Background & Aims
Lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) youth experience a significant amount of discrimination which is known to be associated with increased physical and mental health symptoms. LGBTQIA+ youth may also be at greater risk for experiencing chronic pain, which can develop from the interaction of continuous biological, psychological, and social stress experienced during childhood. Research on pediatric chronic pain and the experiences of LGBTQIA+ youth continue to grow, but there is little research examining the intersection of the two identities. The aim of the current study is to understand the impact of the intersectionality of LGBTQIA+ and chronic pain identities through pain variables (e.g., diagnosis, pain-related functioning), social experiences, and psychosocial functioning.
Methods
Participants were recruited from the Pediatric Pain Management Clinic at Stanford Medicine Children’s Health if they a) disclosed an LGBTQIA+ identity or b) had an LGBTQIA+ identity in their medical record. LGBTQIA+ youth with chronic pain (N = 20) engaged in semi-structured interviews. The interviews consisted of prompts around examining pain and LGBTQIA+ identities and the intersectionality of these identities as well as experiences in pain treatment. Interviews were transcribed and analyzed using interpretative phenomenological analysis (IPA).
Results
Youth (Mage = 16) represented a range of gender identities: Nonbinary (n = 11, 55%), Transgender (n = 5, 25%), the remainder identified with their sex assigned at birth. Additionally, 65% of youth (n = 13) held a diagnosis of Ehlers-Danlos syndrome (EDS)/Hypermobility. Themes that emerged centered largely around experiences of how the identities of gender diversity and pain at times can work for each other and at other times against each other. Another prominent theme that emerged was experiences within the healthcare setting. Youth discussed difficulties navigating providers who appeared to not care about using their preferred name or pronouns. Additionally, youth spoke about how gender affirming actions, such as binding and taping, are usually disregarded in the context of pain treatment, particularly when those actions result in an increase in pain. Finally, youth spoke about moments of discrimination and stigma.
Conclusions
Results indicate that gender and sexual minority identities must be considered in the context of pain care. The medical setting may often feel like an uncertain and unsafe place for youth when medical providers directly disregard their LGBTQIA+ identity. By doing so medical providers increase stigma and stressors for LGBTQIA+ youth which will impact both their physical and mental health. This study represents a critical first step for increased research and development of equitable and inclusive chronic pain care for LGBTQIA+ youth. Future research will look towards improving pain interventions to consider LGBQTIA+ identities as well as how steps towards increased body comfort such as binding can be considered in the context of pain care.
References
Boerner, K. E., Harrison, L. E., Battison, E. A., Murphy, C., & Wilson, A. C. (2023). Topical Review: Acute and Chronic Pain Experiences in Transgender and Gender-Diverse Youth. Journal of Pediatric Psychology, 48(12), 984-991.
Lee, J. Y., & Rosenthal, S. M. (2023). Gender-affirming care of transgender and gender-diverse youth: Current concepts. Annual Review of Medicine, 74, 107-116.
Nelson, S. M., Cunningham, N. R., & Kashikar-Zuck, S. (2017). A conceptual framework for understanding the role of adverse childhood experiences in pediatric chronic pain. The Clinical journal of pain, 33(3), 264-270.
Sayeem, M., Carter, B., Phulwani, P., & Zempsky, W. T. (2021). Gender dysphoria and chronic pain in youth. Pediatrics, 148(4).
Wakefield, E. O., Belamkar, V., Litt, M. D., Puhl, R. M., & Zempsky, W. T. (2022). “There’s nothing wrong with you”: Pain-related stigma in adolescents with chronic pain. Journal of Pediatric Psychology, 47(4), 456-468.
Presenting Author
Ellison Choate
Poster Authors
Ellison Choate
MS
Stanford University School of Medicine
Lead Author
Courtney W. Hess
PhD
Stanford University School of Medicine
Lead Author
Nicole Jehl
BA
Stanford University School of Medicine
Lead Author
Lauren Harrison
PhD
Stanford University School of Medicine
Lead Author
Topics
- Gender/Sex Differences