Age and psychosocial contributors to well-being among older adults living with chronic pain

Abstract

Objectives

This study examined the influence of age variables along with psychosocial variables on well-being among older adults living with chronic pain.

Methods

Using a cross-sectional survey design, older adults living with chronic pain in Canada (N = 220) completed an online survey assessing age variables (ie age at onset of chronic pain, current age), psychosocial variables (ie pain catastrophizing, pain disability, physical functioning, psychological inflexibility), and well-being variables (ie autonomy, environmental mastery, self-acceptance, overall eudaimonic well-being).

Results

Current age, but not age of onset of chronic pain, significantly predicted eudaimonic well-being and self-acceptance. Physical functioning, pain catastrophizing, and pain disability significantly predicted eudaimonic well-being, autonomy, and environmental mastery. Pain catastrophizing also significantly predicted self-acceptance. With regards to the relative importance of effect sizes, physical functioning followed by pain catastrophizing were the most important factors contributing to autonomy, environmental mastery, and self-acceptance. These psychosocial factors were more important for self-acceptance than they were for autonomy or environmental mastery.

Conclusion

When living with chronic pain, the psychosocial variables of most importance to older adults’ well-being may be physical functioning and pain catastrophizing, and the development of psychological interventions for older chronic pain populations should account for these psychosocial factors.

Keywords:

• Autonomy
• environmental mastery
• pain catastrophizing
• pain disability
• physical functioning
• psychological inflexibility
• self-acceptance
• eudaimonic well-being

Reviewing Editor:

• Daryl O’Connor, University of Leeds, United Kingdom

Subjects:

• Health Psychology
• Aging
• Disability
• Aging and Health
• Health Conditions

Introduction

Carstensen’s (1995) Socioemotional Selectivity Theory states that, as individuals advance in age, the perceived time left in their lifetime continuously shrinks. According to this theory, the salience of one’s time horizon leads to a shifting of goals and motivations from expanding and pursuing opportunities (knowledge-focused goals) in younger adulthood toward focusing on close, personal relationships in older age (emotion-focused goals; Carstensen, 1995). Older individuals place more emphasis on the social relationships that matter most to them (emotion-focused goals) because they already have an advanced knowledge repository (knowledge-focused goals) and a perceived limited amount of time, causing them to place more emphasis on the social relationships that matter most to them (Carstensen et al., 1999). The concomitant selective winnowing of relationships maximizes positive emotional experiences and minimizes negative emotional experiences (Carstensen, 1995), a process that is not a direct product of one’s chronological age, but rather a shift in time perspective which can be associated with chronological age (Carstensen et al., 2000). Research indicates that, in line with this theory, well-being seems to increase with age despite the decrease of traditional well-being determinants, such as health, social networks, and income (Carstensen, 2019; Carstensen et al., 1999; Kusumastuti et al., 2016).

Well-being is an umbrella term that refers to components of individual and collective well-being wherein an individual realizes their abilities, copes with normal stresses in life, works productively, and contributes to their community (WHO, 2022). Adults living with chronic pain (ie pain that has persisted for more than three months and is associated with significant emotional distress or functional disability; Treede et al., 2019) tend to report lower levels of well-being, likely fueled by the increase of magnitude and variety of problems associated with chronic pain, such as functional limitations, difficulties with sleep, depression, and increased health costs, and care needs (Topcu, 2018). With age, the prevalence of chronic pain increases, reaching peak prevalence in the seventh decade of life (Macfarlane, 2016). Among older adults with chronic pain, lower levels of life satisfaction have been observed; however, when compared to the life satisfaction levels of their healthy peers, the observed difference appears to be trivial (Dong et al., 2020a). That is, age-related changes in well-being may be attributable to the experiences associated with age, such as the shift of one’s time horizon that can follow a health crisis such as the onset of chronic pain, rather than age itself (Carstensen, 1995).

