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, 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.


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). For this project, we will conduct a follow-up study to re-assess resilience and patient-reported outcomes approximately 18 months after patients completed the initial study. With this, we aim to determine whether children receiving treatment for CMP experience changes in resilience over the course of the study and whether improvements in resilience correlate with changes in symptom severity and treatment adherence.  

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 these data with data from the initial study to measure changes in patient and parental resilience and examine potential factors that correlate with resilience, linking our findings to information from the electronic medical record. We will also assess whether changes in resilience 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 support future studies evaluating the efficacy of resilience training interventions for adolescents with CMP, the focus of Dr. Gmuca’s K23 proposal.

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.

This project page was last updated in August 2019.

Suggested Citation

The 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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