessed: plug in date accessed here]. 

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