Research Article| Volume 20, ISSUE 10, P1164-1175, October 2019

Measuring Stigma in Chronic Pain: Preliminary Investigation of Instrument Psychometrics, Correlates, and Magnitude of Change in a Prospective Cohort Attending Interdisciplinary Treatment

  • Whitney Scott
    Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK

    INPUT Pain Management Unit, Guy's and St Thomas’ NHS Foundation Trust, London, UK
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  • Lin Yu
    INPUT Pain Management Unit, Guy's and St Thomas’ NHS Foundation Trust, London, UK
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  • Shrina Patel
    INPUT Pain Management Unit, Guy's and St Thomas’ NHS Foundation Trust, London, UK
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  • Lance M. McCracken
    Address reprint requests to Whitney Scott, Health Psychology Section, King's College London, Guy's Hospital Campus, London SE1 9RT.
    Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK

    INPUT Pain Management Unit, Guy's and St Thomas’ NHS Foundation Trust, London, UK
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      • The Stigma Scale for Chronic Illness 8-item version is a psychometrically sound measure of stigma in chronic pain.
      • Stigma was uniquely associated with depression and daily functioning.
      • Total stigma scores did not change after interdisciplinary treatment.


      Chronic pain is a potentially stigmatizing condition. However, stigma has received limited empirical investigation in people with chronic pain. Therefore, we examined the psychometric properties of a self-report questionnaire of stigma in people with chronic pain attending interdisciplinary treatment. Secondarily, we undertook an exploratory examination of the magnitude of change in stigma associated with interdisciplinary treatment in a prospective observational cohort. Participants attending interdisciplinary treatment based on acceptance and commitment therapy completed the Stigma Scale for Chronic Illness 8-item version (SSCI-8; previously developed and validated in neurological samples), and measures of perceived injustice, pain acceptance, and standard pain outcomes before (n = 300) and after treatment (n = 247). A unidimensional factor structure and good internal consistency were found for the SSCI-8. Total SSCI-8 scores were correlated with pain intensity, indices of functioning, and depression in bivariate analyses. Stigma scores were uniquely associated with functioning and depression in multiple regression analyses controlling for demographic factors, pain intensity, pain acceptance, and perceived injustice at baseline. SSCI-8 total scores did not significantly improve after treatment, although an exploratory subscale analysis showed a small improvement on internalized stigma. In contrast, scores on perceived injustice, pain acceptance, and pain outcomes improved significantly. Taken together, these data support the reliability and validity of the SSCI-8 for use in samples with chronic pain. Further research is needed optimize interventions to target stigma at both the individual and societal levels.


      This study supports the use of the SSCI-8 to measure stigma in chronic pain. Stigma is uniquely associated with worse depression and pain-related disability. Research is needed to identify how to best target pain-related stigma from individual and societal perspectives.

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