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

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。 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怀疑的机会， 他人疼痛相关的耻辱是一个重要的公共卫生优先事项，因为它对延迟诊断的潜在影响 和损害恢复。患有CWMP的青少年容易受到来自几个方面的与疼痛有关的耻辱感的影响。 来源，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。的目标 这一建议是：1）研究如何疼痛相关的耻辱是一个新的和必要的心理社会组成部分， 青少年CWMP，2）开发和验证青少年疼痛相关污名量表（PReSS-A）， CWMP患者对这一年轻人群中与疼痛有关的耻辱感了解不够。这项建议 使用混合方法设计，在心理社会研究的新领域开发理论框架， 青少年CWMP这项研究将为理解疼痛相关的耻辱感提供基础， 制定干预措施，针对这一社会结构的青少年与CWMP。具体目标是：1） 使用单独的青少年焦点组，制定与疼痛相关的污名框架和PReSS-A项目， CWMP和幼年特发性关节炎（JIA）及其父母的PReSS-A项目; 2）用经典项目对PReSS-A项目进行改进 在CWMP青少年样本中进行分析; 3）在更大的样本中验证最终的PReSS-A项目， CWMP青少年，并使用JIA青少年的比较样本测试结构效度， 假设由于支持JIA诊断的医学证据，报告较少的耻辱;以及4） 利用结构方程模型探索感知疼痛相关污名与 心理社会和健康结果。使用多个患者群体（即，CWMP和JIA）及其 父母检查和验证这一社会结构的措施是创新的。这种职业发展 该奖项的目的是让艾米丽韦克菲尔德博士，在疼痛和姑息科的儿科心理学家， 康涅狄格州儿童医学中心的医学博士和康涅狄格大学儿科学助理教授 康涅狄格州医学院，利用这两个机构的充足资源，成为一个独立的 致力于改善慢性疼痛青少年健康状况的研究人员。她的短期目标是 了解导致疼痛相关污名的机制，并制定干预措施，重点是减少这种情况 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 在定性和定量研究设计方面提供培训、指导和咨询， 统计分析、儿科疼痛、污名和随机临床试验培训。她的长期目标是 成为儿科慢性疼痛心理社会研究的国家领导者和青少年疼痛专家- 相关的心理健康结果。

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.