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What is the Link Between Chronic Pain, Stigma and Mental Health?

Uncovering the connections between chronic pain, stigma and mental health.

Person sitting on dock with their back to the camera looking at the water

By Terris Schneider

Warning: Mentions of sexism and discrimination, medical gaslighting. Source links and references contain gendered language.

In March 2021, I was asked to participate in a survey about Chronic Pain and Emotional Health due to my current and past experiences with endometriosis. The study was a partnership between the Bill Nelems Pain and Research Centre and the University of British Columbia (UBC).

After the study results came back, one particular part stood out to me. It was how people who experienced others questioning the validity of their pain were at a much higher risk for depression. After years of being gaslighted by doctors and being told my pain was “just stress” or “IBS” (when I was actually dealing with the devils inside me known as ovarian cysts), I wondered how much of this denial of my pain had led to my current mental health struggles.

Today on the TENC blog, we will explore how stigma or not believing someone’s pain can lead to adverse mental health outcomes for people living with chronic pain. 

What did the study discover?

The Bill Nelems Pain and Research Centre and UBC study Chronic Pain and Emotional Health featured 305 people who took part in the research. Participants ranged from ages 18 to 89, with an average age of 55. In regards to gender, 74% identified as female, 25% male, and 1% non-binary. Respondents predominantly identified as white (92.8%), or Indigenous or Metis (6.7%). In addition, around 30% of respondents were retired, while 25.6% were on medical leave or disability.

The study ultimately found that people who experienced others questioning the genuineness of their pain were at a much greater risk for developing depression. In particular, participants reported that these sentiments mainly came from social services, insurance companies and work colleagues.

In essence, the study discovered that feelings of shame regarding someone’s pain could play a significant role in their mental health. It did so by linking experiences of invalidation to depression. As a result, people who didn’t believe someone’s pain contributed to them feeling more shame and put them at an increased risk for depression.

What is stigma?

One fascinating study called Sexism-Related Stigma Affects Pain Perception (which we’ll dive more into later) describes stigma as being viewed as a ”disgraceful identity” which features a devalued social attribute. In other words, people who have characteristics that society stigmatizes will be negatively viewed and/or devalued by other people. As a result, negative feelings and experiences due to stigma can impact their social interactions.

People who experience chronic pain, in particular, will be more vulnerable to the social consequences and psychology that come with stigma. This stigma can be internalized more by people who have chronic pain. In addition, significant experiences of exclusion were linked with an increase in pain sensitivity. However, no direct research has studied the impact of stigma on stimulus-evoked pain with both behavioural and electrophysiological findings.

Dealing with chronic pain and mental health can be a struggle. Check out our article Endometriosis + Mental Health

Stigma is viewed as a “disgraceful identity” which features a devalued social attribute. In other words, people who have characteristics that society stigmatizes will be negatively viewed and/or devalued by other people.    

Are chronic pain and emotional stress connected?

According to psychological research, pain is linked to tremendous emotional stress and less emotional awareness, expression, and processing. In essence, this social research indicates that emotions are vital to assessing and treating chronic pain.

Chronic pain, in particular, can be a condition that others stigmatize. It is essential to note that stigma has not received much empirical analysis in people with chronic pain. However, researchers analyzed a self-report survey of stigma in people with chronic pain undergoing interdisciplinary treatment. This report found that stigma is related to worse depression rates and disability linked to pain. Again, further research is needed. That way, researchers can determine how to target pain-related stigma from individual and societal perspectives.

Person laying on bed with their arm over their forehead with eyes closed

What’s sexism got to do with it?

In the previously mentioned study, Sexism-Related Stigma Affects Pain Perception, the researchers analyzed whether stigma related to a person’s identity could impact someone’s pain perceptions. This study, specifically, aimed to find out whether sexism-related paradigms could affect how people perceive chronic pain.

This study also researched stigmatized cues that could remind females that they faced unfair treatment due to their gender. Whether it’s their own experiences or others, people who have stigmatized identities can become hyper aware of whether they will be devalued.

According to the study, sexism-related stigma implied attributes and adverse treatment that would hurt the female respondents’ emotions. In addition, it would keep them vigilant when it came to sexism. Then, the researchers observed the neural responses that came with their feelings and attention. It was determined that stigma based on gender impacts both the affective component of pain and the cognitive assessment of pain. Essentially, if stigmatized cues can trigger negative feelings and warnings of potential threats, then the cognitive brain regions that affect emotion and attention could contribute to pain perception.

The researchers observed the neural responses that came with their feelings and attention. It was determined that stigma based on gender impacts both the affective component of pain and the cognitive assessment of pain. Essentially, if stigmatized cues can trigger negative feelings and warnings of potential threats, then the cognitive brain regions that affect emotion and attention could contribute to pain perception.

Overall, the study showed how sexism-related stigma increases pain perception in females. This type of stigma leads to less of a threshold and/or tolerance, an increase in pain rate, and the modulation of pain-evoked brain responses. However, it is essential to note that the observed effects of sexism-related stigma were relatively weak in the present study.

Hopefully, future studies will be performed to verify these results and to include more diverse genders that also experience sexism. That way, researchers can better understand the physiological or clinical importance of the impacts created by sexism-related stigma.

In summary

It is clear that researchers seem to be finding links between chronic pain, mental health, and stigma. However, this area needs to be further explored in future studies and research, which will be beneficial for people dealing with chronic pain conditions like endo. That way, people can become more educated and learn how to stop stigmatizing people in chronic pain, whether they are doing it consciously or not.

References

  • Trampleasure, S. (personal communication, September 10, 2021).

  • Sexism-Related Stigma Affects Pain Perception.

    Zhang, M., Zhang Y., Li, Z., Hu, L. and Kong, Y., 2021. Neural Plast. Hindawi.
  • Pain and Emotion: A Biopsychosocial Review of Recent Research.

    Lumley, M.A., Cohen, J.L., Borszcz, G.S., Cano, A., Radcliffe, A.M., Porter, L.S., Schubiner, H., and Keefe, F.J., 2011. J Clin Psychol., 67(9), pp. 942-968.
  • Measuring Stigma in Chronic Pain: Preliminary Investigation of Instrument Psychometrics, Correlates, and Magnitude of Change in a Prospective Cohort Attending Interdisciplinary Treatment.

    Scott, W., Yu, L., Patel, S., and McCracken, L.M., 2019. J Pain, 20(1), pp. 1164-1175.

The content of this post does not provide or replace medical advice. It is important to follow up with your doctor with any healthcare concerns you may have and to work with medical professionals to develop treatment plans that are right for you.