Characterizing the Effects of Pain Dismissal among Adolescents with Chronic Pain

Pain dismissal (PD) is the perception that someone is diminishing, denying, or disbelieving one’s report of pain, which can be traumatic. Whereas current research is based on retrospective reports from young adults, this study fills a gap in studying more acutely, possible physical and psychosocial effects of PD on youth with chronic pain. Participants (N=50; aged 13-17) completed questionnaires about PD experiences, watched an animated video depicting a dismissive doctor, and completed questionnaires assessing quality of life (QoL), depression, fatigue, psychological stress, functional disability, cognitive intrusion of pain, and somatic symptoms. Classification and Regression Tree (CART) analyses were used to explore relationships among variables, followed by Mann-Whitney tests. Fifty-four percent of participants reported one or more PD experiences (n=27). QoL interacted with PD such that dismissed patients with more impaired QoL had greater depression than those with less impaired QoL (p≤0.001). Similarly, among dismissed patients, those who had more trouble falling asleep had worse cognitive intrusion (p<0.05). Dismissed patients with clinically elevated depression had greater psychological stress than those with subclinical depression (p<0.001). Dismissed patients with greater physical impairment had greater functional disability (p<0.001) than those with less physical impairment. Lastly, dismissed patients with worse QoL had more fatigue (p<0.001) and somatization (p<0.001) than those with better QoL. This study shows that among youth with chronic pain, PD is associated with worse physical and psychosocial functioning, which suggests a need and possible targets for educational intervention about PD. Funded by Children’s Research Institute at Children’s Wisconsin.