Development of an Opioid Stigma Scale for People Living With Chronic Pain

High levels of stigma among patients with chronic pain contribute to negative psychological well-being. Existing measures have not focused on opioid stigma among individuals with chronic pain who may have legitimate need for opioid therapy.

We developed a measure of opioid stigma that captures two constructs: perceived stigma (awareness of others' negative attitudes) and internalized stigma (application of stereotypes to oneself) among individuals with chronic pain.

We recruited 180 participants with chronic pain via the online platform CloudResearch to modify an existing stigma scale. We developed items related to perceived stigma (8 items) and internalized stigma (5 items). Concurrent and discriminant validity were evaluated using the Center for Epidemiologic Study Depression Scale-10, Rosenberg Self-Esteem and Brief Resilience Scales. Factor structure were based on Iterated principal factor analysis with Promax rotation.

The final sample included 151 participants, primarily Caucasian (80%), between 30-39 years old (40%), with a history of opioid use (81%). A two-factor solution was identified (MSA = .90), representing perceived and internalized stigma (Eigenvalues 7.23, 2.53; inter-factor correlation = .45, alphas = .94, .94). Semi-partial item correlations ranged from .61-.78 for perceived stigma and .73-.82 for internalized stigma. Significant correlations were observed between perceived stigma and CESD-10 (0.19, p = 0.02), and internalized stigma and resilience (-0.26, p = .001).

The adapted 13-item measure demonstrates sound psychometric properties in evaluating awareness and agreement with stigmatizing attitudes, supporting its reliability and validity.

Nurses are uniquely positioned to identify opioid stigma, develop interventions, and reduce its impact for individuals with chronic pain.