Chronic Pain Stigma Research Articles

The Intersectionality of Chronic Pain Stigma and Racial Discrimination in Black and White Adults with Chronic Low Back Pain.

We examined the intersection between chronic pain stigma and racial discrimination, separately among Black and White U.S. adults with chronic low back pain. Participants completed measures of chronic pain stigma, lifetime experiences of racial discrimination, pain severity and interference. A composite variable representing the intersectionality of stigma and discrimination was created, and Black and White participants were separately categorized into 4 groups. Black participants were categorized as: 1) high discrimination/high stigma, 2) high discrimination/low stigma, 3) low discrimination/high stigma, and 4) low discrimination/low stigma. White participants were categorized as: 1) any discrimination/high stigma, 2) any discrimination/low stigma, 3) no discrimination/high stigma, and 4) no discrimination/low stigma. Black participants reported more frequent experiences of racial discrimination than White participants (p<.05), but there was not a racial difference in chronic pain stigma (p>.05). Among Black participants, those in the high discrimination/high stigma and low discrimination/high stigma groups reported greater pain severity and interference than those in the high discrimination/low stigma and low discrimination/low stigma groups (p<.05). Among White participants, those in the any discrimination/high stigma group reported greater pain severity and interference than those in the no discrimination/low stigma group (p<.05), but there were no differences in pain severity or interference between the any discrimination/no stigma and no discrimination/high stigma groups (p>.05). Our findings suggest that the relationship of intersectional chronic pain stigma and racial discrimination with pain is nuanced and differs across racial groups.

‘Just because I’m smiling doesn’t mean I’m not in pain’: navigating the layered stigma of chronic pain and suicidality in social worlds

ABSTRACT This article aims to provide an illustrated account of layered stigmatisation processes and consequences for those who experience chronic pain and accompanying suicidality. Using constructivist grounded theory, I draw from 20 in-depth interviews conducted from 2022 to 2023 to explore how chronic pain and suicidality operate within people’s social worlds. Findings demonstrate how layered stigmatising processes, occurring based on chronic pain and suicidality, operate consistently across multiple social arenas to create interactional troubles, which result in enduring negative social, emotional, and financial impacts. Three themes were constructed, including (1) self-stigma and the multiple roles of the family, (2) missed connections, and (3) anticipated stigma and workplace discrimination. Taken together, themes support the overarching category, ‘interactional troubles’. Findings suggest a need for attunement to stigmatising processes’ omnipresence and the depth of their consequences. Clinical interventions may benefit from emphasizing participants’ social worlds and incorporating the complexity of navigating social arenas given layered stigmatisation. Moreover, policies that support those with chronic pain and mental illness could offset the long-term negative economic consequences of discrimination.

Believing women: a qualitative exploration of provider disbelief and pain dismissal among women with interstitial cystitis/bladder pain syndrome from the MAPP research network.

Although allusions to the importance of a good physician-patient relationship are present throughout the interstitial cystitis/bladder pain syndrome (IC/BPS) literature, qualitative analysis of patients' perspectives on the clinical encounter is lacking, particularly among women who are most commonly affected by IC/BPS. Therefore, we adopted a patient-centered experiential approach to understanding female patients' perception of clinical encounters. We re-analyzed previously collected data from a qualitative study on patient flare experiences including eight focus groups of female IC/BPS patients (n = 57, mean = 7/group). Qualitative analysis applied grounded theory to index all physician-patient interactions, then thematically coded these interactions to elucidate common experiences of clinical encounters. Women with IC/BPS shared common experiences of provider disbelief and pain dismissal. Discussions with participants demonstrated the extent to which these negative encounters shape patients' health care-seeking behavior, outlook, and psychosocial well-being. Appearing in more than one guise, provider disbelief and dismissal occurred as tacit insinuations, explicit statements, silence, oversimplification, and an unwillingness to listen and discuss alternative treatment. As a result, women adopted several strategies including: rotating specialists; "testing" physicians; self-advocacy; self-management; avoiding the stigma of chronic pain; crying; and opting for alternative medicine over biomedicine. The prevalence of provider disbelief and pain dismissal among women with IC/BPS indicates a need to improve physician-patient communication, informed by the struggles, anxieties, and gendered inequities that female patients with chronic pain experience in their diagnostic journey. Results suggest that further investigation into the power dynamics of clinical encounters might be required.

