Intersectional health-related stigma in adults with chronic low back pain and high negative affect
Embargo Date
2027-09-24
OA Version
Citation
Abstract
Chronic low back pain (CLBP) is highly prevalent in the United States and is frequently comorbid with negative affective disorders, including depressive and anxiety disorders. CLBP patients with high levels of negative affect (NA) experience worse treatment outcomes and are at higher risk for opioid misuse. They are also at higher risk for experiencing stigma at the intersection of chronic pain, negative affect, and opioid use. This study capitalized on a randomized clinical trial to examine treatment-related changes in intersectional health-related stigma in individuals with CLBP and NA.The study sample comprised of 216 adults with CLBP and high NA, with most participants being White, non-Hispanic, and female. Participants were randomized into one of three treatment conditions: antidepressant optimization (AD), enhanced fear-avoidance physical therapy (EFAR), or a combination of the two (AD + EFAR). Participants completed measures of stigma including the Internalized Stigma of Chronic Pain Scale, the Self Stigma and Perceived Public Stigma Scale, and the Brief Opioid Stigma Scale, prior to the onset of treatment and following completion of 16 weeks of treatment.
Using mixed-model ANOVAs, results showed that regardless of treatment group, participants showed an improvement across dimensions of stigma including alienation, social withdrawal, stigma resistance, stereotype endorsement, and discrimination experience. However, perceived public stigma of mental health and two aspects of opioid-related stigma remained stable. There were no significant differences in stigma reduction between treatment groups.
Improvement in stigma outcomes was likely due to common factors from participation in this research study, such as frequent positive, interpersonal interaction with healthcare providers and study staff. However, perceived public stigma related to mental health and opioid use may be more resistant to change due to societal beliefs and media narratives. More focus is needed to address various stigma outcomes and improve healthcare outcomes for individuals with chronic pain. For future studies, examining how these various stigmas interact with pain experience and treatment outcomes, specifically in marginalized groups, will be important to further examine the effects of intersectional health-related stigma.
Description
2024