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

摘要 与疼痛相关的耻辱是青少年慢性疾病患者中一个重要而未被研究的心理社会因素 放大的肌肉骨骼疼痛(CMP)，包括慢性广泛性肌肉骨骼疼痛(CWMP)， 与健康后果受损有牵连。疼痛自我报告的主观性增加了机会 对于一个人来说，经历了其他人的症状怀疑。与疼痛相关的污名是一种重大的公共健康 由于其对延迟诊断和康复障碍的潜在影响，应优先考虑。患有慢性萎缩性脑病的青少年 容易受到来自几个来源的与疼痛相关的污名，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。这项提案的目标是：1)检查与疼痛相关的污名是如何 新的和必要的心理社会因素，以及2)发展和验证疼痛-- 青少年污名量表(PRESS-A)在慢性萎缩性胃炎患者中的应用。对疼痛的了解还不够多- 在这一年轻群体中存在相关的耻辱。这项提案使用混合方法设计来开发一种理论 为患有慢性萎缩性麻痹的青少年进行心理社会研究的新领域的框架。这项研究将提供一种 为了解与疼痛相关的耻辱和开发针对这种社会结构的干预措施奠定了基础 患有慢性萎缩性脑病的青少年。具体目标是：1)开发与疼痛相关的污名框架和PRESS-A项目 对患有慢性粒细胞白血病和幼年特发性关节炎(JIA)的青少年及其父母进行单独的焦点小组研究； 2)使用经典条目分析对患有慢性粒细胞白血病的青少年样本进行精炼PRESS-A条目；3)验证期末考试 PRESS-A项目在更大样本的患有CMP的青少年中，并使用比较的 患有JIA的青少年样本，由于医学证据，假设他们报告的耻辱较少 支持他们的JIA诊断；以及4)利用结构方程建模来探索 感知到的与疼痛相关的耻辱以及心理社会和健康结果。使用多个患者群体 (即《议定书》/《议定书》/《公约》和《联合执行机构》)及其父母审查和验证这一社会结构的措施是创新的。 这个职业发展奖旨在让艾米丽·韦克菲尔德博士，一位儿科心理学家 康涅狄格州儿童医学中心疼痛和姑息医学部助理教授 康涅狄格大学医学院儿科，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。她的短期目标是理解 促进疼痛相关耻辱的机制并制定干预措施，重点是减少这种耻辱 患有慢性萎缩性脑病的青少年。她的长期目标是成为全国儿科心理社会研究的领先者 他是一位研究青少年疼痛相关心理社会健康结果的专家。这样做的目的是 生命伦理学补充是通过加强种族研究来建设与疼痛相关的污名研究的研究能力 参与者的多样性，通过(1)为患有CMP的种族主义青年确定疼痛治疗公平的障碍，以及 (2)通过建立多样性工作队，制定克服这些障碍的解决办法。

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.