Stigma and mental health in endometriosis.

This review provides an overview of patient experiences of endometriosis, endometriosis-related types and sources of stigma pertaining to menstruation, chronic pain, and infertility, and their impact on patients' mental health with particular implications for patient care. Because endometriosis is a complex disease with multifactorial etiology, complicated pathophysiology, and a spectrum of clinical features, diagnosis of endometriosis is typically a lengthy process, and many patients experience initial misdiagnosis. A hallmark symptom is severe menstrual pain with other symptoms including chronic pelvic pain, dysmenorrhea, and infertility. Prior research documents that the diagnostic odyssey, complex management, disabling and unpredictable nature of the disease, and painful symptom profile affect multiple life domains of patients, resulting in poor physical, social, and psychological functioning and clinically-significant rates of anxiety and depression for many. More recently, stigma has been recognized as a potent contributor to poor mental health in endometriosis patients, but existing research is limited and largely atheoretical. We identify major sources of stigma related to endometriosis, including menstrual stigma, chronic pain stigma, and infertility stigma, and their likely impact on patients and health care provision. An integrative theoretical approach is described to facilitate research on the prevalence and effects of endometriosis stigma and their explanatory mechanisms, highlighting specific well-validated psychological instruments to assess stigma. Implications for patient care are emphasized. Better understanding of stigma and mental health in people with endometriosis will enhance the standard of care for this patient population.

Public Chronic Pain Stigma and the Role of Pain Type and Patient Gender: An Experimental Vignette Study

Research exploring the specific manifestations of chronic pain (CP) public stigma is scarce. One potential factor influencing public stigma manifestations may be the CP type, that is, the presence (secondary CP) or absence (primary CP) of a clearly identifiable pathophysiology. Furthermore, patient gender may play a key role, whereby pain-related gender stereotypes may evoke distinct gender role expectations towards men and women experiencing CP. The aim of the research was 2-fold. First, by means of an experimental vignette design, the general population’s cognitive, affective, and behavioral responses were investigated, both towards primary versus secondary CP and towards men versus women. Second, a potential interaction was examined between CP type and patient gender. The research is divided into 2 separate samples: individuals with CP (N = 729) and individuals without CP (N = 283). Factorial ANOVA models were estimated with CP type, patient gender, and participant gender included as factors, age as control variable. The findings support, partly, the general hypothesis of higher (perceived) public stigma towards individuals with primary (vs secondary) CP. No main effects of patient gender were observed. Gender bias in stigmatizing manifestations only emerged in certain contextual circumstances (ie, pain type and participant gender). Different interaction effects (with a combination of gender, patient gender, or CP type) were significant for the distinctive outcome variables. Interestingly, throughout the findings, different patterns of results are found in both samples. The study contributes to the literature on CP stigma, as well as the psychometric examination of items assessing stigmatizing manifestations. PerspectiveThis study examined the role of contextual factors chronic pain type and patient gender into cognitive, affective, and behavioral stigmatizing manifestations coming from the general population towards individuals with chronic pain through an experimental vignette study. The study contributes to the chronic pain stigma literature, as well as the psychometric examination of items assessing stigmatizing manifestations.

Development of a patient-centered text message-based platform for the self-management of interstitial cystitis/bladder pain syndrome symptoms.

