Expanding neurobiological frameworks of resilience in chronic pain: the role of allostatic-interoceptive overload

Resilience has been most frequently defined as a coalescence of factors that promotes positive adaptations despite adversities. Conceiving resilience as an active psychophysiological process in chronic pain management can guide evidence-based clinical practices, promoting better outcomes for patients. Traditional models partially address the multilevel and transnosological aspects of chronic pain, particularly the interactions between interoception, allostasis, and resilience. Encouraging further debates in the field, this theoretical article synthetizes recent evidences that suggests a synergy between these three phenomena, highlighting them as key modifiers of the neurobiology and phenomenology of chronic pain, and offers a comprehensive understanding of how resilience mechanisms work in conjunction with bodily perception and stress modulation systems.