Building pain resilience in LGBTQIA+ individuals

Abstract

Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and individuals with other related experiences or identities (LGBTQIA+) experience chronic pain and disability at twice the rate as their cisgender, endosex, and heterosexual counterparts. These disparities are shaped by intersecting social, structural, and historical factors, including minority stress, health care discrimination, and barriers to affirming care. While contextualized approaches to pain management have been recommended to address the unique lived experiences of LGBTQIA+ individuals, prevailing pain models largely remain grounded in deficit-oriented frameworks that emphasize vulnerability, maladaptive cognitions, and individual pathology. Such approaches risk obscuring the broader social determinants of health that shape pain experiences and may inadvertently reproduce dynamics of stigma and medical mistrust. This perspective argues for a conceptual shift toward an affirmative, resilience-based approach to chronic pain management for LGBTQIA+ individuals. Drawing on evidence from LGBTQIA+ affirming care, trauma-informed practice, and resilience-based approaches, this perspective proposes a framework that integrates recognition of social and structural inequities with strengths-based principles that emphasize adaptive coping, psychological flexibility, identity affirmation, and community connection. It outlines how physical therapists are uniquely positioned to operationalize this approach by fostering psychological safety, supporting meaningful movement and values-based engagement, and addressing contextual barriers to care. By moving beyond vulnerability-focused models and centering resilience as a dynamic, contextually situated process, this perspective offers a pathway for physical therapists to promote equity, empowerment, and more effective pain care for LGBTQIA+ individuals.

Prevailing pain management models for LGBTQIA+ individuals are largely deficit-oriented, often overlooking minority stress, structural inequities, and the historical pathologization of LGBTQIA+ identities. Resilience-based, LGBTQIA+-affirming approaches integrate strengths, adaptive coping, and community resources while explicitly acknowledging social determinants of health and previous trauma. This perspective calls for a conceptual and practice-level shift in physical therapy, positioning affirming, resilience-informed pain care as essential to advancing equity and improving outcomes for LGBTQIA+ communities.

Introduction

People who are lesbian, gay, bisexual, transgender, queer, intersex, asexual and those with other related identities and experiences (LGBTQIA+) represent a significant and rising proportion (9.3%) of the adult population in America.¹ The LGBTQIA+ community experience chronic pain and disability at rates 2 times higher than cisgender, endosex, and heterosexual populations.^2,3 A recent study of LGBTQIA+ adults indicated that 55% of participants experienced chronic pain.^4,5 Chronic pain prevalence was highest among those identifying as bisexual or “something else” (24% and 27%, respectively), followed by gay or lesbian adults (21.7%), compared to 17.2% of heterosexual adults.³ Transgender and gender diverse individuals report significantly higher rates of chronic pain than their cisgender counterparts,⁶ with widespread pain affecting more than one-third of this population.⁴ These disparities highlight the growing need for physical therapists to be knowledgeable and equipped to provide effective pain management for LGBTQIA+ individuals.⁷

Stigma, discrimination, and cumulative stressors may contribute to the onset and perpetuation of chronic pain for LGBTQIA+ people,⁸ as well as co-occurring poor mental and physical health outcomes.^9,10 Minority stress theory helps explain the disproportionate burden of pain and poor health among LGBTQIA+ communities.¹¹ This theory acknowledges the unique stressors faced by LGBTQIA+ people, including persistent shame, fear of discrimination, family or religious rejection, identity concealment, violence, and internalized stigma (transphobia/homophobia). Discrimination and marginalization further shape psychological functioning and psychosocial responses to pain, with cumulative stress heightening the risk of negative pain outcomes. Prolonged exposure to stress can diminish coping capacity, perpetuate pain-related disability, and reinforce the chronic pain cycle.¹² These social challenges associated with navigating a cisgender, heterosexual, and endosex normative world contribute to increased allostatic loads. Over time, these compounded stressors can lead to psychological and physiological dysregulation,^13,14 increasing vulnerability to the emergence and perpetuation of chronic pain states.¹⁵ Recognizing these unique contextual stressors is important for understanding potential mechanisms that contribute to persistent pain among LGBTQIA+ people.¹⁶