To develop a patient-centered text message-based platform that promotes self-management of symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS). Adult women with IC/BPS interested in initiating a first- or second-line treatments per American Urological Association guidelines (recategorized as "behavioral/non-pharmacologic treatments" and "oral medicines" in the 2022 version) participated in rapid cycle innovation consisting of iterative cycles of contextual inquiry, prototype design and development. We delivered treatment modules and supportive messages using an algorithm-driven interactive messaging prototype through a HIPAA-compliant texting platform. Patients provided feedback through narrative text messages and an exit interview. Feedback was analyzed qualitatively and used to iteratively revise the platform until engagement ≥ 85% and accuracy ≥ 80% were achieved. The final version consisted of four treatment module categories (patient education and behavioral modification, cognitive behavioral therapy, pelvic floor physical therapy, and guided mindfulness practices) and supportive messages delivered through an automated algorithm over 6 weeks. Thirty IC/BPS patients with moderate symptom bother (median IC Problem Index score 9, range 6-12) participated in five cycles of contextual inquiry. Qualitative analysis identified three overarching concepts that informed the development of the platform: preference for patient centered terms, desire to gain self-efficacy in managing symptoms, and need for provider support. Patients preferred the term "interstitial cystitis" to "bladder pain syndrome" which carried the stigma of chronic pain. Patients reported greater self-efficacy in managing symptoms through improved access to mind-body and behavioral treatment modules that helped them to gain insight into their motivations and behaviors. The concept of provider support was informed by shared decision making (patients could choose preferred treatment modules) and reduced sense of isolation (weekly check in messages to check on symptom bother). A patient centered text message-based platform may be clinically useful in the self-management of IC/BPS symptoms.

Diminishing pain stigma: patient perceptions of encounters with interprofessional teams in biopsychosocial pain rehabilitation

Purpose To explore how patients in biopsychosocial pain rehabilitation perceive encounters with interprofessional teams. The focus of this article is to explore how interactions can perpetuate or diminish chronic pain stigma. Material and methods An ethnographic approach was applied to the study. Participant observation of interprofessional encounters and clinical encounters in a pain rehabilitation ward was undertaken in 2016 (19 weeks). Interviews with 12 professionals and seven patients were conducted. Data were analysed in an abductive process using thematic analysis. Results The patients perceived their encounters with interprofessional teams as supportive, with implications for pain stigma. This is presented as two themes: (1) being seen as credible, involving patients being believed in and a concept of being overactive at the expense of their own health, and (2) being helped to see their situation in a new light, which involves enthusiasm about changing and challenging views in a process with professionals who were supportive and united across professions. Conclusion Interprofessional biopsychosocial pain rehabilitation may be an intervention that can diminish internalised stigma in patients suffering from chronic pain. The study contributes to increased understanding of patient perceptions of positive encounters with professionals during a learning process in rehabilitation and of the imbued influence on power relations. This appears to be fundamental to diminishing pain stigma, as the occurrence of stigma is dependent on differences in power. KEY MESSAGES Interprofessional biopsychosocial pain rehabilitation can be an intervention for diminishing internalised pain stigma in patients. Knowledge on how encounters with professionals induce personal learning processes among people with chronic pain.

The Determinants and Effects of Chronic Pain Stigma: A Mixed Methods Study and the Development of a Model

People with chronic pain report experiencing stigma, but few studies have explored this in detail. This mixed-methods study aimed to investigate factors that contribute to chronic pain stigma, the effects of stigma, and to explore the stigma experiences of people with chronic pain. Participants were 215 adults with chronic pain who completed questionnaires assessing chronic pain stigma, opioid use, mental health conditions, pain, depression, disability and social support, and 179 also answered open-ended questions about stigma experiences. Linear regression and path analysis showed that greater stigma was experienced by those who used more opioids, had a mental health condition, viewed their pain as organic, and were unemployed. Stigma was associated with greater disability, depression and lower social support. Qualitative results supported quantitative findings, with 3 themes: 1. “Faking It”: Others disbelieve pain and attribute it to drug seeking, laziness, or mental health problems, 2. A spectrum of stigma: Experiences of stigma vary from none to widespread, and 3. “I hide it well”: Concealing pain and avoiding stigmatizing situations lead to isolation & disability. This study demonstrates the negative influence of stigma and presents a novel integrated model of chronic pain stigma which may be used to develop interventions. PerspectiveThis study demonstrates the contributors to, and negative effects of, stigma for people with chronic pain. It presents an integrated model which could guide strategies to reduce chronic pain stigma amongst health professionals and the public, and to reduce self-stigma amongst people with pain.

