The development and validation of the pain-related stigma scale for adolescents (PReSS-A) with chronic pain

Adolescents with chronic pain often feel stigmatized by their pain condition. Despite the frequency of stigma in this population, few measures exist to assess pain-related stigma in youth with chronic pain. This study reports on the development and validation of the self-report Pain-related Stigma Scale for Adolescents (PReSS-A). The PReSS-A was designed to assess several dimensions of pain-related stigma (felt stigma, peer stigmatization, internalized stigma, and anticipatory stigma/concealment), and to assess stigma across multiple interpersonal relationships. Reliability, construct validity and factor structure of the instrument were evaluated in youth with chronic pain. The sample consisted of 286 adolescents (aged 12-17) with juvenile fibromyalgia (JFM), other chronic primary musculoskeletal pain conditions (CPMP), juvenile idiopathic arthritis (JIA), and disorders of gut-brain interactions (DGBI). Examination of the underlying structure of the instrument was conducted with exploratory factor analysis. Stigma dimension scores were explored between adolescents with different chronic pain conditions. PReSS-A subscales demonstrated strong internal consistency. Construct validity was established through subscale and total score correlations with complementary constructs. The exploratory factor analysis revealed two broad factors for the PReSS-A: felt stigma and internalized stigma. Majority of the sample reported pain-related stigma from all sources: medical providers, school personnel, family members, and peers. Adolescents with JFM reported significantly higher pain-related stigma than those with other conditions. The PReSS-A can facilitate the advancement of pain-related stigma research among adolescents with varied chronic pain conditions. Future research should focus on the degree to which pain-related stigma influences functioning and social development. PERSPECTIVE: This paper presents the development and psychometric properties of the Pain-related Stigma Scale for Adolescents (PReSS-A) among adolescents with chronic pain. This measure can advance our understanding of pain-related stigma among children and adolescents living with chronic pain.