Broader social and political determinants of health, such as systemic inequities in health care access and socioeconomic disparities (eg, health insurance instability, employment discrimination, housing insecurity, and financial strain) further contribute to the heightened risk of chronic pain in LGBTQIA+ people.¹⁷ LGBTQIA+ communities also experience social and structural barriers to health care including provider discrimination, lack of culturally responsive care, safety concerns, and disbelief of symptoms and/or identity or orientation. These challenges can lead to avoidance of health care services, delayed treatment, and medical distrust,^18,19 which contribute to poorer mental and physical health outcomes, including higher rates of suicidality, depression, anxiety, and psychological distress.^20,21 In addition to these health disparities, the LGBTQIA+ community experiences additional risk factors that can influence pain outcomes and recovery. For example, limited access to inclusive health promoting activities,²² lower rates of physical activity,^23,24 poor sleep,² and the use of substances without harm reduction strategies, which can contribute to poor pain management.²⁵ To date, much of the literature has centered on minority stress as a primary explanatory pathway for these disparate outcomes, emphasizing increased risk associated with identity-related stressors such as stigma, discrimination, and structural exclusion.

An exclusive focus on disparities and harm may obscure the rich capacity of adaptability, resilience, and growth evident in LGBTQIA+ communities. While the health of the LGBTQIA+ community has habitually been explored through a lens emphasizing risks, deficits, and individual factors that determine health, such deficit-oriented framings may inadvertently reinforce narratives of vulnerability and obscure the strengths, adaptive strategies, and community resources that LGBTQIA+ people draw upon to thrive. Emergent research highlights the value of strengths-based understandings, including resilience, community connection, self-advocacy, and identity affirmation,^26,27 important factors that shape pain experiences and recovery. Resilience-based approaches are well established in other areas of LGBTQIA+ affirming care, including in gender-affirming health care,²⁸ social work,²⁹ and psychology,³⁰ yet remain largely absent from pain management discourse. This body of work can provide a conceptual foundation for re-imagining chronic pain approaches. Resilience-based frameworks consider how identity, community, visibility, and self-determination may buffer stress exposure and support functional adaptation, coping, and pain modulation. These approaches acknowledge social and structural factors (eg, stigma and discrimination) that have historically been overlooked but play an important role in shaping health, without positioning LGBTQIA+ people as vulnerable or damaged. In chronic pain, this shift to strengths-based approaches would recognize and celebrate the unique lived experiences, coping mechanisms, and community resilience of the LGBTQIA+ community.

Many LGBTQIA+ individuals develop substantial resilience, a dynamic process, capacity, and outcome of human development,³¹ and commonly described as the capacity to withstand or overcome significant stress or adversity, yet this asset is seldom integrated into prevailing understandings of LGBTQIA+ health. Resilience-based models, including those underpinning affirming care and trauma-informed approaches, offer alternative pathways for pain management that prioritize empowerment, autonomy, and connection over deficit. There is a need for researchers and clinicians to make a “conceptual shift” toward promoting approaches that build resilience, including pain resilience.³² This perspective highlights the need for contextualized approaches to chronic pain for the LGBTQIA+ community and provides recommendations for integrating resilience-based approaches in physical therapy to promote equity and empowerment for LGBTQIA+ individuals experiencing chronic pain.