Intersectional HIV and Chronic Pain Stigma: Implications for Mood, Sleep, and Pain Severity.

Intersectional HIV and Chronic Pain Stigma: Implications for Mood, Sleep, and Pain Severity.

Symptoms of Depression and Insomnia Help Explain the Relationship Between Stigma and Chronic Pain Severity in People with HIV

People living with HIV experience high rates of chronic pain. HIV and chronic pain are both highly stigmatized health conditions. Previous research suggests that stigmatization has negative consequences on mood, sleep, and pain outcomes. Whether the relationship between stigma and chronic pain severity can be explained by symptoms of depression and insomnia has yet to be determined. Participants included 85 people with HIV and chronic pain recruited from an HIV Clinic at a major medical campus. Participants completed the HIV Stigma Mechanisms Scale and the Internalized Stigma of Chronic Pain Scale, as well as the Center for Epidemiological Studies Depression Scale, the Insomnia Severity Index, and the Brief Pain Inventory-Short Form. A series of sequential mediation models controlling for covariates were analyzed via bootstrapping methods. The indirect effect of HIV stigma on chronic pain severity through both depressive symptoms and insomnia severity was significant with a point estimate of .026 and a 95% confidence interval of .003 to .057. In a subsequent model, the same pattern of significant results was found when examining the indirect effect of chronic pain stigma on chronic pain severity through depressive symptoms and insomnia severity (point estimate of .728 and a 95% confidence interval of .259 to 1.360). Findings suggest that the experience of both HIV and chronic pain stigma may perpetuate depressed mood, which can lead to poor sleep (i.e., insomnia). In turn, depression and insomnia can exacerbate the chronic pain severity of people with HIV. These findings are important because stigma-related worsening of mood, sleep, and chronic pain is likely to impede appropriate HIV management and retention in care. UAB center for AIDS research: P30AI027767, NHLBI: R01HL147603.

Tweeting Stigma: An Exploration of Twitter Discourse Regarding Medications Used for Both Opioid Use Disorder and Chronic Pain

We examined the content of tweets on the social media site Twitter to better understand the contemporary discourse about medications for opioid use disorder (MOUD), how this chat contributes to the pervasive underpinnings of drug addiction, chronic pain stigma, and the impact it has on demand and availability of treatment. A retrospective review of tweets over 3 months containing keywords buprenorphine, naltrexone, methadone, or bupe was conducted resulting in 5,068 tweets. A content analysis was carried out focusing on a subset of tweets. Themes emerged from including suspicion and conspiracy theories about MOUD, and frustration and lack of control over their treatment options. Other tweets shared stigmatizing language and attitudes related to OUD/MOUD (e.g., “Junkies”). Twitter is a rich source of data reflecting thoughts, opinions, and sentiments entities regarding MOUD. However, this information can contain malicious comments that perpetuate stigma for people with OUD and result in avoidance of treatment.

Using contact-based education to destigmatize opioid use disorder among medical students

