Pain-Related Stigma and Its Associations With Clinical and Experimental Pain Severity in Youth With Chronic Musculoskeletal Pain Conditions

Nicholas R Boileau; Kathryn A Thompson-Phillips; Burel R Goodin; Mary K Lynch-Milder; Corinne T Evans; Tolulope Adetayo; Arionna F Rudolph; Matthew L Stoll; Peter Weiser; Aaron D Fobian; Marissa A Gowey; Emily O Wakefield

doi:10.1093/jpepsy/jsad048

Pain-Related Stigma and Its Associations With Clinical and Experimental Pain Severity in Youth With Chronic Musculoskeletal Pain Conditions

J Pediatr Psychol. 2023 Oct 20;48(10):842-851. doi: 10.1093/jpepsy/jsad048.

Authors

Affiliations

¹ Department of Psychology, University of Alabama at Birmingham, USA.
² Children's of Alabama, Behavioral Health Ireland Center, USA.
³ Department of Anesthesiology, Washington University in St. Louis, USA.
⁴ Great Lakes Neurobehavioral Center, USA.
⁵ Department of Pediatrics, Division of Pediatric Rheumatology, University of Alabama at Birmingham, USA.
⁶ Department of Psychiatry & Behavioral Neurobiology, University of Alabama at Birmingham, USA.
⁷ Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, University of Alabama at Birmingham, USA.
⁸ Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, USA.
⁹ Division of Pediatric Psychology, Connecticut Children's Medical Center, USA.
¹⁰ Department of Pediatrics, University of Connecticut School of Medicine, USA.

PMID: 37500594
PMCID: PMC10588972 (available on 2024-07-27)
DOI: 10.1093/jpepsy/jsad048

Abstract

Objective: Many children with chronic musculoskeletal pain conditions experience stigma which can have negative downstream consequences. This study compares ratings of clinical pain (current pain intensity and pain interference), experimental pain (temporal summation, cold water tolerance, and cold pain intensity), and pain-related stigma among three groups of youth with rheumatic conditions. The relations among ratings of pain-related stigma and pain variables were explored.

Methods: Eighty-eight youth aged 8-17 years with a diagnosis of juvenile idiopathic arthritis (JIA = 32), juvenile fibromyalgia (JFM = 31), or non-specific chronic pain (NSCP = 25) completed measures of clinical pain ratings (average 7-day pain intensity, day of assessment pain (DoA), and pain interference), experimental pain (cold pain tolerance, cold pain intensity, and temporal summation of mechanical pain), and pain-related stigma. Data analysis compared pain-related stigma and pain ratings across the three groups and examined the relations among pain-related stigma and pain ratings.

Results: Youth with JFM reported higher ratings of clinical pain and pain-related stigma than their counterparts with NSCP or JIA. However, there were no differences in experimental pain. Pain-related stigma was associated with greater ratings of pain interference, particularly for those with JIA and NSCP. Pain-related stigma was also associated with greater average daily pain intensity but not DoA.

Conclusion: Youth with medically unexplained pain report greater stigma and worse pain than their peers; thus, robust assessment of pain in this population is necessary. Future work should longitudinally explore the impact of pain-related stigma on pain outcomes and treatment responses.

Keywords: chronic and recurrent pain; juvenile arthritis; rheumatology; school age children; social functioning and peers; stress.

Abstract

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