The resilience gap in current pain management approaches

The history of the development of pain management approaches is complex and did not develop in a cultural vacuum. Many contemporary models are grounded in psychological frameworks shaped by pathology-based thinking, developed within a historical context that pathologized deviations from cisgender, endosex, and heterosexual norms. Throughout much of the 20th century, LGBTQIA+ identities and bodies were pathologized, surveilled, and subjected to interventions aimed at “correcting” or suppressing diversity and difference, including harmful and coercive practices such as conversion therapies and nonconsensual and medically unnecessary surgeries on intersex bodies intended to reinforce binary sex norms. These approaches contributed to potentially lifelong physical and psychological harm. Homosexuality remained classified as a psychiatric disorder for nearly 50 years, nonconsensual surgeries are still being performed, and access to gender affirming care continues to rely on a diagnosis of gender dysphoria, pathologizing the natural diversity of experience and identity. The harmful legacy of medical pathologization continues to impact health care experiences for LGBTQIA+ individuals, including in the realm of pain management.³³

A key shortcoming in contemporary pain management approaches is an emphasis on vulnerability and maladaptive cognitions as primary drivers of persistent pain, positioning the problem within the individual. Current approaches, rooted in the fear-avoidance model, have informed widely used interventions such as cognitive behavioral therapy (CBT) for pain, pain neuroscience education (PNE), and cognitive functional therapy (CFT). While these methods provide value, they are premised on the assumption that the individual’s maladaptive thoughts are the primary problem and site of intervention. This framing becomes problematic when we consider the LGBTQIA+ community. Although LGBTQIA+ people report higher levels of pain catastrophizing compared to heterosexual peers,³⁴ evidence suggests these responses are not simple intrapersonal cognitive distortions. Rather, they are understandable and predictable responses to chronic minority stress.³⁵ Under these conditions, directing treatment toward changing intrinsic, individual-level characteristics risks replicating the very dynamics of shame and pathologization that contribute to distress in the first place. A more trauma-informed and scientifically supported approach acknowledges that the meaning of pain is shaped by cultural messages about whose bodies and identities are afforded legitimacy, safety, and care. The pain problem, in other words, should not be understood solely as an individual phenomenon but also as a product of social environments that have historically shaped the pain experiences of LGBTQIA+ individuals and required adaptation to persistent social threat.

Current approaches to pain management are problematic in several ways when applied to LGBTQIA+ individuals. First, these approaches and materials have historically been developed without consideration of LGBTQIA+-specific experiences, such as minority stress, discrimination, and the need to legitimize both pain experience and identity or orientation.^36,37 This is, in part, because LGBTQIA+ pain management has traditionally been understood through a cisgender, endosex, and heterosexual normative lens where the needs and experiences of LGBTQIA+ people are assumed to be the same as cisgender, endosex, and/or heterosexual people. Pain education content that is not inclusive or that fails to address the unique psychosocial and contextual factors influencing pain in LGBTQIA+ populations is a result of this normative approach. Physical therapists delivering such interventions may also lack training in LGBTQIA+ affirming care,^38,39 leading to unintentional assumptions, misgendering, and discrimination.⁴⁰ These experiences can erode trust, reduce engagement, and exacerbate health care avoidance for LGBTQIA+ patients.^41,42 Diagnostic overshadowing, where pain symptoms are dismissed and incorrectly attributed to sex characteristics, gender identity, or sexual orientation, and provider skepticism (about the legitimacy of identity or pain experience) are additional, significant barriers to affirming pain care for LGBTQIA+ people.⁴¹

The intersection of LGBTQIA+ identities and experiences with other factors, including neurodiversity, race, or disability, can further complicate pain experiences and access to health care.^36,41 Lack of representation in pain research and the development of pain education materials perpetuates these gaps and limits the relevance and effectiveness for LGBTQIA+ communities. Pain management models are developed and researched on populations that are largely cisgender, heterosexual, and endosex,⁴³ rendering these frameworks insufficiently representative of LGBTQIA+ lived experiences. When clinicians are encouraged to apply these models universally, they may inadvertently contribute to furthering disparities, particularly for individuals who do not fit the dominant normative frameworks. This misalignment raises important questions about whether non-responders’ to mainstream interventions are in fact, patients whose experiences fall outside the narrow scope of existing models.

