Protection from Chronic Musculoskeletal Pain: A Scoping Review

Research in the management of chronic musculoskeletal pain often focuses on negative factors associated with poor outcomes. In contrast, strengths-based approaches attempt to identify factors associated with positive outcomes, referred to as protective factors. Significant potential value lies in understanding protective factors in chronic musculoskeletal pain to deliver strengths-based care. This scoping review aimed to identify protective factors associated with lower pain-related disability or higher physical function in adults with chronic musculoskeletal pain.

Searches were conducted across five databases: Medline, CINAHL Ultimate, Embase PsycINFO and SPORTDiscus. Research Screener was used for abstract screening.

Seventy-nine articles met inclusion criteria for data extraction. Overall methodological quality was low and most studies were cross-sectional. A range of psychological, lifestyle, social and physical factors were associated with lower pain-related disability/higher physical function. Self-efficacy was the most frequently reported factor. Other psychological factors included psychological resources, coping strategies, psychological health, acceptance, cognitive factors, perceptions of control and motivational factors. Lifestyle factors included health promotion practices, Mediterranean diet, sleep and physical activity. Identified social factors were socioeconomic and interpersonal factors. Physical factors included exercise capacity, walking performance, strength and range of motion.

These factors align with the biopsychosocial understanding of pain and offer a balancing point to the prevailing deficits-based focus. The findings can be used as a unique resource for clinicians, researchers and educators working in the field of chronic musculoskeletal pain and may assist in developing strength-based approaches to musculoskeletal pain care.

This scoping review maps available evidence on psychological, lifestyle, social and physical factors that have shown an association with lower pain-related disability or higher physical function. This offers a contrasting yet complementary perspective to the prevailing focus on deficits in the literature and shines light on factors that could underpin a strengths-based approach for chronic musculoskeletal pain.