Resilience and Resistance: A Proposed Model of Chronic Pain Resilience in Native Americans

American Indians/Alaska Natives (AI/AN) have higher rates of chronic pain than other U.S. groups. Research has attempted to uncover mechanisms behind this disparity, but risk factors for chronic pain have been delineated at the expense of examining resilience factors. Chronic pain resilience is typically defined as "the capacity to resist, adapt to, recover, or grow from a challenge." However, this conceptualization may not capture strengths inherent to AI/AN. To our knowledge, no investigations of AI/AN chronic pain resilience have been conducted to date. This project investigated the construct of chronic pain resilience among 27 AI/AN adults experiencing chronic pain. A semi-structured interview asked about personal definitions of resilience, experiences with chronic pain, and cultural influences. Interviews were conducted in-person or virtually, and transcripts of responses were generated, verified, and coded using 2 independent coders. Results produced 2 complementary sets of findings. First, participants indicated that pain was not a special form of adversity that would meaningfully change their definitions of resilience. Rather, pain was seen as another hardship requiring persistence, balance, and acceptance. Second, despite this general view, thematic analysis identified 4 interrelated themes describing how resilience is expressed in the context of chronic pain: Pain Management and Adaptation Strategies, Psychological and Behavioral Resilience Processes, AI/AN Cultural Resources and Practices Supporting Resilience, and System-Level Impacts on the Chronic Pain Experience. This study proposes the first model of AI/AN chronic pain resilience and provides a foundation for future investigations to clarify the interplay of the themes identified. PERSPECTIVE: This study provides the first model of chronic pain resilience in American Indians/Alaska Natives, showing that resilience is defined generally but expressed through culturally grounded practices and shaped by systemic inequities. These findings highlight the need for culturally centered interventions and greater attention to structural factors affecting pain experiences.