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 广泛性肌肉骨骼疼痛(CWMP)，与健康结局受损有关。这个 疼痛自我报告的主观性增加了个体体验症状怀疑的机会 其他。与疼痛相关的耻辱是一个重要的公共卫生优先事项，因为它可能会对延误诊断产生影响 以及康复过程中的障碍。患有CWMP的青少年容易受到与疼痛相关的耻辱 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 这项建议是为了：1)研究与疼痛相关的耻辱是如何成为 青少年CWMP，以及2)开发和验证青少年疼痛相关污名量表(PRESS-A) CWMP患者。对于这一年轻群体中与疼痛相关的耻辱，人们知之甚少。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一个理论框架 患有CWMP的青少年。这项研究将为理解与疼痛相关的耻辱和 制定干预措施，针对患有CWMP的青少年的这一社会结构。具体目标是：1) 制定与疼痛相关的污名框架和Press-A项目，使用不同的青少年焦点小组 CWMP和幼年特发性关节炎(JIA)及其父母；2)用经典项目细化PRESS-A项目 对患有CWMP的青少年样本的分析；3)在更大的样本中验证最终PRESS-A项目 CWMP青少年，并使用JIA青少年对照样本进行结构效度测试 由于医学证据支持他们的JIA诊断，假设报告的耻辱较少；以及4) 利用结构方程模型探索知觉到的疼痛相关耻辱和 心理社会和健康结果。使用多个患者群体(即CWMP和JIA)及其 父母审查和验证这种社会结构的措施是创新的。这一职业发展 该奖项旨在让疼痛和缓解科的儿科心理学家艾米丽·韦克菲尔德博士 康涅狄格州儿童医学中心医学和加州大学儿科学助理教授 康涅狄格州医学院，利用两所机构的充足资源成为独立的 致力于改善患有慢性疼痛的青少年的健康结果的研究人员。她的短期目标是 了解导致疼痛相关耻辱的机制，并制定旨在减少这种耻辱的干预措施 CWMP青少年的耻辱。为了实现这一点，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的培训、指导和咨询，以及高级 关于统计分析、儿科疼痛、耻辱和随机临床试验的培训。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先者和青少年疼痛专家- 相关的心理社会健康结果。

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.