The Impact of Social Rejection: Investigating Pain-related Stigma in Adolescents with Chronic Widespread Musculoskeletal Pain

摘要 在患有慢性疼痛的青少年中，与疼痛相关的耻辱是一个重要且未被充分研究的社会心理因素。 广泛的肌肉骨骼疼痛（CWMP）与健康结果受损有关。的 疼痛自我报告的主观性增加了个体经历症状难以置信的机会 其他人。与疼痛相关的耻辱因其对延迟诊断的潜在影响而成为重要的公共卫生优先事项 和恢复障碍。患有 CWMP 的青少年很容易受到一些与疼痛相关的耻辱的影响 来源，包括医生、学校工作人员、家人和同龄人，可能会影响他们的健康。的目标 该提案旨在：1）研究与疼痛相关的耻辱如何成为一种新颖且必要的心理社会组成部分。 青少年 CWMP，以及 2) 制定并验证青少年疼痛相关耻辱量表 (PReSS-A) CWMP 患者。对于这个年轻人口中与疼痛相关的耻辱还知之甚少。这个提议 使用混合方法设计来开发心理社会研究新领域的理论框架 患有 CWMP 的青少年。这项研究将为理解与疼痛相关的耻辱感和 针对 CWMP 青少年的这种社会建构制定干预措施。具体目标是：1） 使用单独的青少年焦点小组制定与疼痛相关的耻辱框架和 PRESS-A 项目 CWMP 和幼年特发性关节炎 (JIA) 及其父母； 2) 使用经典项目细化 PRESS-A 项目 对患有 CWMP 的青少年样本进行分析； 3) 在更大的样本中验证最终的 PRESS-A 项目 患有 CWMP 的青少年，并使用患有 JIA 的青少年的比较样本来测试构建有效性，他们 由于支持幼年特发性关节炎诊断的医学证据，假设他们报告的耻辱感较少；和 4) 利用结构方程模型来探索感知到的疼痛相关耻辱与 社会心理和健康结果。多个患者群体（即 CWMP 和 JIA）的使用及其 父母检查和验证这种社会建构的措施是创新的。这个职业发展 该奖项旨在让疼痛与姑息治疗科的儿科心理学家艾米丽·韦克菲尔德 (Emily Wakefield) 博士获得奖励 康涅狄格州儿童医学中心医学博士和康涅狄格大学儿科助理教授 康涅狄格医学院，利用两家机构的充足资源，成为独立的医学院 研究人员致力于改善患有慢性疼痛的青少年的健康结果。她的短期目标是 了解导致疼痛相关耻辱感的机制，并制定旨在减少这种耻辱感的干预措施 CWMP 青少年的耻辱。为了实现这一目标，职业发展计划包括正式和非正式的 定性和定量研究设计以及高级研究方面的培训、指导和咨询 统计分析、儿科疼痛、耻辱和随机临床试验方面的培训。她的长期目标是 成为儿童慢性疼痛心理社会研究的全国领导者和青少年疼痛专家 相关的社会心理健康结果。

ABSTRACT Pain-related stigma is a significant and understudied psychosocial factor among adolescents with chronic widespread musculoskeletal pain (CWMP) that has been implicated in impaired health outcomes. The subjectivity of pain self-report increases the opportunity for an individual to experience symptom disbelief by others. Pain-related stigma is a significant public-health priority due to its potential impact on delayed diagnosis and impairment in recovery. Adolescents with CWMP are vulnerable to pain-related stigma from several sources, including physicians, school staff, family, and peers, likely impacting their health. The objectives of this proposal are to: 1) examine how pain-related stigma is a novel and necessary psychosocial component of adolescent CWMP, and 2) develop and validate the Pain-Related Stigma Scale for Adolescents (PReSS-A) in patients with CWMP. Not enough is known about pain-related stigma in this young population. This proposal uses a mixed-methods design to develop a theoretical framework in new areas of psychosocial research for adolescents with CWMP. This research will provide a foundation for understanding pain-related stigma and developing interventions to target this social construct in adolescents with CWMP. The specific aims are: 1) develop a pain-related stigma framework and PReSS-A items using separate focus groups of adolescents with CWMP and juvenile idiopathic arthritis (JIA) and their parents; 2) refine PReSS-A items using classical item analyses in a sample of adolescents with CWMP; 3) validate final PReSS-A items in a larger sample of adolescents with CWMP, and test construct validity using a comparative sample of adolescents with JIA, who are hypothesized to report less stigma due to the medical evidence supporting their JIA diagnosis; and 4) leverage structural equation modeling to explore relationships between perceived pain-related stigma and psychosocial and health outcomes. The use of multiple patient populations (i.e., CWMP and JIA) and their parents to examine and validate a measure of this social construct is innovative. This career-development award is designed to allow Dr. Emily Wakefield, a pediatric psychologist in the Division of Pain and Palliative Medicine at Connecticut Children's Medical Center and Assistant Professor of Pediatrics at the University of Connecticut School of Medicine, to draw upon ample resources of both institutions to become an independent researcher dedicated to improving health outcomes for adolescents with chronic pain. Her short-term goal is to understand mechanisms contributing to pain-related stigma and develop interventions focused on reducing this stigma in adolescents with CWMP. To achieve this, the career-development plan includes formal and informal training, mentorship and consultation in both qualitative and quantitative research design, and advanced training on statistical analyses, pediatric pain, stigma, and randomized clinical trials. Her long-term goals are to be a national leader in psychosocial research on pediatric chronic pain and an expert on adolescent pain- related psychosocial health outcomes.