Interventions that focus exclusively on individual coping, without addressing the social conditions that contribute to chronic pain, risk reinforcing the inequities that shape LGBTQIA+ pain experiences. Recognizing the broader social and structural determinants of pain care is therefore essential. This recognition moves pain care from correcting the person’s “maladaptive thinking” to understanding and addressing how the world shapes their pain experience. This approach first requires physical therapists to adopt an affirmative approach to pain care.

Affirmative care: the first step in building pain resilience

Affirmative care is defined as an approach to health care delivery in which providers, programs, and organizations recognize, validate, and support the identity of the individual.⁴⁴ This approach includes acknowledging the complex ways in which structural stigma, rejection, non-acceptance, and discrimination shape the pain experiences of LGBTQIA+ people. Affirming care reduces rejection sensitivity, identity concealment, internalized stigma, and social isolation, which are often the result of previous negative health care experiences for LGBTQIA+ people.⁴⁵ This approach represents an important shift toward effective approaches to pain management for the community, who frequently encounter unique health care barriers stemming from historical marginalization, discrimination, and higher rates of adverse childhood experiences that contribute to complex pain presentations.⁴⁶

Affirmative care comprises effective, psychologically-informed care. Psychologically-informed care addresses psychological, social, and contextual factors, importantly going beyond cognitive interventions (eg, pain neuroscience education) to provide emotional safety to combat stigma and foster resilience through relational and emotional support. When health care providers implement principles that acknowledge LGBTQIA+ lived realities, they create therapeutic environments where patients feel genuinely seen and validated, strengthening the therapeutic alliance. A patient’s perception of a strong therapeutic alliance predicts pain reduction and improvement in physical functioning.^47,48 Affirming care directly impacts physiological pain processing, as psychological safety can modulate neurological pain pathways and reduce the hypervigilance often accompanying chronic pain conditions.⁴⁹ Conversely, pain care lacking an affirming approach may retraumatize individuals, hinder engagement, and lead to negative outcomes as a result of a lack of understanding of the impact of trauma on individuals and systems.

Affirmative care is also trauma-informed care, an approach that recognizes that prior negative experiences may have created lasting hesitancy, requiring providers to consciously establish trust through consistent acknowledgement and acceptance of sex characteristics, sexual orientation, and gender identity, including things such as names, pronouns, and bodily autonomy.⁵⁰ This approach dismantles power inequities that have traditionally characterized medical settings, empowering patients to become collaborative partners in their pain management journey.¹⁹ Affirming and trauma-informed care acknowledges the intersectionality of LGBTQIA+ identities with other social determinants, understanding that discrimination compounds the physical and emotional dimensions of pain. By integrating these principles into clinical practice, physical therapists move beyond simply treating symptoms to addressing the whole person and acknowledging how the LGBTQIA+ experience may exacerbate pain conditions. Supplementary Table 1 presents examples of traditional PNE concepts adapted to be more affirming, psychologically, and trauma-informed for the LGBTQIA+ community, recognizing the role of PNE in pain recovery and the need to address cognitive misbeliefs about pain.

Affirmative care is an evidence-informed practice that enhances clinical outcomes by positioning psychological safety and human dignity as core, rather than supplementary, elements of pain care. It enables physical therapists to acknowledge vulnerability factors while also identifying and amplifying the resilience-based strengths that many LGBTQIA+ individuals draw upon to navigate adversity and foster recovery. Drawing on work from non-LGBTQIA+ populations experiencing pain, the authors believe that integrating both perspectives of recognizing vulnerability while actively promoting resilience is a critical shift for meaningful and sustained pain recovery for LGBTQIA+ individuals.⁵¹

Shifting to a pain resilience approach for LGBTQIA+ people

Pain resilience refers to the ability to maintain or regain function, psychological wellbeing, and quality of life despite persistent or recurrent pain.⁵² Resilience factors buffer the negative outcomes of vulnerability factors.^53–55 Two key factors of pain resilience include cognitive affective positivity and behavioral perseverance.⁵⁶ Resilience-based approaches have been recommended as a path to pain recovery.^53–55 Rather than focusing solely on pathology or impairments, resilience-based approaches empower individuals to take an active role in their health and well-being by recognizing both modifiable and nonmodifiable determinants of health, including social and environmental factors. A shift toward resilience-based frameworks that integrate LGBTQIA+ affirming principles could better support individuals in navigating pain while addressing the structural conditions that contribute to its persistence (Suppl. Table 2).

