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: 9892326
• 负责人: Emily O Wakefield
• 金额: $ 12.98万
• 依托单位: CONNECTICUT CHILDREN'S MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9892326
• 关键词: Adolescent; Age; Anxiety; Area; Child; Childhood; Chronic; Chronic Childhood Arthritis; Clinical; Collaborations; Connecticut; Consultations; Development Plans; Diagnosis; Diagnostic; Disease; Equation; Exhibits; Family; Fibromyalgia; Focus Groups; Foundations; Funding; Future; Goals; Grant; Health; Health Personnel; Impaired health; Impairment; Individual; Institution; Intervention; Judgment; K-Series Research Career Programs; Lead; Measures; Medical; Medical center; Mental Depression; Mentorship; Methods; Modeling; Musculoskeletal Pain; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Outcome; Pain; Pain Nature; Pain intensity; Palliative Medicine; Parents; Pathology; Patient Self-Report; Patients; Pediatric Hospitals; Pediatrics; Perception; Performance; Physicians; Population; Property; Psychologist; Psychometrics; Psychosocial Factor; Quality of life; Randomized Clinical Trials; Recovery; Reporting; Research; Research Design; Research Personnel; Resources; Role; Sampling; Schools; Site; Source; Statistical Data Interpretation; Stigmatization; Structure; Symptoms; Teenagers; Testing; Training; Treatment outcome; Uncertainty; Universities; Work; Youth; adolescent health outcomes; anxiety symptoms; authority; base; career development; chronic pain; comparative; comparison group; cost; depressive symptoms; design; disability; effectiveness evaluation; experience; functional disability; health care service utilization; health disparity; improved; innovation; medical schools; novel; patient population; peer; professor; psychosocial; public health priorities; social; social factors; social relationships; social stigma

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.

抽象的 与疼痛相关的污名是慢性青少年的重要且研究的心理社会因素 与健康结果受损有关的广泛肌肉骨骼疼痛（CWMP）。这 疼痛的主观性自我报告增加了一个人通过症状难以置信的机会 其他的。与疼痛相关的污名是一个重要的公共卫生优先事项，因为它的潜在影响延迟诊断 和恢复中的损害。具有CWMP的青少年容易受到几种与疼痛有关的污名 包括医师，学校工作人员，家人和同龄人在内的消息来源可能会影响他们的健康。目标的目标 该建议是：1）检查与疼痛相关的污名是如何是新颖而必要的社会心理成分 青少年CWMP和2）为青少年（press-a）中的疼痛相关的污名量表开发和验证 CWMP患者。对于这个年轻人群中与疼痛有关的污名还不够。这个建议 使用混合方法设计在社会心理研究的新领域开发理论框架 具有CWMP的青少年。这项研究将为了解与疼痛有关的污名和 开发干预措施，以CWMP的青少年为目标。具体目的是：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按A键 CWMP和少年特发性关节炎（JIA）及其父母； 2）使用经典项目完善按A项目 在具有CWMP的青少年样本中进行分析； 3）在较大的样本中验证最终按A项目 具有CWMP的青少年，并使用与Jia的青少年的比较样本进行测试构造有效性 假设由于支持其JIA诊断的医学证据而报告的污名更少；和4） 利用结构方程建模来探索与疼痛相关的污名与 社会心理和健康成果。使用多个患者人群（即CWMP和JIA）及其 父母检查和验证对这种社会结构的衡量标准是创新的。这个职业发展 奖项旨在允许艾米丽·韦克菲尔德（Emily Wakefield）博士，他是疼痛和姑息治疗的儿科心理学家 康涅狄格州儿童医疗中心医学和儿科助理教授 康涅狄格州医学院，借鉴了两个机构的充足资源，以成为独立的 研究人员致力于改善慢性疼痛青少年的健康状况。她的短期目标是 了解有助于疼痛相关的污名的机制，并制定了重点是减少这一点的干预措施 CWMP青少年的污名。为此，职业发展计划包括正式和非正式 定性和定量研究设计的培训，指导和咨询以及高级 统计分析，小儿疼痛，污名和随机临床试验的培训。她的长期目标是 成为小儿慢性疼痛的社会心理研究的国家领导者，并成为青少年疼痛的专家 相关的社会心理健康结果。