One component of overall well-being is eudaimonic well-being. Eudaimonic well-being is a type of happiness that is derived from a meaningful purpose in life and becoming a fully functioning person (Ryff et al., 2021). Other dimensions of eudaimonic well-being include feelings of autonomy, self-acceptance, and environmental mastery (Ryff & Keyes, 1995). An autonomic individual can be described as self-determining and independent, regulating their behaviours from within (Ryff et al., 2021), which is associated with longevity and good self-assessed health (Sánchez-García et al., 2019). Among older adults experiencing pain-related disability, higher levels of perceived autonomy have been associated with lower pain-related disability (Matos et al., 2016). Like autonomy, self-acceptance has also been found to promote longevity and therefore healthy aging (Ng et al., 2020). Individuals who demonstrate elevated levels of self-acceptance possess positive attitudes toward their entire selves, viewing the self as multi-dimensional and acknowledging both their positive and negative aspects (Ryff et al., 2021). Perceptions of self-acceptance may be particularly threatened by people suffering from chronic pain, as literature demonstrates correlations between chronic pain stigmatization and levels of self-acceptance (Hegarty & Wall, 2014). Finally, environmental mastery may be one of the most important factors influencing older adults’ well-being (Knight et al., 2011). Environmental mastery refers to an individual’s sense of competence in managing their environment and opportunities (Ryff et al., 2021). Age and pain seem to play influential roles in an individual’s levels of autonomy, self-acceptance, and environmental mastery.

Disabilities arising from pain- and health-related functioning is a common experience for older adults living with chronic pain (van der Leeuw et al., 2016). While the direct relationship between functional disability and well-being has produced mixed results, the burden of impaired physical conditions can decrease well-being (Müller et al., 2016). A psychological mechanism that could hinder effective coping with pain is pain catastrophizing, the tendency to have overly negative thoughts in response to pain, which entails pain magnification, rumination, and helplessness (Martinez-Calderon et al., 2019). For instance, older adults’ pain catastrophizing has been linked to pain intensity (Dong et al., 2020b) and levels of depression and anxiety (Chen et al., 2022). In addition to catastrophizing, psychological flexibility (the psychological processes that fuels goal and value-pursuits) can improve the experience of chronic pain (Kwok et al., 2016). Kwok et al. (2016) found that higher levels of flexibility positively impacted pain tolerance, emotional health, and functional adjustment. Both pain catastrophizing and psychological flexibility levels can be improved through training and therapy, presenting us with a modifiable target for psychological intervention (McAteer & Gillanders, 2019; Schütze et al., 2018).

The increased prevalence of chronic pain in older age and the link between chronic pain and lower well-being suggests that chronic pain could moderate the relationship between age and well-being. That is, the experience of chronic pain could hinder the increase in well-being associated with older age. However, research on this phenomenon among chronic pain populations is lacking. Aside from a study conducted on a sample of women with fibromyalgia (Peñacoba et al., 2021), it remains unclear what factors are important for the well-being in older adults living with chronic pain. This study was therefore aimed at examining the influence of psychosocial experiences of chronic pain (eg pain- and health-related functioning, pain catastrophizing, psychological inflexibility) on levels of well-being among older adults. Our two research questions were, ‘Does the age at which an individual develops chronic pain influence the experience of well-being?’ and ‘Does pain level, pain catastrophizing, psychological inflexibility, and pain- and health-related functioning influence well-being in older adults living with chronic pain?’ We hypothesized that older adults who developed chronic pain later in life would report greater levels of well-being compared to older adults who developed chronic pain earlier in life. Second, we wanted to know whether pain level, pain catastrophizing, psychological inflexibility, and pain- and health-related functioning influenced well-being in older adults living with chronic pain. We hypothesized that pain- and health-related functioning would be positively predictive of well-being, while pain catastrophizing and psychological inflexibility would be negatively predictive of well-being among older adults above and beyond their age. By measuring multiple dimensions of well-being (eg overall eudaimonic well-being in addition to specific experiences of autonomy, self-acceptance, and environmental mastery), we sought to identify what factors contribute to different experiences of well-being in this population.

Materials and methods

Participants

A G*Power analysis indicated that a sample size of at least 92 participants would be required to detect medium-sized effects with a statistical power level of 0.80 and an alpha (a) of 0.05 (Faul et al., 2009). Participants (N = 220) completed a one-time online survey that was open between December 2022 and May 2023. Participants were required to meet the criteria of residing in Canada, living with chronic pain (ie pain that persists for three or more months and causes significant emotional distress), and being at least 60 years of age. This age was selected with reference to the United Nations’ definition of older persons (Scherbov & Sanderson, 2019, slide 2). Participants were excluded if they did not meet these three criteria. Participants were primarily women (65%), white (94%), older adults (M = 66 years). Full demographic information is presented in Table 1. Participants mostly resided in British Columbia (30%) and the prairie provinces (Alberta, Manitoba, and Saskatchewan; 21.7%).

