The Determinants and Effects of Chronic Pain Stigma: A Mixed Methods Study and the Development of a Model.

People with chronic pain report experiencing stigma, but few studies have explored this in detail. This mixed-methods study aimed to investigate factors that contribute to chronic pain stigma, the effects of stigma, and to explore the stigma experiences of people with chronic pain. Participants were 215 adults with chronic pain who completed questionnaires assessing chronic pain stigma, opioid use, mental health conditions, pain, depression, disability and social support, and 179 also answered open-ended questions about stigma experiences. Linear regression and path analysis showed that greater stigma was experienced by those who used more opioids, had a mental health condition, viewed their pain as organic, and were unemployed. Stigma was associated with greater disability, depression and lower social support. Qualitative results supported quantitative findings, with 3 themes: 1. "Faking It": Others disbelieve pain and attribute it to drug seeking, laziness, or mental health problems, 2. A spectrum of stigma: Experiences of stigma vary from none to widespread, and 3. "I hide it well": Concealing pain and avoiding stigmatizing situations lead to isolation & disability. This study demonstrates the negative influence of stigma and presents a novel integrated model of chronic pain stigma which may be used to develop interventions. PERSPECTIVE: This study demonstrates the contributors to, and negative effects of, stigma for people with chronic pain. It presents an integrated model which could guide strategies to reduce chronic pain stigma amongst health professionals and the public, and to reduce self-stigma amongst people with pain.