Around 770,000 New Zealanders suffer from chronic
pain.
Chronic pain is a leading cause of disability
that affects one in six adults worldwide, but it is poorly
understood by the general public and many health
professionals. As a result, people who live with persistent
or recurring pain may experience various forms of
stigma.
Dr Debbie
Bean, a Senior Research Fellow with a joint appointment
across Auckland
University of Technology (AUT) and Te Whatu Ora
Waitematā, has published a research article in The
Journal of Pain investigating the determinants and
effects of chronic pain stigma.
Three themes emerged
from the study: (1) faking it, (2) a spectrum of stigma, and
(3) I hide it well.
“Because pain is invisible, it
is often disbelieved and attributed to mental illness, or
viewed as imaginary and ‘all in your head’. Mental
health conditions, opioid use, pain beliefs, and
unemployment are associated with experiences of greater
stigma,” says Dr Bean.
“Our study shows that
people with chronic pain will anticipate stigma, often
concealing their pain and avoiding potentially stigmatising
experiences across all areas of life. Consequently, stigma
is associated with higher levels of isolation, depression,
and disability.”
More than 200 people with chronic
pain participated in the study, conducted by researchers at
the AUT Health and Rehabilitation
Research Institute, and Pain Management Unit at Te Whatu
Ora Waitematā.
While previous studies have focused on
individual aspects of chronic pain stigma, this is the first
time that multiple determinants and effects have been
considered together. The result is a comprehensive
integrated model of chronic pain stigma that could inform
future research and interventions.
Health-related
stigma is common. Stigma can be defined as stereotypes or
negative views attributed to a person or groups. It is
characterised by exclusion, rejection, blame, devaluation,
or social judgement.
People with chronic pain
experience a spectrum of stigma, that ranges from
little-or-none to widespread, from employers and colleagues,
teachers, family and friends, and society.
Health
professionals in particular were identified as a source of
stigma. Although pain science has documented the
physiological underpinnings of chronic pain, it is not
adequately taught in medical training. Even clinicians who
understand chronic pain and attempt to provide appropriate
care can be misunderstood.
“While opioids are not
recommended for treatment of non-cancer pain, they are
frequently prescribed despite the guidelines. Inconsistent
prescribing can create misunderstandings. If a clinician
declines to prescribe opioids, this could be misinterpreted
as disbelief of pain and patients may feel accused of
drug-seeking, even when the clinician understands that the
pain is real,” says Dr Bean.
“Education for health
professionals has been shown to reduce mental health stigma,
and the same may be true for chronic pain. Improving public
knowledge, altering prescribing behaviour, and equipping
clinicians with the necessary communication skills to
discuss opioids with patients would be
helpful.”
Self-stigma also occurs with chronic pain.
Participants in the study expressed low self-worth and
elevated distress.
“Clinical interventions may be
beneficial if they challenge beliefs that pain must be
either biomedical or psychological. One intervention that
holds promise is acceptance and commitment therapy, which
has shown to reduce self-stigma in substance use
disorders,” says Bean.
“Other interventions may
need to target societal views more broadly and the
socio-political structures that enable the stigma in order
to be more effective. These strategies include education,
mass media campaigns, personal contact with people in pain,
and protest.”
Dr Bean is a registered health
psychologist with more than a decade’s experience working
at an interdisciplinary pain centre. She is also Chair of
the Institute of Health Psychology at the New Zealand
Psychological Society.
In September, Dr Bean was
awarded the New Zealand Pain Society’s 2022 Broadfoot
Trust Prize for outstanding research in recognition of
this study. Her research interests focus on understanding
the interactions between psychological factors and
pain.
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