Investigating Determinants, Correlates, and Effects of Chronic Pain Stigma

Background & Aims

An expanding body of literature suggests that individuals with chronic pain often encounter stigmatizing reactions from others (2,3). Stigma is defined by the WHO (7) as a “hidden burden of disease,” which has psychological, physical, and social repercussions. It can lead to underassessment and undertreatment of chronic pain and result in negative health outcomes such as increased disability, depression, and isolation (1-5). Several characteristics of chronic pain can heighten stigma towards individuals living with this condition, including its ambiguous etiology, invisible nature, and association with opioid use (1,4,6). As social processes play a crucial role in the pain experience, more studies are warranted to gain a deeper understanding of chronic pain stigma and its determinants, correlates, and adverse effects. This study aimed to investigate chronic pain stigma enacted by the general population (public stigma) and experienced by individuals with chronic pain (perceived stigma).

Methods

This web-based study was two-fold. A first study examined public stigma in a sample of 160 healthy adults from the general population (58% female, mean age 40). Participants were assigned to one of four vignettes depicting a fictional character in pain. Three vignettes illustrated chronic pain characteristics (unknown etiology, invisibility, opioid use), and a fourth depicted acute pain. Immediate responses towards the character were assessed using the Social Distance Scale (SDS). Familiarity with chronic pain was measured using the Level of Contact Report (LCR) and the Chronic Pain Myth Scale (CPMS). A second study examined perceived stigma and its correlates in a community sample of 291 adults with chronic pain (91% female, mean age 45). Participants provided data pertaining to sociodemographic and pain characteristics and completed an adapted version of the Stigma Scale for Chronic Illnesses (SSCI-8), along with the Brief Pain Inventory (BPI) and the Psychiatric Symptom Index (PSI).

Results

The initial study unveiled significant differences in public stigma across pain characteristics. Members of the general population exhibited greater reluctance to engage with an individual experiencing chronic pain of unknown origin compared to acute pain. Chronic pain was perceived as more intense and unpleasant than acute pain, with the exception of invisible chronic pain. Notably, desired social distance (SDS) was significantly influenced by knowledge, attitudes, and beliefs about chronic pain (CPMS). The second study revealed that individuals experiencing chronic pain within the community report low to moderate levels of chronic pain stigma (SSCI). These levels varied based on sociodemographic and pain-related factors, including income, employment status, pain intensity, pain relief, and pain location. Interestingly, perceived chronic pain stigma (SSCI), along with pain intensity, emerged as a significant predictor of both psychological distress (PSI) and pain interference (BPI).

Conclusions

Our study contributes to the understanding of both public and perceived stigma related to chronic pain, offering insights into some of the factors associated with this complex social phenomenon. Distinct patterns of stigma were observed across chronic pain characteristics, highlighting the potential contribution of specific features such as ambiguous etiology and invisibility in heightened stigmatizing responses. This was particularly true among individuals with limited understanding of the condition. Our findings also emphasize the important link between perceived stigma among individuals with persistent pain within the community and adverse outcomes, including increased psychological distress and decreased daily function. Overall, this study underscores the imperative need for awareness campaigns and strengthened educational initiatives aimed at demystifying chronic pain, thereby reducing the hidden burden of chronic pain stigma experienced by individuals living with this condition.

References

1. Bean, D. J., Dryland, A., Rashid, U., & Tuck, N. L. (2022). The determinants and effects of chronic pain stigma: A mixed methods study and the development of a model. The Journal of Pain, 23(10), 1749–1764. DOI: 10.1016/j.jpain.2022.05.006.

2. De Ruddere, L., & Craig, K. (2016). Understanding stigma and chronic pain: A-state-of-the-art review. Pain, 157(8), 1607-1610. DOI: 10.1097/j.pain.0000000000000512.

3. Lévesque-Lacasse, A., & Cormier, S. (2020). La stigmatisation de la douleur chronique : un survol théorique et empirique. Douleurs : Évaluation-Diagnostic-Traitement, 21(3), 109-116. DOI: 10.1016/j.douler.2020.04.013.

4. Perugino, F., De Angelis, V., Pompili, M., & Martelletti, P. (2022). Stigma and chronic pain. Pain and Therapy, 11(4), 1085-1094. DOI: 10.1007/s40122-022-00418-5.

5. Scott, W., Yu, L., Patel, S., & McCracken, L. M. (2019). Measuring stigma in chronic pain: Preliminary investigation of instrument psychometrics, correlates, and magnitude of change in a prospective cohort attending interdisciplinary treatment. The Journal of Pain, 20(10), 1164–1175. DOI: 10.1016/j.jpain.2019.03.011.

6. Wakefield, E., Zempsky, W., Puhl, R, & Litt, M. (2018). Conceptualizing pain-related stigma in adolescent chronic pain: A literature review and preliminary focus group findings. Pain Reports, 2018; 3 (Suppl 1): e679. DOI: 10.1097/PR9.0000000000000679

7. World Health Organization (2001). Mental health problems: The undefined and hidden burden. Geneva. Available from: www.who.int.

Presenting Author

Stéphanie Cormier

Poster Authors

Stéphanie Cormier

PhD

Université du Québec en Outaouais (UQO)

Lead Author

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