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.

抽象的 在患有慢性疼痛的青少年中，与疼痛相关的耻辱是一个重要且未被充分研究的社会心理因素。 放大性肌肉骨骼疼痛 (CMP)，其中包括慢性广泛性肌肉骨骼疼痛 (CWMP) 与健康结果受损有关。疼痛自我报告的主观性增加了机会 一个人经历他人不信任的症状。与疼痛相关的耻辱是一个重要的公共卫生问题 优先考虑，因为它对延迟诊断和损害康复有潜在影响。患有 CMP 的青少年是 容易受到来自多个方面的与疼痛相关的耻辱，包括医生、学校工作人员、家人和同龄人， 可能会影响他们的健康。该提案的目标是：1）研究与疼痛相关的耻辱如何成为一种影响 青少年 CMP 的新颖且必要的心理社会组成部分，以及 2）开发和验证疼痛- CMP 患者的青少年相关耻辱量表 (PReSS-A)。对疼痛的了解还不够—— 这个年轻人口中的相关耻辱。该提案使用混合方法设计来开发理论 CMP 青少年心理社会研究新领域的框架。这项研究将提供 为理解与疼痛相关的耻辱和制定针对这种社会建构的干预措施奠定了基础 患有 CMP 的青少年。具体目标是：1）开发与疼痛相关的耻辱框架和 PRESS-A 项目 对患有 CMP 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； 2) 使用 CMP 青少年样本中的经典项目分析来完善 PRESS-A 项目； 3) 验证最终结果 在患有 CMP 的青少年的较大样本中进行 PRESS-A 项目，并使用比较测试构建有效性 患有幼年特发性关节炎的青少年样本，根据医学证据，假设他们报告的耻辱感较少 支持他们的幼年特发性关节炎诊断； 4）利用结构方程模型来探索之间的关系 感知到的与疼痛相关的耻辱以及社会心理和健康结果。多个患者群体的使用 （即 CMP 和 JIA）及其父母来检查和验证这种社会结构的衡量标准是创新的。 该职业发展奖旨在让儿科心理学家 Emily Wakefield 博士能够 康涅狄格州儿童医学中心疼痛与姑息医学科助理教授 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结果。她的短期目标是了解 造成与疼痛相关的耻辱的机制，并制定旨在减少这种耻辱的干预措施 患有 CMP 的青少年。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心理社会健康结果的专家。本次活动的目标 生物伦理学补充是通过增强种族歧视来建立与疼痛相关的耻辱研究的研究能力 通过 (1) 确定 CMP 种族青年疼痛治疗公平性的障碍，以及 (2) 通过建立多元化工作组来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