Stigma Associated With Poorly Understood Chronic Pain Detrimental to Overall Well-Being

chronic pain, woman with shoulder pain, hot patch
The researchers compared well-being and feelings of stigmatization in people with well understood conditions and in those with less understood condition, fibromyalgia, using daily diaries.

Feelings of stigmatization may be detrimental to the well-being of patients with poorly understood chronic pain conditions such as fibromyalgia, according to results of a daily diary study published in The Clinical Journal of Pain.

Researchers contacted all members of the Flemish Pain League and the League for Rheumatoid Arthritis to participate in this study. Individuals with fibromyalgia (n=79), rheumatoid arthritis (n=86), or both (n=33) responded to a questionnaire about sociodemographic characteristics and an end-of-day diary on 14 consecutive days. The diaries comprised 31 items that assessed pain; physical, psychological, and social well-being; and perceived stigma.

Participants were had a mean age of 54.9 (range, 19-86) years, 85.9% were women, 30.3% were single, and 97.5% were Belgian. Individuals with fibromyalgia were significantly younger (P <.001), less likely to be employed (P <.01), had experienced pain for longer (P <.001), and reported more severe pain (P <.001) compared with those with rheumatoid arthritis.

After correcting for age, pain duration, and daily pain, individuals with fibromyalgia reported higher pain intensity (b, 1.99; standard error [SE], 0.26; P £.001) and isolation (b, 1.47; SE, 0.28; P £.001) and less contact (b, -1.44; SE, 0.31; P £.001) and fewer plans (b, -1.68; SE, 0.31; P £.001) compared with those with rheumatoid arthritis.

Individuals with rheumatoid arthritis reported more plans (b, 1.64; SE, 0.42; P £.001) and fewer negative effects (b, -8.58; SE, 2.59; P £.01), isolation (b, -1.70; SE, 0.28; P £.001), and perceived stigma (b, -0.59; SE, 0.24; P <.05) compared with individuals who had both fibromyalgia and rheumatoid arthritis.

No characteristics differed between the fibromyalgia-alone and comorbid cohorts.

Significant variability for the effect of perceived stigma was observed within the 3 patient groups for negative affect (b, 1.06; SE, 0.19; P £.001), self-esteem (b, -0.17; SE, 0.03; P £.001), disability (b, 0.07; SE, 0.03; P <.05), and positive affect (b, -0.22; SE, 0.09; P <.05).

This study was largely biased toward a nondiverse group of women and may not be generalizable.

These data indicated that individuals living with less well-defined chronic pain conditions may experience poorer daily well-being and increased perceived stigma.


van Alboom M, de Ruddere L, Kindt S, et al. Well-being and perceived stigma in individuals with rheumatoid arthritis and fibromyalgia: a daily diary study. Clin J Pain. 2021;37(5):349-358. doi:10.1097/AJP.0000000000000929