Understanding the Intersectional Relationship of Pain Stigma, Weight Bias Internalization, and Clinical Indicators in a Rural Population with Back Pain: a Survey-Based Study.

-BACKGROUND: Stigma is understood to be intersec-tional, meaning multiple characteristics can be stigma-tizing, and they may be both overlapping and coconstitutive. Chronic pain and overweight are common complaints in the spinal surgery clinic. Since being over-weight may relate to back pain in a complex fashion, we sought to understand if there is a moderating effect be-tween weight bias and pain stigma.-METHODS: This study involves a survey-based, quanti-tative, cross-sectional, observational design using previ-ously validated measures and demographic and clinical information. There were 192 participants. Statistical cal-culations were done with statistical package for the social sciences.-RESULTS: Pain stigma was not significantly correlated with BMI (body mass index), and weight bias was not significantly correlated with back pain. There was a strong positive correlation between weight bias and pain stigma. There was a strong positive correlation between weight bias and BMI when pain stigma was also high.-CONCLUSIONS: Given the relationship between weight stigma and pain, the intersection of weight and pain stigma is important because it indicates the vulnerability of pa-tients with higher BMI to other forms of stigma, such as stigma for their pain complaints. Clinicians should be mindful of expressing pain stigma more significantly amongst patients with higher BMI.