Table 1. Descriptive statistics of demographic characteristics.

Demographic characteristics	M (SD) or N (%)
Age in years	66 (9)
Age in years at pain onset	51 (14)
Gender
Man	66 (35%)
Woman	125 (65%)
Missing or prefer not to answer	27
Ethnic background
Asian	7 (3.8%)
Black	3 (1.6%)
Indigenous	2 (1.1%)
White	173 (94%)
Missing or prefer not to answer	33

Measures

Chronbach’s alpha is presented for each measure in Table 2. Seven questionnaires were combined into one survey, in addition to a demographic questionnaire.

Table 2. Number and percent of participants from each Canadian region.

Canadian region	N (%)
Atlantic Canada (New Brunswick, Newfoundland & Labrador, Nova Scotia, Prince Edward Island)	18 (15%)
British Columbia	36 (30%)
Canadian Prairies (Alberta, Manitoba, Saskatchewan)	26 (21.7%)
Central Canada (Ontario, Québec)	15 (12.5%)
Territories (Northwest Territories, Yukon)	8 (6.7%)
Missing or prefer not to answer	98

Chronic pain

A modified version of the Chronic Pain Inventory (CPI) was used to measure participants’ experiences with chronic pain (Multidisciplinary Pain Center Toolkit Advisory Group, 2021). The measure consists of two sections: assessment of persistent baseline pain (five questions) and assessment of persistent breakthrough pain (13 questions). For this study, questions regarding current medications, pain location, and pain sensation were removed and a question about age of chronic pain onset was added.

Eudaimonic well-being

The Questionnaire for Eudaimonic Well-Being (QEWB; Waterman et al., 2010) is comprised of 21 questions rated on a 5-point Likert scale (0 = strongly disagree; 4 = strongly agree) measuring self-discovery, perceived development of one’s best potentials, a sense of purpose and meaning in life, intense involvement in activities, investment of significant effort, and enjoyment of activities as personally expressive. Higher scores indicate greater eudaimonic well-being.

Self-acceptance, autonomy, and environmental mastery

Three modified subscales from Ryff’s Scales for Psychological Well-Being (RSPW) were used to assess self-acceptance, autonomy, and environmental mastery (Ryff & Keyes, 1995). Items were rated on a 7-point Likert scale (1 = strongly disagree; 7 = strongly agree), with higher scores indicating greater self-acceptance, autonomy, and environmental mastery. Each subscale was initially comprised of three questions; however, one question from each subscale was dropped during statistical analysis to improve the subscales’ internal consistency (ie ‘I tend to be influenced by people with strong opinions’, ‘The demands of everyday life often get me down’, and ‘When I look at the story of my life, I am pleased with how things have turned out so far’).

Pain disability index

Disruption of participants’ functioning due to their chronic pain was measured with the Pain Disability Index (PDI; Tait & Chibnall, 2005). The PDI is composed of seven questions rated on an 11-point Likert scale (0 = no disability; 10 = worst disability), with higher scores indicating greater pain disability.

Physical health-related functioning

The Physical Functioning (10 items) and Role Limitations due to Physical Health (4 items) subscales of the 36-Item Short Form Survey (SF-36) were used to measure participants’ levels of health-related functioning (RAND Corporation, n.d.). For both subscales, participants answered questions on a 3-point Likert scale (1 = not at all; 2 = limited a little; 3 = limited a lot), with higher scores indicating greater difficulties with functioning.

Pain catastrophizing

Levels of pain catastrophizing (including rumination, magnification, and helplessness) were measured using the Pain Catastrophizing Scale (PCS; Sullivan et al., 1995), which consists of 13 items rated on a 5-point Likert scale (0 = not at all; 4 = all the time), with higher scores indicating greater pain catastrophizing.

Psychological inflexibility

Psychological inflexibility was measured with the Psychological Inflexibility in Pain Scale (PIPS; Wicksell et al., 2006). The scale consists of 16 items which are measured using a 7-point Likert scale (1 = never true; 7 = always true), with higher scores indicating greater psychological inflexibility.

Demographics

Participants provided demographic information through open-ended questions including their age, racial background, gender identity, and province of residence.