Problem: Opioid-related overdose deaths are a significant public health concern globally, and current recommendations to address chronic pain and opioid-related stigma in medical curricula may be accomplished using contact-based education. To assess the effectiveness of this technique in changing medical students’ opioid use disorder (OUD) stigma and opioid-related postgraduate intentions, the authors implemented two curricular interventions – (1) a modified contact-based education panel and (2) a didactic lecture – at a medical school. Intervention: Medical students were randomized to a curricular intervention and completed pre- and post-assessments to measure opioid misuse knowledge, opioid-related postgraduate intentions, and OUD stigma. One group of participants attended a lecture on opioids and medication assisted treatment (MAT) developed by a clinical psychiatrist; a second group interacted with a 5-member panel of opioid content experts and an individual in recovery. We conducted Fisher’s exact tests, paired t-tests, repeated-measures mixed ANOVAs, and logistic regression to examine changes in pre- and post-assessment responses. Context All first- and second-year (i.e., pre-clinical) medical students at a large, Midwestern medical school with three campuses were invited to participate in a two-arm, parallel educational study comparing the efficacy of two types of curricular interventions. Students at the main campus attended the modified contact-based education panel or the didactic lecture in person, while students at the two distance campuses attended the modified contact-based education or lecture remotely using the University’s videoconferencing system. Impact: A total of 109 students participated in the study (average age 24.2 years (SD = 2.6), 64.2% female, 79.8% white, 56.0% second-year students, 67.9% attended on main campus, lecture = 52 participants, modified contact-based = 57 participants). Baseline responses were similar across groups. Following the session, participants in both interventions rated drug abuse (percent increase = 21.2%, p < .001) and prescription drug diversion (percent increase = 7.6%, p = .004) as more serious problems. Participants from both interventions expressed increased confidence in caring for patients with OUD (percent increase = 45.5%, p < .001) and increased interest in pursuing MAT training (percent increase = 21.5%, p = .04). Both curricular interventions were equally effective at reducing OUD stigma with a significant 8.2% decrease in total stigma scores and a large effect size (p < .001, ηp 2 = .34). Lastly, participants with lower post-assessment OUD stigma scores were more likely to indicate that they would pursue additional training to provide MAT (p = .02). Lessons learned: Exposure to opioid-specific education with a focus on MAT and recovery, regardless of education type, positively affected opioid-related postgraduate intentions and reduced OUD stigma. Notably, these findings suggest that there are multiple efficacious techniques to reduce OUD stigma during preclinical training.

Perceived Injustice Helps Explain the Association Between Chronic Pain Stigma and Movement-Evoked Pain in Adults with Nonspecific Chronic Low Back Pain.

For most patients with chronic low back pain (cLBP), the cause is "nonspecific," meaning there is no clear association between pain and identifiable pathology of the spine or associated tissues. Laypersons and providers alike are less inclined to help, feel less sympathy, dislike patients more, suspect deception, and attribute lower pain severity to patients whose pain does not have an objective basis in tissue pathology. Because of these stigmatizing responses from others, patients with cLBP may feel that their pain is particularly unjust and unfair. These pain-related injustice perceptions may subsequently contribute to greater cLBP severity. The purpose of this study was to examine whether perceived injustice helps explain the relationship between chronic pain stigma and movement-evoked pain severity among individuals with cLBP. Participants included 105 patients with cLBP who completed questionnaires assessing chronic pain stigma and pain-related injustice perception, as well as a short physical performance battery for the assessment of movement-evoked pain and physical function. Findings revealed that perceived injustice significantly mediated the association between chronic pain stigma and cLBP severity (indirect effect = 6.64, 95% confidence interval [CI] = 2.041 to 14.913) and physical function (indirect effect = -0.401, 95% CI = -1.029 to -0.052). Greater chronic pain stigma was associated with greater perceived injustice (P = 0.001), which in turn was associated with greater movement-evoked pain severity (P = 0.003). These results suggest that perceived injustice may be a means through which chronic pain stigma impacts nonspecific cLBP severity and physical function.

