Exploring the Effect of Disease Explanations of Chronic Pain on Stigma

J Pain. 2026 Apr 23:106299. doi: 10.1016/j.jpain.2026.106299. Online ahead of print.

ABSTRACT

Chronic pain is a subjective experience, and the absence of objective medical evidence can contribute to stigma. Despite being classified as a disease in the ICD-11 and research findings showing brain dysfunction associated with chronic pain, the framing of chronic pain can shape public perceptions and influence stigma. In this study, we investigated whether framing chronic pain as a brain disease reduces the stigma that adults without chronic pain place on a fictional person with chronic pain. A total of 508 participants without chronic pain from the US and Canada anonymously completed a survey to assess stigma through the proxy measures of social distance and pain-related judgments. Participants were randomly assigned to read 1 of 5 contrastive vignette explanations of the cause of a fictional person's chronic pain: No Physical Cause, Biopsychosocial Model, Disease Model, Brain Disease Model, or Brain Disease Model, Biomarker, and Image. We found a main effect on pain-related judgments, specifically disease explanations compared to the No Physical Cause explanation. However, there was no effect on social distance. Demographic variables showed group-level associations with social distance (age 35-44, Asian, right-leaning political affiliation, not knowing anyone and low familiarity with chronic pain, and Canadian) and pain-related judgments (age 35-44 and 65-74, men, right-leaning political affiliation, and college diplomas or undergraduate degrees). Our findings suggest that framing chronic pain as a disease may reduce negative judgments, but may not influence social distance. This study has implications for public health communication strategies aimed at reducing chronic pain stigma.

PERSPECTIVE: This study describes five models that explain how adults in Canada and the US who do not have chronic pain may judge or stigmatize people with chronic pain. Our findings suggest that different chronic pain explanations may impact specific dimensions (such as judgments) of pain-related stigma.

PMID:42034181 | DOI:10.1016/j.jpain.2026.106299