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

社会排斥的影响：调查患有慢性广泛肌肉骨骼疼痛的青少年与疼痛相关的耻辱

• 批准号: 10791605
• 负责人: Emily O Wakefield
• 金额: $ 8.91万
• 依托单位: CONNECTICUT CHILDREN'S MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-14 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10791605
• 关键词: Adolescent; Advisory Committees; African American; Area; Award; Bioethics; Black American; Black race; Caring; Child; Childhood; Chronic; Chronic Childhood Arthritis; Clinical; Communities; Connecticut; Cultural Sensitivity; Data Collection; Dedications; Development; Diagnosis; Enrollment; Equation; Equity; Evaluation; Failure; Family; Feedback; Female; Focus Groups; Foundations; Funding; Goals; Grant; Health; Impaired health; Impairment; Improve Access; Individual; Intervention; Interview; K-Series Research Career Programs; Link; Measures; Medical; Medical center; Methods; Modeling; Musculoskeletal Pain; National Institute of Arthritis, and Musculoskeletal, and Skin Diseases; Not Hispanic or Latino; Outcome; Outcome Assessment; Pain; Pain Clinics; Pain management; Palliative Medicine; Parents; Participant; Patient Self-Report; Patients; Pattern; Pediatrics; Physicians; Population; Provider; Psychologist; Psychosocial Factor; Quality of life; Race; Racial Equity; Recovery; Reporter; Reporting; Research; Research Design; Research Personnel; Research Project Grants; Sampling; Schools; Secondary to; Sickle Cell Anemia; Source; Stigmatization; Symptoms; Testing; Universities; Validation; Work; Youth; adolescent health outcomes; chronic pain; comparative; design; experience; follow-up; health care disparity; improved; infancy; innovation; juvenile onset fibromyalgia; marginalization; medical schools; novel; patient population; pediatric patients; peer; poor health outcome; professor; psychosocial; public health priorities; racial bias; racial diversity; racial population; recruit; social; social factors; social stigma; treatment disparity; validation studies

ABSTRACT Pain-related stigma is a significant and understudied psychosocial factor among adolescents with chronic amplified musculoskeletal pain (CMP), which includes 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 CMP 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 CMP, and 2) develop and validate the Pain- Related Stigma Scale for Adolescents (PReSS-A) in patients with CMP. 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 CMP. This research will provide a foundation for understanding pain-related stigma and developing interventions to target this social construct in adolescents with CMP. The specific aims are: 1) develop a pain-related stigma framework and PReSS-A items using separate focus groups of adolescents with CMP and juvenile idiopathic arthritis (JIA) and their parents; 2) refine PReSS-A items using classical item analyses in a sample of adolescents with CMP; 3) validate final PReSS-A items in a larger sample of adolescents with CMP, 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., CMP 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 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 CMP. 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. The objectives of this bioethics supplement are to build the research capacity of pain-related stigma research by enhancing the racial diversity of participants via (1) identifying barriers to pain treatment equity for racialized youth with CMP, and (2) develop solutions to overcome these obstacles via the development of a Diversity Task Force.

摘要 疼痛相关的耻辱感是青少年慢性疼痛患者中一个重要且研究不足的心理社会因素。 放大的肌肉骨骼疼痛（CMP），包括慢性广泛性肌肉骨骼疼痛（CWMP）， 与健康受损有关疼痛自我报告的主观性增加了 让一个人体验到别人的怀疑症状。与疼痛相关的耻辱感是一个重要的公共健康问题， 由于其对延迟诊断和损害恢复的潜在影响，优先考虑。青少年CMP 容易受到来自多个来源的与疼痛相关的耻辱，包括医生、学校工作人员、家庭和同龄人， 可能会影响他们的健康。本提案的目标是：1）研究与疼痛相关的耻辱感是如何成为一种 青少年CMP的新的和必要的心理社会组成部分，和2）开发和验证疼痛- 青少年相关污名量表（PReSS-A）用于CMP患者。对疼痛的了解还不够- 在这个年轻的群体中。本提案采用混合方法设计， 青少年CMP心理社会研究新领域的框架。这项研究将提供一个 了解疼痛相关的耻辱和制定干预措施，以针对这一社会结构的基础， 青少年CMP具体目标是：1）建立疼痛相关污名框架和PReSS-A项目 使用单独的重点小组的青少年与CMP和青少年特发性关节炎（JIA）和他们的父母; 2)在青少年CMP样本中使用经典项目分析来细化PReSS-A项目; 3）验证最终结果 PReSS-A项目在更大样本的青少年与CMP，并测试结构效度使用比较 JIA青少年样本，假设他们报告较少的耻辱，由于医学证据 支持他们的JIA诊断; 4）利用结构方程模型来探索 疼痛相关的耻辱感和心理社会和健康结果。使用多个患者人群 (i.e., CMP和JIA）及其父母检查和验证这种社会建构的措施是创新的。 这个职业发展奖的目的是让艾米丽韦克菲尔德博士，一个儿科心理学家在 康涅狄格州儿童医学中心疼痛和姑息医学部， 康涅狄格大学医学院儿科学，成为独立研究员 致力于改善患有慢性疼痛的青少年的健康状况。她的短期目标是了解 机制有助于疼痛相关的耻辱，并制定干预措施，重点是减少这种耻辱， 青少年CMP她的长期目标是成为儿科心理社会研究的全国领导者。 慢性疼痛和青少年疼痛相关的心理社会健康结果的专家。这一目标 生物伦理学补充是通过加强种族歧视， 参与者的多样性，通过（1）确定CMP种族化青年疼痛治疗公平性的障碍，以及 (2)通过建立多样性工作队，制定克服这些障碍的解决方案。

项目成果

Does Diagnostic Certainty Matter?: Pain-Related Stigma in Adolescents with Juvenile Idiopathic Arthritis.

诊断确定性重要吗？：青少年特发性关节炎青少年与疼痛相关的耻辱。

• DOI: 10.1093/jpepsy/jsac092
• 发表时间: 2023
• 期刊: Journal of pediatric psychology
• 影响因子: 3.6
• 作者: Wakefield,EmilyO;Belamkar,Vaishali;Sandoval,Ashley;Puhl,RebeccaM;Edelheit,Barbara;Zempsky,WilliamT;Rodrigues,HannahA;Litt,MarkD
• 通讯作者: Litt,MarkD

"If It Ever Really Hurts, I Try Not to Let Them Know:" The Use of Concealment as a Coping Strategy Among Adolescents With Chronic Pain.

• DOI: 10.3389/fpsyg.2021.666275
• 发表时间: 2021
• 期刊: Frontiers in psychology
• 影响因子: 3.8
• 作者: Wakefield EO;Puhl RM;Litt MD;Zempsky WT
• 通讯作者: Zempsky WT