728 The Faces of Autologous Skin Cell Suspension as Epidermal Grafts

Abstract Introduction Facial burns are frequently severe and are difficult to skin graft, which may lead to increased morbidity including chronic pain, scarring, and psychosocial stigma. The aim of this study was to describe outcomes of patients with facial burns who received autologous skin cell suspension as an epidermal graft. Methods A retrospective chart review of patients with facial burns admitted to an ABA verified Burn Center from January 2019 to August 2019 was performed. Each patient underwent tangential excision of superficial and deep partial-thickness burn wounds followed by autologous skin cell suspension applied as an epidermal autograft. The wounds were covered with a non-adherent dressing along with bismuth-impregnated, petroleum-based gauze. The dressings were secured in place with sutures to prevent disruption. On post-operative day 6 the dressings were removed with transition to an antimicrobial ointment applied to any remaining open wounds or a moisturizing lotion. Results Five patients, aged 41–89 years, were included. Total body surface ranged from 7–50%. Etiology of the burns included: flame from metal fabricating, assault followed by dousing the patient in gasoline and lighting on fire, flash flame from a water heater explosion, hot oil contact, and involvement in a house fire. 3 of the 5 patients had complete healing noted by post-operative day 6 with excellent results. Two patients required a second excision and application of autologous skin to small portions of the lateral face after healing the majority of the face. One patient developed mild microstomia requiring oral splinting. One of the two patients that required a second application developed ectropian to one of her eyes which was treated with temporary tarsorrhaphy. The second patient that required a second application, died during her hospitalization secondary to complications from her burns and underlying medical co-morbidities. Surviving patients reported satisfaction with the cosmetic outcomes. Conclusions Autologous skin cell suspension as an epidermal graft is a viable option for cosmetically important areas such as the face. This case series provides evidence for its validity when treating partial-thickness burns utilizing the above described protocol in conjunction with a multidisciplinary care team within a burn center. Applicability of Research to Practice By sharing our institutions experience with this relatively new technique we hope to share our positive outcomes as an alternative to stand excision and grafting to areas of significant cosmetic outcomes.

(124) Perceived Injustice Mediates the Relationship between Chronic Pain Stigma and Chronic Low Back Pain (CLBP) Severity

Chronic low back pain (CLBP) is among the most pervasive, painful conditions in the United States. For most patients with CLBP, the cause is “non-specific” – meaning, there is no clear association between pain and identifiable pathology of the spine or associated tissues. Research has shown that laypersons and providers alike are less inclined to help, feel less sympathy, dislike patients more, suspect deception, and attribute lower pain severity to patients whose pain does not have an objective basis in tissue pathology. Because of these stigmatizing responses from others, patients with CLBP may feel their pain is particularly unjust, which in turn could contribute to greater CLBP severity. Further, emerging evidence suggests that pain-related injustice perception is a risk factor for poor CLBP outcomes. The purpose of this study was to examine whether perceived injustice mediates the relationship between chronic pain stigma and pain severity among individuals with CLBP. Study participants with CLBP (N = 44) completed the Internalized Chronic Pain Stigma Scale, the Injustice Experience Questionnaire, the Center for Epidemiological Studies – Depression Scale, and the Brief Pain Inventory – Short Form. In a regression-based model adjusted for depressive symptoms, findings revealed that perceived injustice significantly mediated the association between chronic pain stigma and CLBP severity [Indirect Effect = 1.28, 95% CI: 0.06 to 3.08]. Specifically, greater chronic pain stigma was associated with greater perceived injustice (p = .0002), which in turn was associated with greater CLBP severity (p = .047). This study is the first to examine associations among chronic pain stigma, perceived injustice, and CLBP severity. Our findings suggest that injustice perception may be a mechanism through which stigma impacts CLBP severity. These findings reinforce the importance of further examining stigma and injustice appraisals as targets for intervention, especially among individuals with CLBP.

(189) Intersectional Health-Related Stigma and Poor Quality of Life in People Living with HIV and Chronic Pain

Intersectional health-related stigma (IHRS) refers to stigma that arises at the convergence of multiple health conditions. People living with HIV (PLWH) and chronic pain have two highly stigmatized health conditions, and thus may be at especially high risk for internalizing these stigmas and consequently experiencing reduced health-related quality of life (QOL). This study examined the intersectionality of internalized HIV and chronic pain stigma in relation to mental QOL and physical QOL in a sample of PLWH and chronic pain. Participants (N = 66) were recruited from an HIV clinic in the Southeastern United States. Chronic pain was defined as pain that has been present for at least three consecutive months, and that has been an ongoing problem for at least half the days in the past six months. All participants completed the HIV Stigma Mechanisms Scale, Internalized Chronic Pain Stigma Scale, and the Short Form 36 Health Survey (SF-36). An intersectional HIV and chronic pain stigma composite variable was created and participants were categorized as either high (29%), moderate (35%), or low (36%). Results from two unadjusted ANOVAs revealed that intersectional HIV and chronic pain stigma was significantly associated with poor mental QOL (F2,65 = 3.09, p = .05) and poor physical health QOL (F2,65 = 8.74, p

