Stefan Elbers

14 Chapter 1 Taken together, the system of biomedical, psychological, and social factors provides a comprehensive understanding of how an inherently adaptive function can become a disease in itself, leading to severe disability and an inability to fulfil social roles and personally valued activities. LIVING WITH CHRONIC PAIN Psychosocial Coping Variables The previous section showed how a cluster of interrelated biopsychosocial factors contributes to the development of chronic pain. For patients who live with pain for years on end, it is also important to understand how to manage the impact of chronic pain on day-to-day activities. Although subgroups in coping patterns have been observed (e.g. Hasenbring et al., 2020), the multitude of identified personal and social factors that influence coping with pain suggest unique behavioural responses and pain management strategies for each patient (O’Sullivan et al., 2018). An example of these factors is the personality trait of optimism (i.e. a general tendency towards favourable expectations concerning their future), which is positively related to more flexible goal-adjustment when confronted with goal-conflict situations (Ramírez-Maestre et al., 2019). Other factors that have been observed to positively influence coping are undertaking physical activity, self- compassion, and acceptance of pain (Åkerblom et al., 2015; Edwards et al., 2019; Edwards et al., 2016). As regards coping with pain, an important vulnerability factor is the amount of negative affect, such as distress, felt by the patient (Edwards et al., 2016). Difficulties in regulating these negative emotions may result in symptoms of depression or anxiety, which negatively influence long-term outcomes (Edwards et al., 2016; Karoly, 2020). The social environment also influences coping with chronic pain (Edwards et al., 2016). For example, global social support is positively associated with pain coping, unless this support encourages pain-contingent behaviours or excessive resting (Jensen et al., 2011). Goals and Goal-Conflict In addition to the various psychosocial variables that influence pain coping, it is also important to consider the continuous impact of chronic pain on goal pursuit in general. Goals are defined as mental representations of desired future outcomes (Ramnerö & Törneke, 2015). They serve as a reference standard to guide current actions towards these envisioned outcomes. Goals do not operate in a vacuum but are embedded in a hierarchical motivational network where higher-order values are associated with goals and concrete actions (Carver & Scheier, 2017; Höchli et al., 2018). Given the limitations of a humans attention span, goals are not continuously active. Instead, they can be retrieved from