Procedure

This cross-sectional study was conducted using an online survey hosted by Qualtrics. Participants were recruited primarily online via emails to Canadian organizations who worked with older adults or chronic pain populations. This study was approved by the University of Regina Research Ethics Board (#2022-222), and informed consent was obtained from participants prior to their commencement of the survey. At the end of the survey, participants were thanked for their time and provided their email for a chance to win one of five $50 Amazon gift cards.

Data analysis plan

To assess our research questions, a series of multiple linear regressions were conducted with age variables (ie age at onset of chronic pain, current age) and psychosocial variables (ie pain catastrophizing, pain disability, physical functioning, psychological inflexibility) entered as predictor variables and well-being variables entered as outcome variables. A separate regression model was carried out for each well-being variable (ie autonomy, environmental mastery, self-acceptance, overall eudaimonic well-being). In particular, we relied on measures of relative importance using the Lindeman, Merenda and Gold (lmg) method in Grömping’s (2006) relaimpo() package in R for effect sizes. Relative importance is a decomposition of the total R² for each variable such that coefficients sum to R². This analysis enabled us to compare how well age and psychosocial variables predicted different types of well-being.

Results

Descriptive statistics of participant demographic characteristics and measures used are presented in Tables 1–4. Bivariate correlations are presented in Figure 1. Age was significantly associated with most variables, but associations with age varied by predictor (value of r ranged from −0.49 to 0.57). In general, the predictor variables were moderately correlated with each other as one would expect. Excluding intercorrelations among measure subscales, none of the correlations were strong enough to raise concerns over multicollinearity (ie had simple bivariate correlations less than 0.70), and therefore each factor made relatively unique contributions in explaining variations in experiences of well-being.

Figure 1. Bivariate correlations between key study variables. Pink represents positive correlations and grey represents negative correlations. Non-significant correlations are crossed out.

Table 3. Descriptive statistics for pain-related and well-being measures.

Measures	M (SD) or N (%)	Range	Reliability
Self-acceptance	4.60 (1.11)	1–7	0.70
Autonomy	5.54 (1.32)	1–7	0.75
Environmental Mastery	5.24 (1.40)	1–7	0.76
Overall Eudaimonic Well-being	3.75 (0.54)	1–5	0.79
Physical Functioning	1.78 (0.44)	1–3	0.86
Psychological inflexibility	4.29 (1.10)	1–7	0.91
Pain Disability Index	5.86 (2.28)	1–12	0.85
Role Limitation	6.50 (2.35)	0–10	0.71

Reliability is measured with Chronbach’s alpha.

Table 4. Number and percentage participant-reported pain experiences.

Pain experiences	N (%)
Pain experienced in past week	196 (90%)
Pain is persistent if not treated	179 (90%)
Pain can be reduced with certain activities	129 (70%)
Pain worsens with certain activities	150 (82%)
Pain episodes occur	128 (59%)
Know what causes pain episodes	78 (59%)
Pain episodes occur with certain activities	96 (72%)
Pain episodes occur with certain bodily functions	38 (29%)

Our first regression model was built to predict variance in eudaimonic well-being based on 6 independent variables (Table 5). The model was significant, F(6, 188) = 7.09, p < .001. Collectively, 5 variables explained 18% of the variance in well-being, mainly due to the relative importance of catastrophizing (ri = 0.07).

Table 5. Multiple regression model predicting variance in eudaimonic well-being.

Predictors	Estimates	Std. β	95% CI	Std. CI	p
Age	0.01	0.19	0.00 to 0.02	0.03 to 0.34	.02
Age at Pain Onset	−0.00	−0.01	−0.01 to 0.01	−0.16 to 0.14	.92
Physical Function	0.19	0.16	0.00 to 0.37	0.00 to 0.31	.04
Pain Catastrophizing	−0.17	−0.30	−0.27 to −0.07	−0.48 to −0.12	.01
Pain Disability Index	0.06	0.24	0.02 to 0.09	0.09 to 0.39	.02
Psychological Inflexibility	0.00	0.00	−0.09 to 0.09	−0.18 to 0.18	.99

Bolded values reflect significance at the p < .05 level.

Our second regression model was built to predict variance in self-acceptance based on the same 6 independent variables (Table 6). The model was significant, F(6,188) = 13.69, p < .001. One-quarter of the variance in self-acceptance (R² = 0.30) was accounted for, mainly due to the relative importance of pain catastrophizing (ri = 0.12), psychological inflexibility (ri = 0.07), and current age (ri = 0.06).

