Wakefield Emily O, Kissi Ama, Mulchan Siddika S, Nelson Sarah, Martin Sarah R
Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, CT, United States.
Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, United States.
Front Pain Res (Lausanne). 2022 Nov 14;3:1020287. doi: 10.3389/fpain.2022.1020287. eCollection 2022.
Pediatric patients with invisible symptomology, such as chronic pain syndromes, are more likely to experience pain-related stigma and associated discrimination by others, including medical providers, peers, school personnel, and family members. The degree of this pain-related stigma may depend on several social dimensions, including observer (e.g., attentional and implicit biases) and patient characteristics (e.g., racial identity, socioeconomic stressors). In this mini-review, we introduce the concept of pain-related stigma, and the intersectionality of stigma, within the context of social determinants of health in pediatric pain populations. Stigma theory, observer attentional biases, healthcare provider implicit/explicit biases, adverse childhood experience, and psychophysiology of socio-environmental stressors are integrated. Several ethical, clinical, and research implications are also discussed. Because the study of pain-related stigma in pediatric pain is in its infancy, the purpose of this conceptual review is to raise awareness of the nuances surrounding this social construct, propose avenues through which stigma may contribute to health inequities, present frameworks to advance the study of this topic, and identify areas for further investigation.
患有隐形症状的儿科患者，如慢性疼痛综合征患者，更有可能遭受与疼痛相关的耻辱感以及来自他人（包括医疗服务提供者、同龄人、学校工作人员和家庭成员）的相关歧视。这种与疼痛相关的耻辱感程度可能取决于几个社会层面，包括观察者（如注意力和隐性偏见）和患者特征（如种族身份、社会经济压力源）。在这篇小型综述中，我们在儿科疼痛人群健康的社会决定因素背景下，介绍了与疼痛相关的耻辱感概念以及耻辱感的交叉性。耻辱感理论、观察者注意力偏见、医疗服务提供者的隐性/显性偏见、童年不良经历以及社会环境压力源的心理生理学相互融合。还讨论了一些伦理、临床和研究方面的影响。由于儿科疼痛中与疼痛相关的耻辱感研究尚处于起步阶段，这篇概念性综述的目的是提高人们对围绕这一社会建构的细微差别的认识，提出耻辱感可能导致健康不平等的途径，提供推进该主题研究的框架，并确定需要进一步研究的领域。
