Social and cultural variables: Persistent Pain Stigma Questionnaire (PPSQ): preliminary validation of a measure to assess perception of negative attitudes towards people with pain

Abstract

Research has documented negative public attitudes towards those with certain chronic medical conditions (stigma), which can influence patient mood, interpersonal relationships and health behaviors. To explore this phenomenon for persistent pain, we created the Persistent Pain Stigma Questionnaire (PPSQ), a 28-item Likert-type inventory evaluating patients' perceptions of negative attitudes held by their family, physicians and the general public and across hypothesized dimensions of pain-related stigma (e.g. beliefs that people with pain misuse pain medication, somaticize, malinger, or deserve blame). A representative item is “Doctors think that people with chronic pain exaggerate their pain.” Participants (N=178) with moderate-severe persistent back pain or osteoarthritis (pain severity >4 on a 0-10 scale) completed the PPSQ and measures of mood and function (BDI, HADS, SF-36). Internal consistency, factor structure, convergent and discriminant validity and individual item responses were evaluated. High alpha reliability (>.85) was found for the three perceived stigma (PS) sources (general public, physician and family). Principal components analysis with rotation detected three interpretable factors (eigenvalues 1.0, 54.5% of variance) roughly consistent with those sources. Patient ratings of PS differed between sources, from highest to lowest: general public, physicians, family (p<.001). PS was modestly associated with depression measures (r's of .25-.30, p<.001), higher among patients on “permanent disability” (p<.01), and lower among African Americans than Caucasians (p=.001). Frequently endorsed items included “People believe that chronic pain is used as an excuse to get pain medication” (71.6%) and “Doctors think that people with chronic pain want more pain medication than is necessary” (68.8%). This study provides preliminary psychometric data for the PPSQ. Many people with persistent pain expect to encounter negative attitudes among physicians and the general public. Further research is needed to explore the impact of perceived stigma on patients' acceptance of and adherence to prescribed pain medications. Supported by Purdue Pharma LP.