What is it about?
People with chronic musculoskeletal pain often respond differently to their pain-some avoid activity, while others persist too much or struggle to pace themselves. This study looked at how basic personality systems linked to sensitivity to punishment (the Behavioral Inhibition System, BIS) and reward (the Behavioral Activation System, BAS) influence these pain-related behaviors. We analyzed questionnaire data from 579 patients with musculoskeletal pain to understand whether these basic personality traits affect behavior directly, or whether they work through a person’s ability to regulate emotions and control their actions (self-regulation and volition). The results showed that people who are more sensitive to potential threats or punishment (high BIS) are more likely to avoid activity and engage in unhelpful patterns like over-persistence or poor pacing- but this happens mainly because of differences in their self-regulation skills. Similarly, people who are more sensitive to rewards (high BAS) tend to show less avoidance and excessive persistence, and again, this is explained by better self-regulation.
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Why is it important?
Overall, our findings suggest that how people manage their emotions and behavior plays a key role in how personality influences pain responses. This highlights the importance of including strategies that strengthen emotional self-regulation in chronic pain treatment programs.
Perspectives
In our clinical and research work, we were repeatedly struck by the observation that patients with similar levels of pain often show very different behavioral responses. While existing models emphasize sensitivity to threat and reward, these alone did not seem sufficient to explain such variability. This motivated us to look more closely at the role of self-regulatory and volitional processes as potential mechanisms linking personality to pain behavior.From a clinical perspective, these findings are encouraging because they shift attention toward modifiable processes. While temperament may be relatively stable, self-regulatory skills can be strengthened. This suggests that enhancing emotional regulation and volitional capacities could be a promising avenue for improving pain management outcomes. Looking ahead, we believe that future research should move beyond cross-sectional designs to examine these mechanisms longitudinally and within intervention studies. A better understanding of how self-regulation can be trained and sustained may help translate these insights into more personalized and effective treatments for chronic pain.
Anne Kaestner
Pain Clinic, Department of Anaesthesiology, University Medical Center, Göttingen, Germany
Read the Original
This page is a summary of: A theory-driven structural equation modeling approach to the behavioral inhibition and behavioral activation systems model of chronic pain: Evaluating the mediating role of self-regulatory and volitional abilities., Health Psychology, March 2026, American Psychological Association (APA),
DOI: 10.1037/hea0001605.
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