Stigma is uniquely associated with important chronic pain outcomes: A cross-sectional study in a large community sample

Abstract

Stigma is common in people experiencing chronic pain and there are indications that it may adversely affect pain outcomes. However, to date there is no systematic review of stigma in relation to pain-related outcomes. Therefore, this review aimed to systematically review existing literature assessing the association between stigma and key chronic pain outcomes, including the presence of pain, pain intensity, pain-related disability, quality of life, depression, and anxiety. Seven databases were searched for studies reporting on adults with chronic pain lasting for ≥3 months, which reported a measure of association between stigma and at least one pain outcome. Search terms were based around the keywords of ‘chronic pain’ and ‘stigma’, adapted from previous reviews. Studies were screened by two independent researchers. Seventeen studies met eligibility criteria and data were extracted, quality assessed, and narratively synthesised. The narrative synthesis found that stigma was consistently significantly associated with chronic pain outcomes in all but one of the included studies. Across studies, stigma was significantly associated with pain intensity, pain-related disability, quality of life, depression, and anxiety with medium to large bivariate correlations. However, studies were primarily cross-sectional and employed small sample sizes. Furthermore, the studies were heterogenous in terms of patient characteristics and stigma and outcome measurement. This review points to the need for theoretical advancements to better understand stigma and its clinical management among people affected by chronic pain conditions.

Date of Award	1 Oct 2023
Original language	English
Awarding Institution	King's College London
Supervisor	Whitney Scott (Supervisor) & Matteo Cella (Supervisor)