For LGBTQIA+ individuals, building pain resilience (a state versus a trait) must be understood as a process through the lens of unique stressors, such as minority stress, discrimination, and past medical trauma, which not only influence access to care but also shape pain recovery. Pain resilience emerges through ongoing adaptation and growth in response to adversity rather than as a single intervention or fixed trait. Pain resilience as a multidimensional process of behavior change has been recommended in physical therapy.⁵⁵  Supplementary Table 2 provides guidance for providers in adopting a resilience-based approach to pain care that centers LGBTQIA+ experiences.

Building pain resilience encourages physical therapists to focus on the strengths and positive resources in the lives of LGBTQIA+ individuals, serving as a foundation for strategies that support healing and adaptation. Resilience in this context is not merely the ability to endure adversity, but the capacity to thrive despite it. Resilience-building is a dynamic process of positive adaptation that can mitigate the impact of chronic stressors, including chronic pain, on health.¹¹  Individual resilience refers to qualities a person possesses that may facilitate coping (eg, mastery or personal agency) that will make them more or less resilient, as well as personality traits or broader constructs such as hardiness.¹¹

For the LGBTQIA+ population, community resilience is also particularly salient, and refers to the ways in which supportive social environments, shaped by shared norms, values, role models, and access to affirming networks, can further enhance individuals’ capacity to develop and sustain wellbeing.⁵⁷ This form of resilience relies on “outness,” personal comfortability being LGBTQIA+,⁵⁸ a social identity as an LGBTQIA+ individual, as well as affiliation with the LGBTQIA+ community.¹¹ Connection to a collective identity can facilitate access to emotional support, validation, and culturally relevant resources. For LGBTQIA+ people with chronic pain, community resilience can lead to more nuanced, responsive approaches to pain management by affirming lived experiences, promoting adaptive coping, and reducing isolation often associated with both chronic pain and minoritized identities. However, reaping the benefits of community resilience requires a sense of acceptance and psychological safety regarding the disclosure of LGBTQIA+ identity.⁵⁸ Individuals must feel secure and affirmed to meaningfully engage with and benefit from the support and strengths of the community.

By integrating principles of LGBTQIA+ affirming care, trauma-informed practice, and community support, resilience-based approaches can offer a whole-person approach to pain care that is empowering. This reorientation not only addresses the limitations of existing models but also creates opportunities for physical therapists to foster self-efficacy, engagement, and well-being in LGBTQIA+ individuals experiencing chronic pain.

Building pain resilience in LGBTQIA+ people

Based on research investigating the experience of LGBTQIA+ people receiving health care and mental health services, several authors have recommended that health care organizations and providers intentionally invest in strategies to make their services more inclusive and affirming.^59–62 Each LGBTQIA+ person will undoubtedly have a unique experience; however, queer scholars have identified insights we can learn from and apply to physical therapist practice. First, there is a reduction of the survival emotions known to perpetuate the downward spiral of pain (Figure 1A).⁶³ Shame, guilt, injustice, and fear, along with hypervigilance,⁶⁴ avoidance, and withdrawal are reduced. The negative emotions and experiences that isolate LGBTQIA+ people are replaced by more positive emotions that drive reward learning and facilitate positive affective experiences (Figure 1B). In the presence of a non-judgmental, affirming, resilience-believing physical therapist, a sense of safety, acceptance, hope, and optimism begins to build. An affirming, resilient presence lends itself to accessing courage where an LGBTQIA+ person willingly opens up, shares their pain, and begins to trust the physical therapist with their health. In this cooperative paradigm, pride inflates, and the all-important harmonious therapeutic relationship begins to flourish.⁵⁹ The physical therapist is not a barrier to pain care, because having one’s sexual orientation or gender identity being seen is validating,⁶⁵ which is essential to effective, resilience-building pain care.