Table 6. Multiple regression model predicting variance in self-acceptance.

Predictors	Estimates	Std. β	95% CI	Std. CI	p
Age	0.03	0.23	0.01 to 0.05	0.09 to 0.38	.01
Age at Pain Onset	0.00	0.05	−0.01 to 0.01	−0.08 to 0.19	.43
Physical Function	0.17	0.07	−0.18 to 0.52	−0.07 to 0.21	.33
Pain Catastrophizing	−0.34	−0.30	−0.53 to −0.14	−0.46 to −0.13	.01
Pain Disability Index	−0.02	−0.04	−0.09 to 0.05	−0.18 to 0.10	.56
Psychological Inflexibility	−0.15	−0.15	−0.32 to 0.01	−0.32 to 0.01	.07

Bolded values reflect significance at the p < .05 level.

Our third regression model was built to predict variance in autonomy based on the same 6 independent variables (Table 7) and was significant, F(6,188) = 5.03, p < .001. Collectively, the 6 variables predicted just over one-fifth of the variance in autonomy (R² = 0.14), mainly due to the relative importance of physical functioning (ri = 0.06) and pain disability (ri = 0.05).

Table 7. Multiple regression model predicting variance in autonomy.

Predictors	Estimates	Std. β	95% CI	Std. CI	p
Age	0.00	0.01	−0.02 to 0.03	−0.15 to 0.17	.88
Age at Pain Onset	0.00	0.02	−0.01 to 0.02	−0.13 to 0.18	.76
Physical Function	0.88	0.30	0.41 to 1.34	0.14 to 0.45	.01
Pain Catastrophizing	−0.27	−0.20	−0.52 to −0.01	−0.38 to −0.01	.04
Pain Disability Index	0.18	0.31	0.09 to 0.27	0.16 to 0.47	.01
Psychological Inflexibility	0.06	0.05	−0.16 to 0.27	−0.14 to 0.23	.62

Bolded values reflect significance at the p < 0.05 level.

Our fourth regression model was built to predict variance in autonomy based on the same 6 independent variables (Table 8). The model was significant, F(6, 187) = 6.27, p < .001. Collectively, the 6 variables predicted 17% of the variance, mainly due to the relative importance of physical functioning (ri = 0.05) and pain catastrophizing (ri = 0.05).

Table 8. Multiple regression model predicting variance in environmental mastery.

Predictors	Estimates	Std. β	95% CI	Std. CI	p
Age	−0.02	−0.12	−0.05 to 0.01	−0.28 to 0.03	.13
Age at Pain Onset	0.01	0.13	−0.00 to 0.03	−0.02 to 0.28	.09
Physical Function	0.72	0.23	0.23 to 1.21	0.07 to 0.38	.01
Pain Catastrophizing	−0.32	−0.22	−0.59 to −0.05	−0.41 to −0.04	.02
Pain Disability Index	0.12	0.20	0.03 to 0.21	0.04 to 0.35	.01
Psychological Inflexibility	−0.14	−0.11	−0.37 to 0.09	−0.29 to 0.07	.22

Bolded values reflect significance at the p < .05 level.

A comparison of the relative importance of effect sizes is in Table 9, showing the six variables ranked in the same order of importance for each dimension of well-being, although the degree of importance for each variable differs by well-being dimension. Although physical functioning was the most important determinant of variance for each type of well-being, it was twice as important as any other variable for self-acceptance. Pain catastrophizing was the second most important factor followed by psychological inflexibility. Both these variables were more important for self-acceptance than they were for environmental mastery or autonomy.

Table 9. Relative importance of effect sizes for each dimension of well-being.

Self-Acceptance		Autonomy		Environmental Mastery
Physical functioning	0.12	Physical functioning	0.06	Physical functioning	0.05
Pain catastrophizing	0.07	Pain catastrophizing	0.05	Pain catastrophizing	0.05
Psychological inflexibility	0.06	Psychological inflexibility	0.02	Psychological inflexibility	0.04
Pain disability index	0.02	Pain disability index	0.01	Pain disability index	0.01
Age at pain onset	0.02	Age at pain onset	0.00	Age at pain onset	0.01
Age	0.01	Age	0.00	Age	0.01
R^2	0.25		0.14		0.17
R^2 –of top predictors	0.20		0.11		0.14

Bolded values reflect significance at the p < 0.05 level. A relative importance value of = > 0.02 is considered to be “relatively important.”

