Scott Whitney, Yu Lin, Patel Shrina, McCracken Lance M
Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
J Pain. 2019 Oct;20(10):1164-1175. doi: 10.1016/j.jpain.2019.03.011. Epub 2019 Mar 30.
Chronic pain is a potentially stigmatizing condition. However, stigma has received limited empirical investigation in people with chronic pain. Therefore, we examined the psychometric properties of a self-report questionnaire of stigma in people with chronic pain attending interdisciplinary treatment. Secondarily, we undertook an exploratory examination of the magnitude of change in stigma associated with interdisciplinary treatment in a prospective observational cohort. Participants attending interdisciplinary treatment based on acceptance and commitment therapy completed the Stigma Scale for Chronic Illness 8-item version (SSCI-8; previously developed and validated in neurological samples), and measures of perceived injustice, pain acceptance, and standard pain outcomes before (n = 300) and after treatment (n = 247). A unidimensional factor structure and good internal consistency were found for the SSCI-8. Total SSCI-8 scores were correlated with pain intensity, indices of functioning, and depression in bivariate analyses. Stigma scores were uniquely associated with functioning and depression in multiple regression analyses controlling for demographic factors, pain intensity, pain acceptance, and perceived injustice at baseline. SSCI-8 total scores did not significantly improve after treatment, although an exploratory subscale analysis showed a small improvement on internalized stigma. In contrast, scores on perceived injustice, pain acceptance, and pain outcomes improved significantly. Taken together, these data support the reliability and validity of the SSCI-8 for use in samples with chronic pain. Further research is needed optimize interventions to target stigma at both the individual and societal levels. PERSPECTIVE: This study supports the use of the SSCI-8 to measure stigma in chronic pain. Stigma is uniquely associated with worse depression and pain-related disability. Research is needed to identify how to best target pain-related stigma from individual and societal perspectives.
慢性疼痛是一种可能会带来污名化的病症。然而，污名在慢性疼痛患者中受到的实证研究有限。因此，我们检验了一份针对接受多学科治疗的慢性疼痛患者的污名自评问卷的心理测量特性。其次，我们在前瞻性观察队列中对与多学科治疗相关的污名变化程度进行了探索性研究。基于接受与承诺疗法接受多学科治疗的参与者在治疗前（n = 300）和治疗后（n = 247）完成了慢性病污名量表8项版本（SSCI - 8；先前在神经学样本中开发并验证），以及感知不公正、疼痛接纳和标准疼痛结果的测量。发现SSCI - 8具有单维因素结构和良好的内部一致性。在双变量分析中，SSCI - 8总分与疼痛强度、功能指标和抑郁相关。在控制了人口统计学因素、疼痛强度、疼痛接纳和基线时的感知不公正的多元回归分析中，污名得分与功能和抑郁独特相关。尽管探索性子量表分析显示内化污名有小幅改善，但治疗后SSCI - 8总分没有显著提高。相比之下，感知不公正、疼痛接纳和疼痛结果的得分有显著改善。综上所述，这些数据支持了SSCI - 8在慢性疼痛样本中使用的可靠性和有效性。需要进一步研究以优化针对个体和社会层面污名的干预措施。观点：本研究支持使用SSCI - 8来测量慢性疼痛中的污名。污名与更严重的抑郁和疼痛相关残疾独特相关。需要开展研究以确定如何从个体和社会角度最佳地针对与疼痛相关的污名。
