Adding insult to injury: Examining the influence of peer pain-related stigma on daily functioning in youth with chronic musculoskeletal pain.

Our research, in line with previous literature, has indicated that pain-related stigma plays a role in pain outcomes for children and adolescents with chronic musculoskeletal pain conditions. However, the influence of pain-related stigma on functioning and internalizing symptoms is less clear, as is whether stigma may differently influence youth dependent on gender and chronic pain type. The current study was a secondary analysis of cross-sectional data from 32 youth with Juvenile Idiopathic Arthritis (JIA), 31 youth with Juvenile Primary Fibromyalgia Syndrome (JFM), and 25 youth with non-specific chronic pain (NSCP) from a study examining group differences and biopsychosocial correlates of chronic musculoskeletal pain conditions. Participants self-reported their pain-related stigma, pain, physical, school, emotional and social functioning, and symptoms of anxiety and depression. Multiple regression analyses assessed associations between pain-related stigma and functioning, and pain-related stigma and internalizing symptoms, as well as interactions between stigma and gender as well as stigma and chronic pain type. Results showed that pain-related stigma significantly influenced physical and social functioning across groups. Stigma was associated with worse emotional functioning for girls, who also reported worse overall emotional functioning and greater anxiety and depression symptoms. Youth with JFM and NSCP demonstrated lower functioning compared to children and adolescents with JIA. These findings indicate that stigma substantially influences functioning and wellbeing of children and adolescents with chronic pain, especially for girls. Regardless of stigma experienced, those with chronic pain diagnoses lacking a known pathophysiology reported lower functioning in several domains. PERSPECTIVE: Youth with chronic musculoskeletal pain experience stigma about their pain which contributes not only to pain outcomes, but also physical and social functioning. Girls and youth with chronic pain conditions with unclear pathophysiology are especially at risk for adverse outcomes.