在城市安全网初级保健诊所治疗慢性非癌性疼痛、阿片类药物使用障碍和心理健康的过程中,考虑人际创伤和结构性创伤的相互作用。

IF 4.1 Q1 PSYCHIATRY SSM. Mental health Pub Date : 2023-11-15 Epub Date: 2023-07-07 DOI:10.1016/j.ssmmh.2023.100243
Stacy Castellanos, Alexis Cooke, Sedona Koenders, Neena Joshi, Christine Miaskowski, Margot Kushel, Kelly Ray Knight
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引用次数: 0

摘要

虽然流行病学文献承认慢性非癌性疼痛(CNCP)、阿片类药物使用障碍(OUD)与由身体、情感、性虐待或忽视引起的人际创伤之间存在关联,但对慢性非癌性疼痛人群中人际创伤和结构性创伤之间的复杂病因和相互作用却未进行充分研究。有研究表明,童年的多重不良经历(ACEs)与成年后罹患 OUD 的可能性之间存在关系。然而,ACE 框架因未能指出形成家庭中 ACE 脆弱性的社会和结构背景而受到批评。社会科学理论和人种学方法提供了有用的方法来探索人际和结构性创伤如何影响 CNCP、药物使用和心理健康的共存经历。我们报告了一项定性和人种学纵向队列研究的结果,研究对象是在安全网环境中接受治疗的 CNCP 患者(48 人)及其初级保健提供者(23 人)。我们在 2018 年至 2020 年期间进行了半结构化访谈以及临床和家庭参与观察。在此,我们重点分析了患者和医疗服务提供者在阿片类药物处方减少的更大临床背景下如何解释和定位患者创伤的作用,以突出美国阿片类药物过量危机的政治格局及其对临床互动的影响。研究结果揭示了结构性、种族化创伤对 CNCP、药物使用和精神健康症状造成的过重负担,塑造了患者对疼痛和药物使用的具体体验,以及他们与医疗服务提供者之间的情感体验。创伤经历影响了临床护理的轨迹,但医疗服务提供者和患者表示补救的选择有限。我们认为,应调整创伤知情护理方法,将创伤的结构性决定因素及其与人际交往经历之间的相互作用作为背景,以改善临床护理效果。
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Accounting for the interplay of interpersonal and structural trauma in the treatment of chronic non-cancer pain, opioid use disorder, and mental health in urban safety-net primary care clinics.

While the epidemiological literature recognizes associations between chronic non-cancer pain (CNCP), opioid use disorder (OUD), and interpersonal trauma stemming from physical, emotional, sexual abuse or neglect, the complex etiologies and interplay between interpersonal and structural traumas in CNCP populations are underexamined. Research has documented the relationship between experiencing multiple adverse childhood experiences (ACEs) and the likelihood of developing an OUD as an adult. However, the ACEs framework is criticized for failing to name the social and structural contexts that shape ACE vulnerabilities in families. Social scientific theory and ethnographic methods offer useful approaches to explore how interpersonally- and structurally-produced traumas inform the experiences of co-occurring CNCP, substance use, and mental health. We report findings from a qualitative and ethnographic longitudinal cohort study of patients with CNCP (n = 48) who received care in safety-net settings and their primary care providers (n = 23). We conducted semi-structured interviews and clinical and home-based participant observation from 2018 to 2020. Here we focus our analyses on how patients and providers explained and situated the role of patient trauma in the larger clinical context of reductions in opioid prescribing to highlight the political landscape of the United States opioid overdose crisis and its impact on clinical interactions. Findings reveal the disproportionate burden structurally-produced, racialized trauma places on CNCP, substance use and mental health symptoms that shapes patients' embodied experiences of pain and substance use, as well as their emotional experiences with their providers. Experiences of trauma impacted clinical care trajectories, yet providers and patients expressed limited options for redress. We argue for an adaptation of trauma-informed care approaches that contextualize the structural determinants of trauma and their interplay with interpersonal experiences to improve clinical care outcomes.

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来源期刊
SSM. Mental health
SSM. Mental health Social Psychology, Health
CiteScore
2.30
自引率
0.00%
发文量
0
审稿时长
118 days
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