Stigmatisation in medical encounters for patients with fibromyalgia: A focus group study.

Abstract

People with the chronic pain condition fibromyalgia experience stigma relating to their condition, including in medical consultations. We aimed to understand how patients with fibromyalgia describe their experience of stigma in medical consultations, using a recently developed stereotypes-and-behaviours stigma framework, and to explore any aspects of stigma in consultations not encompassed by this framework. We conducted a qualitative focus group study in partnership with a Pan-European patient advocacy group for people with chronic pain. We conducted six focus groups comprising 20 adults with fibromyalgia from seven different European countries. Analysis involved mapping of experiences to the stereotype-behaviour stigma framework and an inductive analysis, informed by concepts of trauma and retraumatisation. Mapping experiences to the framework indicated that participants described many different forms of condition related stigmatisation in medical consultations. These accounts corresponded to all but one of the 18 stereotype-behaviour pairs. The most frequently observed pair was person-othering, followed by stigma targeting the condition rather than the person or their behaviour. Inductive analysis examined the repeated nature of stigmatisation in medical consultations for fibromyalgia. The pattern of events, experiences and long term effects of this is suggestive of medically induced retraumatisation. Stigmatisation in medical consultations for people with fibromyalgia takes many form; these can be categorised using a framework of stereotypes and behaviours. When stigmatising experiences are repeated, they may comprise a form of medically induced retraumatisation. These findings underline the importance of a trauma-informed approach to care for this patient group.