Discussion

The purpose of this study was to identify the influence of age variables (ie age of onset of chronic pain, current age) and psychosocial variables (ie pain catastrophizing, pain disability, physical functioning, psychological inflexibility) on levels of well-being among older adults living with chronic pain. Findings from this study revealed that levels of eudaimonic well-being and specific components of well-being (ie autonomy, environmental mastery, self-acceptance) were not significantly influenced by the age of onset of chronic pain among older adults living with chronic pain. The current study, therefore, does not link the early onset of chronic pain to subsequent lower well-being, which is contrary to findings linking the onset of chronic pain as young as 44 years to poorer health and well-being in the following two decades of life (Blanchflower & Bryson, 2022). However, due to the cross-sectional nature of our study, we cannot determine if the participants’ reported levels of well-being declined since the onset of their chronic pain. Physical functioning and pain catastrophizing were the most and second most relatively important determinants of lower levels of autonomy, environmental mastery, and self-acceptance. Physical functioning was twice as relatively important of a determinant of lower levels of self-acceptance than any other variable. Psychological inflexibility was the third most relatively important determinant for self-acceptance and environmental mastery, but not for autonomy. These psychosocial determinants were more important for self-acceptance than they were for environmental mastery or autonomy. This pattern of results is further discussed in the following sections.

Physical functioning

Physical functioning was the most important determinant of lower levels of each type of well-being. This finding is consistent with previous reports which have found that physical health impairment directly affects aspects of well-being among older adults (Cho et al., 2015). Previous research also indicates that functional limitations are associated with a decline in quality of life among older adults (McAuley et al., 2011). Interestingly, the pain disability index said to measure the extent to which aspects of one’s life are disrupted due to chronic pain, had less of an impact on participants’ well-being compared to general physical functioning. These findings indicate that participants’ overall levels of physical functioning were more influential than their pain-related disabilities to their levels of well-being. This finding is in line with previous research which reports mixed results concerning the relationship between disability-related functioning and well-being (Müller et al., 2016). Interventions such as self-efficacy training may help older adults improve physical functioning (McAuley et al., 2011).

Pain catastrophizing

The psychosocial mechanism of pain catastrophizing was the second most important determinant that contributed to lower levels of well-being. Pain catastrophizing had the largest impact in the variance of overall eudaimonic well-being but ranked second on the three well-being dimensions of autonomy, environmental mastery, and self-acceptance. Pain catastrophizing is thought to play a key role in the development and maintenance of chronic pain, highlighted in multiple pain models (eg Fear-Avoidance Model, Communal Coping Model; Martinez-Calderon et al., 2019). In addition to being consistently predictive of people’s adjustment to chronic pain, pain catastrophizing has been identified as positively correlating with pain intensity and disability, as well as a mediator in the influence of pain intensity and pain interference on well-being (Martinez-Calderon et al., 2019; Furrer et al., 2019). Even when controlling for sociodemographic characteristics and pain intensity, pain catastrophizing negatively mediates the relationship between spiritual well-being and depression (Shaygan & Shayegan, 2019). Our findings fall in line with previous literature, working to highlight the entangled impact of pain catastrophizing on other constructs and to further emphasize the importance of treating it. Implementation of treatments such as cognitive-behavioural therapy, multimodal treatment, and acceptance and commitment therapy, which have been identified as effective in reducing pain catastrophizing levels among chronic pain participants (Schütze et al., 2018), may be a promising tool in reducing pain intensity and improving well-being.

Psychological inflexibility

Psychological inflexibility, while not significant in our regression models, was found to be significant as the third biggest factor responsible for variance in self-acceptance and environmental mastery scores. The variance in significance between the models may not be surprising, as a scoping review revealed mixed evidence on the role of psychological inflexibility, determining it to be unrelated to positive affect and inconsistently related to quality-of-life measures (Plys et al., 2022). We were able to predict much more of the variance attributable to psychological inflexibility in self-acceptance than in environmental mastery. This falls in line with previous research on men living with prostate cancer, which found a positive correlation between psychological flexibility and masculine self-esteem (McAteer & Gillanders, 2019). A strong positive correlation between psychological flexibility and self-esteem has also been reported (Gloster et al., 2011), but the same study found acceptance as a subcomponent of psychological flexibility to be unrelated to environmental mastery (Gloster et al., 2011). Perhaps the intertwined nature of psychological flexibility and acceptance can help explain the elevated levels of variance that psychological flexibility contributed to self-acceptance compared to environmental mastery. These findings indicate the value of improving psychological flexibility among the chronic pain population. A popular model to do so is a variance of acceptance and commitment therapy which aims to reduce chronic pain by following a psychological flexibility model (Scott et al., 2016). With the broader goal of treating chronic pain, acceptance and commitment therapy following the psychological flexibility model has produced promising outcomes (Scott et al., 2016), and has been demonstrated as a method of directly improving levels of psychological flexibility (Scott & McCracken, 2015).

