Reframing Chronicity in Research and Care: A Patient-Informed Framework of Pain Adaptation.

Chronic pain is a complex and heterogeneous condition shaped by interactions among biological processes, psychological responses, behaviors, environmental contexts, cultural and structural constraints. Yet many prevailing models remain static, insufficiently capturing how patient experiences evolve over time, particularly during the transition from acute to chronic pain. This conceptual paper advances a patient-informed conceptual framework developed through qualitative research conducted within a National Institutes of Health-funded study on patient preferences and appropriateness of care. The Chronic Adaptive Resilience & Endurance (CARE) Framework of Pain situates pain along an acute to chronic continuum and identifies a critical experiential shift from cure-seeking to coping-oriented goals. It also conceptualizes chronic pain as an adaptive process characterized by feedback loops between pain and everyday life that encompasses cognitive, emotional, behavioral, and environmental domains. Distinct from traditional biopsychosocial models, this framework highlights patient assessments, treatment preferences, individual capacity for treatment seeking and disease management, medical mistrust due to prior healthcare experiences, and economic resources as crucial influences that shape recovery trajectories and treatment engagement. By reframing chronicity as a reorganization of goals rather than a simple temporal threshold, the CARE Framework seeks to describe the patient experience of chronicity in greater depth. Finally, this framework expands on prior literature that describe a shift in focus from pain reduction to functional improvement as a marker of treatment success.