Highlights
- •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.
Abstract
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.
Perspective
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.
Key Words
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References
- Adaptive EAP estimation of ability in a microcomputer environment.Appl Psychol Measure. 1982; 6: 431-444
- Interventions to reduce HIV/AIDS stigma: What have we learned?.AIDS Educ Prev. 2003; 15: 49-69
- Pain-related catastrophizing and perceived social responses: Inter-relationships in the context of chronic pain.Pain. 2007; 127: 234-242
- A couple-based psychological treatment for chronic pain and relationship distress.Cogn Behav Pract. 2018; 25: 119-134
- Correlates and consequences of the disclosure of pain-related distress to one's spouse.Pain. 2012; 153: 2441-2447
- Social interaction in pain: Reinforcing pain behaviors or building intimacy?.Pain. 2010; 149: 9-11
- Measuring disability in patients with chronic fatigue syndrome: Reliability and validity of the Work and Social Adjustment Scale.J Psychosom Res. 2011; 71: 124-128
- Pain assessment: Global use of the Brief Pain Inventory.Ann Acad Med Singapore. 1994; 23: 129-138
- Cohen J Statistical Power Analysis for the Behavioral Sciences. 2nd ed. L. Erlbaum Associates, Mahwah, NJ1988
- Changes in sleep problems and psychological flexibility following interdisciplinary Acceptance and Commitment Therapy for chronic pain: An observational cohort study.Front Psychol. 2016; 7: 1326
- Understanding stigma and chronic pain: A state of the art review.Pain. 2016; 157: 1607-1610
- Discounting pain in the absence of medical evidence is explained by negative evaluation of the patient.Pain. 2013; 154: 669-676
- Health care professionals' reactions to patient pain: Impact of knowledge about medical evidence and psychosocial influences.J Pain. 2014; 15: 262-270
- Meta-analysis of experiments with matched groups or repeated measures designs.Psychol Methods. 1996; 1: 170-177
- Core outcome measures for chronic pain clinical trials: IMMPACT recommendations.Pain. 2005; 113: 9-19
- Patients' and professionals' understandings of the causes of chronic pain: Blame, responsibility and identity protection.Soc Sci Med. 1997; 45: 699-709
- Applying item response theory (IRT) modeling to questionnaire development, evaluation, and refinement.Qual Life Res. 2007; 16: 5-18
- Validating pain communication: Current state of the science.Pain. 2015; 156: 215-219
- Validation of the Chronic Pain Acceptance Questionnaire (CPAQ) in an Internet sample and development and preliminary validation of the CPAQ-8.Pain. 2010; 149: 435-443
- Responsiveness, reliability, and minimally important and minimal detectable changes of 3 electronic patient-reported outcome measures for low back pain: Validation study.J Med Internet Res. 2018; 20: e272
- Fear of the brown envelope: Exploring welfare reform with long‐term sickness benefits recipients.Soc Policy Admin. 2014; 48: 782-798
- Becoming incapacitated? Long‐term sickness benefit recipients and the construction of stigma and identity narratives.Sociol Health Illn. 2015; 37: 1-13
- Stigma and social identity.in: Goffman E Stigma: Notes on the Management of Spoiled Identity. Prentice-Hall Inc, Englewood Cliffs, NJ1963: 1-40
- Analgesic reduction during an interdisciplinary pain management programme: Treatment effects and processes of change.Br J Pain. 2018; 12: 72-86
- Assessing physical functioning on pain management programmes: The unique contribution of directly assessed physical performance measures and their relationship to self-reports.Br J Pain. 2017; 11: 46-57
- A biopsychosocial formulation of pain communication.Psychol Bull. 2011; 137: 910-939
- A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: Outcome domains, design quality, and efficacy.J Contextual Behav Sci. 2014; 3: 217-227
- Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies.Annu Rev Clin Psychol. 2011; 7: 141-168
- A rationale and test for the number of factors in factor analysis.Psychometrika. 1965; 30: 179-185
- Pain as a threat to the social self: A motivational account.Pain. 2018; 159: 1690-1695
- Validity of the Brief Pain Inventory for use in documenting the outcomes of patients with noncancer pain.Clin J Pain. 2004; 20: 309-318
- Lack of understanding in fibromyalgia and rheumatoid arthritis: The Illness Invalidation Inventory (3* I).Ann Rheum Dis. 2010; 69: 1990-1995
- Understanding the lack of understanding: Invalidation from the perspective of the patient with fibromyalgia.Arthritis Care Res. 2009; 61: 1650-1656
