Abstract
ObjectiveDespite considerable evidence of chronic pain in adolescents, and its adverse consequences for their health and well-being, less is known about pain-related stigma that these youth face, such as pain disbelief by others. Adolescents with chronic pain may conceal their symptoms as a coping strategy to avoid pain-related stigma, contributing to further social isolation and disruptions in medical treatment. In the current study, we used focus group methodology to examine adolescent motivations for using concealment and the possible benefits and harmful consequences of this form of coping.Materials and MethodsFive focus groups of 3–5 adolescents (ages 12–17) with chronic pain conditions (N = 18) were conducted as a part of a larger study to evaluate the impact of, and reaction to, pain-related stigma. Patients were recruited from an outpatient pediatric pain management clinic. Transcripts of focus group sessions were analyzed using directed content analysis for the main study, yielding anticipatory stigma and concealment categories. These categories were then explored using inductive content analysis for the current study.ResultsAdolescents described engaging in concealment of their pain symptoms. Our analysis revealed three social motivations for concealment: (1) avoidance of judgment; (2) avoidance of being a social burden; and (3) desire to be treated normally, and two harmful consequences of concealment: (1) social isolation and (2) cognitive burden.ConclusionDisbelief of pain symptoms may exacerbate the social isolation and disease-related burden in this population. Clinical implications of concealing pain symptoms are discussed, and points of intervention are proposed.
Highlights
Chronic pain in youth has been on the rise over the past 25 years, with a prevalence of approximately one in every 4–5 adolescents (King et al, 2011)
The invisibility of chronic pain symptoms has led to adolescents with chronic pain experiencing pain-related stigma, in the form of others indicating that they do not believe their pain is “real,” and/or believing that the person is making up their symptoms (Wakefield et al, 2018)
The inhibition or internalization of emotions that occurs when one engages in concealment can have a physiological cost, as demonstrated in individuals with trauma (Pennebaker and Beall, 1986). These initial findings demonstrate the potential harm that may result from concealing chronic pain conditions to others, but less is known about the experience of pain-related stigma and motivations among adolescents with chronic pain to use concealment as a coping strategy
Summary
Despite considerable evidence of chronic pain in adolescents, and its adverse consequences for their health and well-being, less is known about pain-related stigma that these youth face, such as pain disbelief by others. Adolescents with chronic pain may conceal their symptoms as a coping strategy to avoid pain-related stigma, contributing to further social isolation and disruptions in medical treatment. We used focus group methodology to examine adolescent motivations for using concealment and the possible benefits and harmful consequences of this form of coping
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