Building pain resilience in LGBTQIA+ individuals

Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and individuals with other related experiences or identities (LGBTQIA+) experience chronic pain and disability at twice the rate as their cisgender, endosex, and heterosexual counterparts. These disparities are shaped by intersecting social, structural, and historical factors, including minority stress, health care discrimination, and barriers to affirming care. While contextualized approaches to pain management have been recommended to address the unique lived experiences of LGBTQIA+ individuals, prevailing pain models largely remain grounded in deficit-oriented frameworks that emphasize vulnerability, maladaptive cognitions, and individual pathology. Such approaches risk obscuring the broader social determinants of health that shape pain experiences and may inadvertently reproduce dynamics of stigma and medical mistrust. This perspective argues for a conceptual shift toward an affirmative, resilience-based approach to chronic pain management for LGBTQIA+ individuals. Drawing on evidence from LGBTQIA+ affirming care, trauma-informed practice, and resilience-based approaches, this perspective proposes a framework that integrates recognition of social and structural inequities with strengths-based principles that emphasize adaptive coping, psychological flexibility, identity affirmation, and community connection. It outlines how physical therapists are uniquely positioned to operationalize this approach by fostering psychological safety, supporting meaningful movement and values-based engagement, and addressing contextual barriers to care. By moving beyond vulnerability-focused models and centering resilience as a dynamic, contextually situated process, this perspective offers a pathway for physical therapists to promote equity, empowerment, and more effective pain care for LGBTQIA+ individuals. Prevailing pain management models for LGBTQIA+ individuals are largely deficit-oriented, often overlooking minority stress, structural inequities, and the historical pathologization of LGBTQIA+ identities. Resilience-based, LGBTQIA+-affirming approaches integrate strengths, adaptive coping, and community resources while explicitly acknowledging social determinants of health and previous trauma. This perspective calls for a conceptual and practice-level shift in physical therapy, positioning affirming, resilience-informed pain care as essential to advancing equity and improving outcomes for LGBTQIA+ communities.