Pain management in liminal spaces.

阈限空间的疼痛管理。

• 批准号: 2592362
• 金额: --
• 依托单位: Brunel University London
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2592362
• 关键词: Pain; management; liminal; spaces.

Chronic pain (CP) is estimated to affect one-third of the UK population [Fayaz 2016] and presents major personal, economic, and societal challenges [Kyu 2018]. There are deficiencies in contemporary healthcare provision for people living with CP (PLWCP), with efficacy of established treatment approaches being challenged [NICE NG59 (2016), NG10069 (2021), Williams 2020]. Treatments for PLWCP, typically informed by the biopsychosocial (BPS) and psychological approaches, are widely accepted in healthcare [Mescouto 2020, Denneny 2020]. However, the BPS approach has been challenged as reductionist and not person-centered [Stillwell 2019]. Misunderstandings of the term psychological fuel (mis)perceptions that CP is "all in the head" [Bransfield 2019]. This can lead to conflict between PLWCP and health care providers, marginalisation, and stigma [Farr 2018, Boulton 2019]. Furthermore, social determinants of health (SDoH) have until recently been largely ignored in pain research, resulting in underexplored inequalities of care [Moscrop 2020]. Only 2% of PLWCP can currently access pain services [Burke 2020] and many are usually discharged with continuing pain. Pain services advocate skills development for independent pain "self-management" yet no consensus definition for self-management exists (Walumbe, pers. com.). Pearce (2015) argues that self-management requires a collaborative approach with health-care systems and is not the sole responsibility of the individual. Advocacy organisations including Chronic Pain Coalition and ARMA support this proposition and request regular review appointments. Ongoing healthcare reviews are not supported with evidence, are unsustainable, and potentially preserve a clinical hegemony where existing inequalities remain unaddressed.

据估计，慢性疼痛（CP）影响了三分之一的英国人口[Fayaz 2016]，并带来了重大的个人、经济和社会挑战[Kyu 2018]。CP（PLWCP）患者的现代医疗保健服务存在缺陷，既定治疗方法的疗效受到挑战[NICE NG 59（2016），NG 10069（2021），威廉姆斯2020]。PLWCP的治疗通常通过生物心理社会（BPS）和心理学方法进行，在医疗保健中被广泛接受[Mescouto 2020，Denneny 2020]。然而，BPS方法被质疑为还原主义者，而不是以人为中心[Stillwell 2019]。对术语心理燃料（mis）的误解认为CP是“全在头脑中”[Bransfield 2019]。这可能导致PLWCP和医疗保健提供者之间的冲突、边缘化和污名化[Farr 2018，Boulton 2019]。此外，健康的社会决定因素（SDoH）直到最近才在疼痛研究中基本上被忽视，导致护理不平等的探索不足[Moscrop 2020]。目前只有2%的PLWCP可以获得疼痛服务[Burke 2020]，许多人通常因持续疼痛而出院。疼痛服务提倡独立疼痛“自我管理”的技能发展，但对于自我管理还没有共识的定义（Walumbe，pers.com）。皮尔斯（2015）认为，自我管理需要与医疗保健系统采取协作方法，而不是个人的唯一责任。包括慢性疼痛联盟和阿尔马在内的倡导组织支持这一主张，并要求定期审查预约。正在进行的医疗保健审查没有证据支持，是不可持续的，并可能保持临床霸权，现有的不平等仍然没有得到解决。