Understanding Intersectional Health-Related Stigma in Patients with Chronic Low Back Pain and Negative Affect: A Qualitative Study

Patients with chronic low back pain (CLBP) often experience high levels of negative affect (NA). CLBP patients with NA experience greater pain and risk for opioid misuse, and have worse treatment outcomes. These patients are also at risk for intersectional health-related stigma (i.e., pain-, mental health- and opioid-related stigma; IHRS). We aimed to determine the sources and outcomes of IHRS in patients with CLBP and NA. We capitalized on a randomized comparative-effectiveness trial of antidepressant optimization, Enhanced Fear Avoidance Rehabilitation, or a combination of the two for people with CLBP and NA. A subset of diverse participants (N=60) completed a semistructured qualitative interview prior to treatment onset. Interview topics included participants’ experiences of public stigma, their own stigmatic beliefs, perceived causes and sources of stigma, the effects of stigma, and how they believe stigma could be addressed. Interviews were coded for the following themes: types of stigma, sources of stigma, and outcomes of stigma. While qualitative analysis is ongoing, preliminary results indicate that participants experienced stigma related to chronic pain, depression, anxiety, and use of opioid medications. Participants reported they not only experience stigma from others (e.g., friends, family, healthcare providers) but also internalize that stigma and endorse their own stigmatizing beliefs. This experience of stigma has resulted in patients’ reluctance to seek treatment and isolation from friends and family. By better understanding patient’s experiences with IHRS, researchers can establish interventions aimed at improving IHRS among patients with CLBP and NA thereby improving patient outcomes.