- Psychological inflexibility and stigma: A meta-analytic review.J Contextual Behav Sci. 2018; 7: 15-28
- The PHQ‐9.J Gen Intern Med. 2001; 16: 606-613
- Determining the number of factors to retain in EFA: An easy-to-use computer program for carrying out parallel analysis.Practical Assessment, Research & Evaluation. 2007; 12: 1-11
- A perspective-taking manipulation leads to greater empathy and less pain during the cold pressor task.J Pain. 2015; 16: 1176-1185
- Effects of HIV stigma reduction interventions in diasporic communities: Insights from the CHAMP Study.AIDS Care. 2018; 30: 739-745
- FACTOR: A computer program to fit the exploratory factor analysis model.Behav Res Methods. 2006; 38: 88-91
- Reducing self-stigma in substance abuse through Acceptance and Commitment Therapy: Model, manual development, and pilot outcomes.Addict Res Theory. 2008; 16: 149-165
- Acceptance and Commitment Therapy and mindfulness for chronic pain: Model, process, and progress.Am Psychol. 2014; 69: 178-187
- Acceptance of chronic pain: Component analysis and a revised assessment method.Pain. 2004; 107: 159-166
- Recent developments in the factor analysis of categorical variables.J Educ Stat. 1985; 11: 3-31
- The Stigma Scale for Chronic Illnesses 8-item version (SSCI-8): Development, validation and use across neurological conditions.Int J Behav Med. 2013; 20: 450-460
- The Work and Social Adjustment Scale: A simple measure of impairment in functioning.Br J Psychiatry. 2002; 180: 461-464
- Effect size, confidence interval and statistical significance: A practical guide for biologists.Biol Rev. 2007; 82: 591-605
- Combating HIV stigma in health care settings: What works?.J Int AIDS Soc. 2009; 12: 15-21
- Measuring stigma across neurological conditions: The development of the Stigma Scale for Chronic Illness (SSCI).Qual Life Res. 2009; 18: 585-595
- A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence.AIDS Behav. 2012; 16: 711-716
- Assessing stigma among African Americans living with HIV.Stigma Health. 2016; 1: 146-155
- The difficulty of test items that measure more than one ability.Appl Psychol Measure. 1985; 9: 401-412
- Psychometric properties of the 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8) in a Swedish chronic pain cohort.J Rehabil Med. 2014; 46: 73-80
- Sources of injustice among individuals with persistent pain following musculoskeletal injury.Psychol Injury Law. 2016; 9: 6-15
- Further validation of a measure of injury-related injustice perceptions to identify risk for occupational disability: A prospective study of individuals with whiplash injury.J Occup Rehabil. 2013; 23: 557-565
- Barriers to change in depressive symptoms following multidisciplinary rehabilitation for whiplash: The role of perceived injustice.Clin J Pain. 2015; 31: 145-151
- Perceived injustice: A risk factor for problematic pain outcomes.Clin J Pain. 2012; 28: 484-488
- The role of perceived injustice in the experience of chronic pain and disability: Scale development and validation.J Occup Rehabil. 2008; 18: 249-261
- Acceptance-and mindfulness-based interventions for the treatment of chronic pain: A meta-analytic review.Cogn Behav Ther. 2016; 45: 5-31
- Resilience does not explain the dissociation between chronic pain and physical activity in South Africans living with HIV.PeerJ. 2016; 4
Wadley AL, Pincus T, Evangeli M: A preliminary analysis of the association between perceived stigma and HIV-related pain. Available at: www.biorxiv.org/content/biorxiv/early/2017/09/27/194191.full.pdf. Accessed September 28, 2018
- Internalized stigma in people living with chronic pain.J Pain. 2014; 15 (550.e551-550.e510)
- It is hard work behaving as a credible patient: Encounters between women with chronic pain and their doctors.Soc Sci Med. 2003; 57: 1409-1419
- Defeating the stigma of chronic pain.Pain. 2016; 157: 1581-1582
- Updating the definition of pain.Pain. 2016; 157: 2420-2423
- Item factor analysis: Current approaches and future directions.Psychol Methods. 2007; 12: 58-79
Article info
Publication history
Published online: March 30, 2019
Accepted:
March 13,
2019
Received in revised form:
February 8,
2019
Received:
July 24,
2018
Footnotes
Disclosures: This research is independent work supported in part by the National Institute for Health Research (NIHR Postdoctoral Fellowship, Dr Whitney Scott, PDF-2015-08-059). L.M.M. is partly funded through the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health. The funder had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
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© 2019 by the American Pain Society