Figure 1.

(A) Downward Spiral of LGBTQIA+ Pain Resilience; (B) Upward Spiral of LGBTQIA+ Pain Resilience. LGBTQIA+ = Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual and Other Related Communities.

Building any form of resilience, including pain resilience, is not achieved in one session, it develops and strengthens over time, through repeated, supportive experiences.^54,66  Figure 1B highlights key factors that contribute to the development of pain resilience for LGBTQIA+ individuals. Acceptance and affirming care, alongside shared-decision making in health care, can foster a sense of autonomy,⁶⁷ and confidence in one’s ability to self-manage pain. These processes extend beyond cognitive reframing, reflecting embodied experiences in which one has the space to be fully present and connected to one’s physical body and senses.⁶⁸ Embodiment is important for all people with pain,⁶⁹ but perhaps especially for those who are exploring or expressing a new identity, orientation or gender. The promotion of identity-affirming health practices influences how LGBTQIA+ individuals experience, express, and understand their physical bodies in relation to their gender identity and sexual orientation.⁷⁰

Specific to physical therapy, movement and physical activity represent important, though inequitably accessible, pathways for building pain resilience among LGBTQIA+ individuals. While physical activity is commonly framed within health care as a means of prevention or risk reduction for chronic conditions, such framings may insufficiently account for the social, cultural, and embodied meanings of movement for LGBTQIA+ people. Experiences of discrimination in sport and fitness settings, body dysphoria, safety concerns in public spaces and lack of inclusive or affirming facilities and programs⁷¹ shape how, where, and whether movement is experienced as safe, enjoyable, or sustainable. These factors are directly relevant for physical therapy in the context of chronic pain, as they influence engagement, adherence and responses to movement-based interventions.

When delivered within an affirming and context-sensitive framework, movement-based physical therapist interventions can build resilience and support pain management, by fostering agency, bodily trust and functional engagement. For some LGBTQIA+ people, movement may facilitate reconnection with the body following experiences of pain, marginalization or bodily threat, fostering identity congruence, confidence and social engagement.⁷² From a physical therapy perspective, graded and meaningful movement may support emotional and physiological regulation, including modulation of autonomic states and enhanced interoceptive awareness, processes relevant to pain adaptation and recovery.

Physical therapists are uniquely positioned to translate these principles into practice through individualized, affirming movement prescription. This includes assessing and addressing barriers to participation, recommending or facilitating access to inclusive and affirming movement spaces, and offering flexible options such as home-based, virtual, or private sessions.^72,73 Framing movement as a tool for self-care, functional participation and empowerment, rather than appearance or performance driven, may enhance acceptability and sustainability for LGBTQIA+ people with chronic pain. Adapting movement recommendations to align with gender-affirming practices and preferences is essential to supporting engagement. For example, some exercises may bring unintentional focus on a body part for which a patient is experiencing sensitivity (eg, the chest in a transgender man) and should be avoided or discussed with the patient prior to prescription. Within a resilience-based model of physical therapy, movement functions not only as a therapeutic modality, but as an embodied process through which individuals cultivate confidence, autonomy, and trust in their bodies, supporting pain resilience within broader social contexts.