Intersectional health-related stigma in persons living with HIV and chronic pain: implications for depressive symptoms

ABSTRACT“Intersectional health-related stigma” (IHRS) refers to stigma that arises at the convergence of multiple health conditions. People living with HIV (PLWH) and chronic pain have two highly stigmatized health conditions, and thus may be at especially high risk for internalizing these stigmas and consequently experiencing depression. This study examined the intersectionality of internalized HIV and chronic pain stigma in relation to depressive symptoms in a sample of PLWH and chronic pain. Sixty participants were recruited from an HIV clinic in the Southeastern United States. Chronic pain was defined as pain that has been present for at least three consecutive months, and that has been an ongoing problem for at least half the days in the past six months. All participants completed the HIV Stigma Mechanisms Scale, Internalized Stigma in Chronic Pain Scale, the Short-Form Brief Pain Inventory, and the Center for Epidemiological Studies – Depression Scale. Clinical data was collected from medical records. An intersectional HIV and chronic pain composite variable was created and participants were categorized as either high (28%), moderate (32%), or low (40%). Results revealed that intersectional HIV and chronic pain stigma was significantly associated with severity of depressive symptoms (p = .023). Pairwise contrasts revealed that participants with high (p = .009) and moderate (p = .033) intersectional stigma reported significantly greater mean depressive symptom severity than those with low intersectional stigma. Participants who reported the highest levels of internalized HIV and chronic pain stigma also reported the greatest severity of depressive symptoms. This suggests that the experience of both HIV and chronic pain stigma (i.e., IHRS) among PLWH and chronic pain may synergistically perpetuate negative mood in a more profound manner than experiencing either one stigma alone.

Depression increases subjective stigma of chronic pain

BackgroundIndividuals suffering from mental as well as physical conditions often face stigma, which can adversely affect functioning, treatment seeking, and emotional health. We compared levels of stigma experienced by individuals with depression and/or chronic pain, to contrast the perception of stigma experienced by the sufferers with that of individuals who have never experienced these conditions, and to determine whether depression is related to greater experience of stigma for chronic pain. MethodsFour groups of participants (N=236) took part in the study: depression only, chronic pain only, comorbid depression and chronic pain, and healthy controls. Participants underwent a clinical interview and completed a stigma measure that assessed general self-stigma, public stigma, treatment stigma, secrecy, and stigmatizing experiences. ResultsHealthy controls largely underestimated the stigma experienced by individuals with depression, but were not inaccurate in estimating stigma experienced by individuals with chronic pain. Further, individuals with chronic pain alone generally perceived less stigma for their condition than did those with depression alone. However, comorbid individuals perceived worse stigma of chronic pain compared to individuals with chronic pain alone, suggesting that depression may affect the stigma felt by sufferers of conditions other than depression. LimitationsSocial desirability may have influenced stigma scores. Comparing several groups required adapting a standardized instrument. ConclusionsResults suggest that depression may play a role in the social experience of having a health condition, as well as indicate that the general public continues to fail to appreciate the negative social pressures experienced by individuals with mental health conditions.

Defeating the stigma of chronic pain.

Defeating the stigma of chronic pain.

Job and the Stigmatization of Chronic Pain

Many ethical and policy analyses of the devastating undertreatment of chronic pain leave unaddressed the role played by stigma, even though the notion that such stigma exists is well documented. This article examines the social and cultural roots of the stigma of chronic pain in American society. I document the long history of illness stigma in Western societies as a way of illustrating the power of this meaning-making construct, and I use the Book of Job as a framework for understanding the deep link between sin and suffering in the context of illness and chronic pain in the United States. Unfortunately, while illness stigma can be ameliorated, there is little evidence of such progress in the undertreatment and stigmatization of chronic pain sufferers, and I explain some of the reasons why the best evidence does not demonstrate much improvement. I conclude by sketching some recommendations for diminishing the stigmatization of the chronic pain sufferer, and warn that the focus on altering the opioid regulatory regime is unlikely to have the desired impact in reducing the suffering of millions of Americans.