Chronic pain stigma was associated with greater pain, poorer function, and greater negative affect, whereas mental health and opioid stigma were primarily associated with greater negative affect, with no sex/gender differences in stigma levels or in the relationships between stigma and health outcomes.
Key Findings
Results
Chronic pain stigma was associated with greater pain, poorer function, and greater negative affect in adults with chronic low back pain.
Study population consisted of 261 adults with chronic low back pain (CLBP) and negative affect enrolled in an RCT of multimodal treatment at three academic medical centers across the Midwest and Northeast.
This was a secondary analysis of cross-sectional baseline data.
Chronic pain stigma showed the broadest association with health outcomes, affecting pain intensity, physical function, and negative affect simultaneously.
Participants completed measures of pain, mental health, and opioid medication stigma along with measures of pain, function, and negative affect upon enrollment.
Results
Mental health stigma and opioid medication stigma were primarily associated with greater negative affect rather than pain or function.
Unlike chronic pain stigma, mental health and opioid stigma showed a narrower pattern of association limited primarily to negative affect outcomes.
This distinction suggests that different types of health-related stigma may have different domains of impact on patient wellbeing.
All three forms of stigma (pain, mental health, opioid) were examined within the same sample of 261 adults with CLBP.
Results
There were no significant sex/gender differences in levels of pain stigma, mental health stigma, or opioid medication stigma.
Comparisons were made between cisgender men and women in the sample.
Despite well-documented sex/gender disparities in pain-related health outcomes in the broader literature, this study found no differences in stigma levels between groups.
There were also no sex/gender differences in the health outcomes measured (pain, function, negative affect).
The sample of 261 adults was drawn from an RCT focused on CLBP and negative affect.
Results
Sex/gender did not moderate the relationships between any form of health-related stigma and health outcomes.
Moderation analyses were conducted to explore whether the stigma-outcome relationships differed for cisgender men versus women.
No significant moderation effects were found for pain stigma, mental health stigma, or opioid stigma in relation to pain, function, or negative affect.
This suggests the associations between stigma and health outcomes operate similarly regardless of sex/gender in this CLBP population.
The authors concluded that stigma interventions 'may be similarly important for men and women.'
Methods
The study design was a secondary analysis of cross-sectional baseline data from an RCT of multimodal treatment for adults with CLBP and negative affect.
Data were collected at enrollment (baseline) from three academic medical centers in the Midwest and Northeast United States.
Total sample size was 261 adults.
Participants were specifically selected for having both CLBP and negative affect, which may limit generalizability.
The cross-sectional design precludes causal inference about stigma-outcome relationships.
What This Means
This research suggests that stigma — the negative social judgments people face about their health conditions — is meaningfully linked to worse health in people with chronic low back pain. Specifically, people who felt more stigmatized because of their chronic pain reported more pain, worse physical functioning, and worse emotional wellbeing. Stigma related to mental health and opioid medications was also linked to worse emotional wellbeing. The study examined 261 adults with chronic low back pain across three medical centers in the U.S.
A key question the researchers asked was whether men and women experience different levels of stigma or are differently affected by it. Despite well-known differences between men and women in pain-related health outcomes more broadly, this study found no differences: men and women reported similar levels of stigma, similar health outcomes, and stigma was equally linked to those outcomes in both groups. This was somewhat surprising given that prior research has highlighted gender disparities in how pain patients are perceived and treated.
This research suggests that addressing stigma could be an important part of helping people with chronic low back pain, and that such efforts may be equally beneficial for both men and women. The findings highlight stigma — particularly chronic pain stigma — as a potential target for treatment alongside more traditional approaches to managing pain and function. However, because the data were collected at a single point in time, the study cannot determine whether stigma causes worse outcomes or vice versa.