“It Can’t Be That Bad”: Stigmatization As A Barrier To Receiving Chronic Pain Treatment
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It is normal for many people to experience pain at some point in their life. However, some people experience chronic pain, which is pain that persists for at least three months and can even last for years. Individuals with chronic pain are often subjected to negative stereotypes that undermine the legitimacy of their pain experience. These individuals are not only stigmatized by the general public, but also the health professionals who work with them during rehabilitation and treatment. The research by Dr. Diane LaChapelle at the University of New Brunswick examines how perceptions of people with chronic pain are influenced by stereotypes and how these perceptions hinder effective decision-making for the treatment of chronic pain.
LaChapelle conducts her research on stereotypes by presenting a vignette to participants of an individual with chronic pain. These vignettes consist of a picture or video clip, along with supplementary information about their diagnosis. Participants then fill out a questionnaire that examines their attitudes about the individual and how valid the participant believes their pain is. Through manipulating different variables in the vignettes, LaChapelle seeks to determine what factors change the way participants interpret accounts of chronic pain from other people.
Variables Affecting Perceptions of Chronic Pain
One key factor that affects perceptions of pain is conventional attractiveness, which LaChapelle attributes to the societal association of beauty with health. Participants presented with a more attractive individual were more likely to assume the individual was exaggerating the severity of their pain. Although this phenomenon occurred regardless of the gender used in the vignettes, LaChapelle reports that these findings were more salient for women with chronic pain than men.
Different types of diagnoses can also affect perceptions of pain, due to the societal expectations of how illness should manifest. When participants were given blood tests or X-rays showing joint deterioration, they were more likely to believe the individual’s pain was valid. When only given self-reports of chronic pain, participants assumed the individual was exaggerating their pain.
In order to replicate more naturalistic situations, LaChapelle has also presented vignettes in which many stereotypes are manipulated and interact with each other. However, the effect of attractiveness on perceptions of pain overshadowed the effects of other variables. Even when providing X-rays or showing individuals with canes as an external sign of their disability, participants were still distrustful of the pain experiences of attractive individuals.
The Challenges of Reducing Stereotypes
In her recent research with healthcare professionals, LaChapelle has found that both participants from the general public and healthcare professionals exhibit similar biases toward people with chronic pain, despite their medical training. A significant contributor to chronic pain stigma in the healthcare system is caregiver fatigue. LaChapelle has observed that healthcare professionals working with chronic pain patients for a long time are susceptible to burnout and decreased sensitivity to the pain of others. The tendency to turn off one’s emotions arises as a mechanism to cope with the devastating situations encountered in day-to-day work.
Caregiver fatigue and stigma can also be found in the friends and family of those with chronic pain, who may feel resentment or frustration when dealing with someone whose chronic pain also affects their life. Social psychology suggests that interaction is the most effective way to reduce stereotypes when dealing with issues such as racism or xenophobia. However, caregiver fatigue makes it challenging to bridge the empathy gap for chronic pain through interaction alone.
Providing Support to People with Chronic Pain
Stereotypes that mislabel those with chronic pain as “lazy,” “drug-seeking,” or “trying to get out of work” impact the well-being of these individuals on many levels. This stigma causes many patients with chronic pain to invest their energy into proving their sickness is real to their doctors, nurses, family, and friends. Furthermore, when these stereotypes are internalized, it can lead to depression and anxiety on top of the pre-existing chronic pain. As they cope with the invalidation of their hardships, the quality of their health declines.
“The reality is, I don’t know a single person in pain who would rather be in pain than have to go to work all the time.” - Dr. Diane LaChapelle
A research project led by one of LaChapelle’s graduate students investigates the positive influence of Facebook groups for people with fibromyalgia, which is a condition that causes chronic musculoskeletal pain. In these Facebook groups, members are able to reach out to others who also have fibromyalgia and understand their experiences with the condition. These shared experiences create a safe place where members do not feel the need to justify themselves and can receive adequate emotional support.
Dr. LaChapelle affirms that research needs to be directed toward finding the most effective methods of educating healthcare professionals and the general public in order to reduce chronic pain stereotypes. This will offer direct benefits to chronic pain patients, as the lack of bias will allow them to access treatment more efficiently. Moreover, the energy used to prove one’s condition can instead be directed towards the process of adjustment, acceptance, and treatment of chronic pain.