Limitations and Future directions

While our study offers novel findings concerning contributors to well-being in a chronic pain older adult population, our six variables were only able to account for a relatively small amount of variance in well-being (17%–25%), indicating that many other factors are contributing to well-being in this population. Future research might expand on our findings by adding more variables to their research (ie income, marital status, social lives, etc.). Because data was collected through an online format, we were limited in our recruitment population. Research has demonstrated that online surveys targeting older adults are constrained by limited internet access and result in poorer generalizability (Remillard et al., 2014). Regardless of the medium used, survey-based research limits the potential participant pool, thereby decreasing the representativeness of the sample. Even collecting data through a paper-and-pencil survey only includes those who are literate, physically able to complete the survey, and able to access letter mail services or visit a site in person. In both cases, access to free time is necessary. Further inhibiting the generalizability of these findings is the unequal distribution of participants’ gender (ie the majority identified as women), and that the sample predominantly consisted of white participants. Future studies should seek to expand these findings by testing for similar outcomes with a larger sample size, which would work to increase the sample’s representation (ie enabling higher generalizability of findings) and statistical power (ie providing more insight into relationships between pain-related constructs and well-being). Expanding on the demographics section of future studies may offer more information about the influence of participants’ social lives and financial income on experienced levels of well-being. Our participants were not asked to specify their chronic pain as primary (chronic pain conceived as a disease in its own right) or secondary (chronic pain resulting from an underlying disease) (Treede et al., 2019). Future research should differentiate between primary and secondary chronic pain to determine, among other things, if these findings can be expanded to a chronic disease population. Additionally, this study focused solely on eudaimonic well-being, and only three of the six subscales of eudaimonic well-being (leaving out personal growth, positive relations with others, and purpose in life). Conclusion

The current study generates knowledge on the experience of chronic pain and pain-related constructs and their influence on different types of well-being. We provide evidence that older adults’ experience of well-being is tied to psychosocial aspects of their chronic pain experience, indicating that treatments targeting these psychological factors may be of value to older chronic pain populations. The observed elevated levels of well-being found in older patients despite their suffering from chronic pain threaten to diminish the identification and treatment of their suffering, and the findings offered by this study can aid in increasing the identification and subsequent treatment for older adults suffering from chronic pain regardless of their reported levels of well-being. The well-being levels of older adults with chronic pain may also benefit from interventions mediating levels of physical functioning, pain catastrophizing, and psychological inflexibility (eg self-efficacy training to improve physical functioning, cognitive behavioural therapy to lessen pain catastrophizing, and acceptance and commitment therapy to improve psychology inflexibility; Aghayousefi et al., 2016; McAuley et al., 2011; Schütze et al., 2018).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available upon reasonable request from the corresponding author, NLG. The data are not publicly available due to their containing information that could compromise the anonymity and confidentiality of research participants.

Additional information

Funding

This work was supported by an Establishment Grant from the Saskatchewan Health Research Foundation (#6127).

Notes on contributors

Amara Kohlert

Amara Kohlert recently graduated with her Bachelor of Arts (Honours) in Psychology with a Minor in Philosophy from the University of Regina. Amara’s research interests include qualitative methods, pain research, and existential and humanistic psychologies.

Natasha L. Gallant

Natasha L. Gallant, PhD, RDPsych, is an Assistant Professor and Canada Research Chair in Aging and Long-Term Care at the University of Regina. She leads a program of research focused on improving the well-being of individuals who are aging with dementia, acute illness, chronic disease, and/or serious mental illness.

Taylor G. Hill

Taylor G. Hill is a PhD Candidate at Dalhousie University studying positive quantitative psychology. Her overall research is in well-being, with both pure (positive psychologysurvey work) and applied (community mental health promotion) streams