Guilty until proven innocent: A qualitative study of the management of chronic non-cancer pain among patients with a history of substance abuse
Guilty until proven innocent: A qualitative study of the management of chronic non-cancer pain among patients with a history of substance abuse
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DOI：
10.1016/j.addbeh.2009.10.008
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发表时间：
2010-03-01
影响因子：
4.4
通讯作者：
Bannister, Jonathan
中科院分区：
文献类型：
--
作者：
Baldacchino, Alex;Gilchrist, Gail;Bannister, Jonathan
简介：医生通常不愿意为慢性非癌性疼痛（CNCP）开出强效阿片类药物。没有研究已经定性地检查医生的信念关于处方阿片类药物为CNCP的患者与药物滥用史（PWHSA）.Aims：To describe physicians' attitudes and experience of prescribing opioid for CNCP to PWHSA.Design，setting and participants：十九个单独的访谈和两个焦点小组进行了与GP，成瘾专家，疼痛专家和风湿病学家。医生“不愿意”为经历CNCP的PWHSA开阿片类药物，因为担心药物成瘾，滥用或转移。许多人表现出“不信任”，这些病人正在经历“真正的痛苦”，导致病人往往被认为有罪，直到证明无辜。对这些患者的这种负面看法是基于以前的操纵性“寻求药物”的遭遇，往往导致疼痛治疗不足。潜在的“标志”被确定，提醒医生滥用或转移他们的处方的可能性，包括：医生购物。处方松动、频繁就诊和提前要求重复处方。医生报告了不同的管理方法和更严格的PWHSA处方制度，以限制成瘾，滥用和转移的可能性。不良疼痛管理的例子进行了描述，吸毒者已根据治疗的结果，消极的态度或缺乏经验的staff.Discussion：应用慢性疾病模型共病成瘾和CNCP将确保一个健康和社会保健系统，使其难以污名化的患者经历这些条件，并将促进处方阿片类止痛药的患者谁可以受益。(C)2009爱思唯尔有限公司保留所有权利。
Introduction: Physicians are often reluctant to prescribe strong opioids for chronic non cancer pain (CNCP). No study has qualitatively examined physicians' beliefs about prescribing opioids for CNCP to patients with a history of substance abuse (PWHSA).Aims: To describe physicians' attitudes and experience of prescribing opioids for CNCP to PWHSA.Design, setting and participants: Nineteen individual interviews and two focus groups were conducted with GPs, Addiction Specialists, Pain Specialists and Rheumatologists.Results: Physicians were "reluctant" to prescribe opioids to PWHSA experiencing CNCP for fear of addiction, misuse or diversion of medications. Many exhibited "distrust" that such patients were experiencing "genuine pain", resulting in patients often being considered guilty until proven innocent. Such negative regard towards these patients was based on previous manipulative "drug seeking" encounters and often resulted in the under treatment of pain. Potential "flags" were identified that alerted physicians to the potential for abuse or diversion of their prescription including: doctor shopping. loosing prescriptions, frequent attendance and early requests for repeat prescriptions. Physicians reported different management approaches and stricter prescribing regimes for PWHSA to limit the potential of addiction, misuse and diversion. Examples of poor pain management were described where drug users had been under treated as a result of negative attitudes or inexperience of staff.Discussion: Applying the chronic disease model to comorbid addiction and CNCP would ensure a health and social care system that makes it difficult to stigmatise patients experiencing these conditions and would facilitate the prescribing of opioid pain medication to patients who could benefit. (C) 2009 Elsevier Ltd. All rights reserved.