AB210. 60. Shame and chronic pain: a narrative review

Background: Chronic pain can affect patients in innumerable ways, ranging from compromised self-esteem and fraught personal relationships, to lowered affect, and skewed personal insight. It is estimated that over 35% of Irish adults experience chronic pain, the treatment of which represents a significant financial burden on the health care system. It has been found that people who suffer from chronic pain also experience high levels of shame associated with their condition. Shame can be described as internalised stigma. It is a painful feeling of humiliation or distress caused by the self-consciousness of wrong or foolish behaviour. People who experience shame perceive themselves as wholly negative. Such judgement can further exacerbate feelings of worthlessness, leading to social avoidance, withdrawal and a deterioration of functioning in patients with chronic pain. Furthermore experiencing shame can dramatically impact the health-seeking behaviours of patients.

Methods: The aim of this research is to enhance our understanding of the role of shame in the management of chronic pain by reviewing existing clinical and empirical work. A narrative review was performed by interrogating electronic databases with a considered search strategy. Studies were selected for review based on specific inclusion criteria.

Results: This review will discuss the literature concerned with chronic pain and its association with shame in relation to patient-identity, therapeutic relationships and treatment outcomes.

Conclusions: It is imperative that healthcare practitioners develop an understanding of how pain-related shame and guilt can be managed in the setting of chronic pain, in order to improve long-term outcomes for their patients.

Keywords: Chronic pain; shame; guilt; patient identity