A Narrative Review of the Impact of Disbelief in Chronic Pain

Newton, Benjamin J.; Southall, Jane L.; Raphael, Jacob; Ashford, Robert; LeMarchand, Karen

doi:10.1016/j.pmn.2010.09.001

Cited by 125 publications

(87 citation statements)

References 29 publications

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“…Also, considerable qualitative research highlights the ubiquity of stigma in the life of individuals with chronic non-malignant pain. 21,25,30,40,48,49,54 Several explanations may apply for our findings. First, the presence of medical evidence may have served to validate the pain symptoms of the patients.…”

Section: Discussionmentioning

confidence: 80%

Patients Are Socially Excluded When Their Pain Has No Medical Explanation

Ruddere

Bosmans

Crombez

et al. 2016

The Journal of Pain

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This study investigated whether observers socially exclude patients who experience pain that is not medically explained by means of an experimental design. Fifty-nine participants (individuals from the general population) viewed videos of 4 patients, each accompanied by a vignette describing the presence or absence of a medical explanation for their pain. Participants estimated patient's pain, and rated the sympathy felt for and the inclination to help the patient.In order to measure social exclusion, participants indicated their willingness to interact with the patients in several situations (Social Distance Scale). Furthermore, the participants were invited to select two of the four patients as confederates to play a game against another duo. When no medical explanation for the pain was provided, participants attributed less pain, reported feeling less sympathy and were less inclined to help the patients with daily activities. Of particular importance to this study, participants were less willing to interact with patients with medically unexplained pain and selected less often patients with 'medically unexplained' pain than patients with 'medically explained' pain as confederates in the social game. These results are indicative of social exclusion of patients with pain for which there is no clear medical explanation.Perspective: Observers socially exclude patients with pain for which there is no clear medical explanation. These findings have important clinical implications. In particular, social exclusion might have detrimental effects on both the mental and physical wellbeing of patients with pain.

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Section: Discussionmentioning

confidence: 80%

Patients Are Socially Excluded When Their Pain Has No Medical Explanation

Ruddere

Bosmans

Crombez

et al. 2016

The Journal of Pain

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“…Abundant evidence highlights the ubiquity of stigma in the lives of individuals with chronic pain [1,21,25,26,32,34,52,54,55,62,73,74,76] …”

Section: Stigma Perceived By the Patientmentioning

confidence: 99%

Understanding stigma and chronic pain: a-state-of-the-art review

Ruddere

Craig

2016

PAIN

225

226

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Chronic nonmalignant pain makes individuals prone to stigmatizing reactions of others.Stigmatizing responses are devaluing and discrediting responses of observers toward individuals who possess a particular characteristic that deviates from societal norms [16]. In the context of chronic nonmalignant pain, an absence of clear tissue damage deviates from the widely held biomedical model, which presumes that clear physiological pathology underlies the pain experience [22]. As well, most people understand pain through acute pain experience, which resolves relatively rapidly over time, leading to uncertainty about pain that does not diminish [48,63]. These and other processes must be understood to explain the substantial evidence that individuals with chronic pain commonly suffer from stigmatization by others [32].The stigma associated with chronic pain are not well understood, with research lacking accounts of determinants, including underlying mechanisms in stigmatizing persons and details concerning vulnerabilities and the impact on stigmatized persons. Furthermore, prevention strategies for teaching how to deal with others' stigmatizing reactions and programs aimed at minimizing stigmatizing behaviors of observers are scarce. This topical review briefly describes the current understanding of stigma attached to chronic pain and has the intent to provide some thought provoking ideas and highlight future directions that will inspire both researchers and clinicians. 2.Stigma and chronic pain Stigma perceived by the patientAbundant evidence highlights the ubiquity of stigma in the lives of individuals with chronic pain [1,21,25,26,32,34,52,54,55,62,73,74,76] Impact of stigma on the wellbeing of pain patientsAlthough thorough research into the consequences of both perceived stigma and public stigma on the wellbeing of pain patients is lacking, preliminary evidence shows that the discounting A C C E P T E D A C C E P T E Dexploited by others [35]. In particular, the absence of a clear medical explanation for the pain might function as a threat for the observer regarding availability of reciprocity (i.e., the social exchange) to be expected from individuals in pain [35].There is a substantial literature demonstrating that individuals stigmatize individuals from the "out group" [58]. "In group" people include those similar to the observer, e.g., kin, friends, age peers, whereas "out group" people likely include those with different skin colors, ideological persuasions, etc. In the context of pain, observers feel less empathy and less altruistic motivation towards members of social out-groups than members of in-groups [29,47] and the pain complaints of "out group" members tend to be discounted [65]. This is consistent with findings that observers attribute lower pain to patients who are considered responsible for their pain condition [17,68].A final useful explanatory approach arises from the considerable research which indicates that healthcare practitioners often feel uncertain or unprepared to manage patients with c...

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“…In some arenas, this model has validated the experience of chronic pain, but an unfortunate side effect appears to be an increasingly pervasive belief that chronic pain after injury is a condition of the weak willed or misinformed. 77,84 Despite its ubiquity, the unidirectional and causal nature of the FA model has been challenged in recent years. Wideman and colleagues 121 statistically refuted the sequential nature of the model, but supported catastrophizing as an important predictive variable.…”

Section: The Fear-avoidance Modelmentioning

confidence: 99%