Building resilience to chronic pain during childhood: The Situate - Experience - Learn - Feel (SELF) Framework

Chronic pain is a significant global public health problem affecting 1 in 4 adults and 1 in 5 young people. Despite the high prevalence of chronic pain, research into its prevention is scarce. In this review, we draw from current, interdisciplinary evidence to present a conceptual Situate - Experience - Learn - Feel (SELF) Framework that takes a developmental and biopsychosocial-societal approach to building children's resilience against future chronic pain. The SELF Framework considers the impact of one's Situation, including social and societal supports and structures, early life Experiences, Learning of skills and knowledge, and the ability to understand and differentiate Feelings, in establishing SELF-empowerment, SELF-enablement, and SELF-reliance for the management of future pain experiences. We argue that childhood (∼0-10 years) is a developmental period that provides a potentially critical and thus far untapped opportunity to build resilience to chronic pain in adolescence and beyond. Our framework has three pillars: (1) LEARN: 'Building Knowledge and Skills' - targets children's understanding of pain and healthcare and associated behaviours; (2) EXPERIENCE: 'Strengthening Social Support and Building Emotional Resilience' - targets the fostering of social supports, community, positive childhood experiences, and emotional wellbeing; and (3) FEEL: 'Building Brain-Body Integration' - targets the development and maintenance of movement, interoception, and body awareness. For each pillar, we present its definition and scope, an evidence-based rationale, and provide implementation strategies that could reduce the risk of chronic pain in the future. Importantly, the SELF Framework considers that disadvantageous aspects of a child's broader societal/structural and social SITUAT[ION] may demand additional supports to mitigate risk, and we present several avenues for future research on this.