As people re-engage in meaningful movement and activity, they may be better positioned to participate in a life aligned with their values. Living in accordance with personal values in the presence of pain requires resilience-based skills that support ongoing engagement despite discomfort, uncertainty, or fluctuating symptoms. Physical therapists can play an important role in supporting LGBTQIA+ individuals to identify and articulate their values, understood as personally meaningful principles that guide choices, relationships, and participation in daily life, and to translate these values into flexible, achievable goals. Values-based approaches emphasize engagement in meaningful activities rather than symptom elimination, recognizing that pain and emotional distress may persist alongside values-based living. Supporting individuals to pursue valued activities while acknowledging the presence of pain can foster psychological flexibility,⁷⁴ the capacity to remain present with all experiences, even painful thoughts, feelings, and physical sensations, while continuing to act in ways that are congruent with one’s values. Psychological flexibility, a well-established resilience factor,⁷⁵ is particularly relevant for LGBTQIA+ people, whose experiences of chronic pain may be shaped by ongoing exposure to stigma, discrimination, and structural inequities.⁷⁴ Physical therapists can support psychological flexibility by validating distress without reinforcing avoidance, and by explicitly acknowledging the social, structural, and contextual factors that can constrain health and participation for LGBTQIA+ communities (Figure 2). Modeling a stance that recognizes inequity, while maintaining a strengths-based and hopeful orientation may help counter deficit-based narratives and reinforce agency, adaptability and resilience in the presence of pain.

Figure 2.

Opportunities for Individualized Interventions that Consider the Individual and Contextual Factors Contributing to Chronic Pain in LGBTQIA+ Individuals, Centered in the Socioecological Model and International Classification of Functioning. LGBTQIA+ = Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual and Other Related Communities.

Physical therapist practice settings represent an important site for addressing health care inequities experienced by LGBTQIA+ communities and for supporting recovery from the physical and psychosocial impacts of chronic pain (Figure 2).^73,76 Beyond the delivery of clinical interventions, practice environments shape patients’ experiences of safety, trust, and engagement with care.⁷³ When individuals are welcomed, provided with inclusive and affirming resources, and supported to experience connection within health care spaces, these conditions may function as protective factors that support pain adaptation and resilience.

For LGBTQIA+ people, physical therapist practices that intentionally foster inclusion and belonging may enhance therapeutic alliance.^40,72,73 Creating environments characterized by kindness, respect, affirmation, and relational care can support both physical recovery and psychological wellbeing, positioning physical therapy settings not only as sites of treatment, but spaces where dignity, agency and community connection are reinforced.⁷⁷

Conclusion

Chronic pain among LGBTQIA+ individuals cannot be adequately understood or treated without accounting for the social, structural, and historical forces that shape pain experiences and health care engagement. This manuscript argues that prevailing deficit-based pain models risk perpetuating harm by locating the problem solely within the individual while overlooking minority stress and systemic inequities. An affirmative, resilience-based approach offers a necessary conceptual shift, one that validates lived experience, enhances psychological safety, and mobilizes existing individual and community strengths as mechanisms of pain modulation and recovery. However, meaningful adoption of resilience-based, LGBTQIA+ − affirming pain care is constrained by the absence of physical therapist practice guidelines to affirm LGBTAIA+ people and DPT curriculum competency standards^78,79 to address LGBTQIA+ health disparities, which are essential for upholding ethical physical therapist practice.⁸⁰ Advancing equitable pain care, therefore, requires not only clinician-level change but coordinated action by professional organizations, researchers, educators, and policymakers to establish and disseminate affirmative, resilience-informed standards that support consistent, accountable, and inclusive physical therapist practice for LGBTQIA+ communities with chronic pain.

CRediT – Contributor roles

Megan H. Ross (Conceptualization [Equal], Writing—original draft [Lead], Writing—review & editing [Equal]), Joe Tatta (Conceptualization [Equal], Writing—original draft [Supporting], Writing—review & editing [Equal]), and Janet Bezner (Conceptualization [Equal], Writing—original draft [Supporting], Writing—review & editing [Equal])

Funding

There are no funders to report for this study.

Disclosure

Megan H. Ross is a member of the PTJ Editorial Board. The authors completed the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported no additional conflicts of interest.