Pain management in liminal spaces.

据估计，慢性疼痛（CP）影响着三分之一的英国人口[Fayaz 2016]，并给个人、经济和社会带来了重大挑战[Kyu 2018]。当代CP （PLWCP）患者的医疗保健服务存在不足，现有治疗方法的有效性受到挑战[NICE NG59 (2016), NG10069 (2021), Williams 2020]。PLWCP的治疗通常采用生物心理社会（BPS）和心理学方法，在医疗保健中被广泛接受[Mescouto 2020， dendeny 2020]。然而，BPS方法因过于简化而非以人为本而受到挑战[Stillwell 2019]。对术语“心理燃料”的误解（错误）认为CP是“全部在头脑中”[Bransfield 2019]。这可能导致PLWCP与卫生保健提供者之间的冲突、边缘化和污名化[Farr 2018， Boulton 2019]。此外，直到最近，健康的社会决定因素（SDoH）在疼痛研究中基本上被忽视，导致对护理不平等的探索不足[moscop 2020]。目前，只有2%的PLWCP患者可以获得疼痛服务[Burke 2020]，许多人出院时通常会持续疼痛。疼痛服务倡导独立疼痛“自我管理”的技能发展，但对自我管理没有一致的定义(Walumbe, pers。com)。Pearce（2015）认为，自我管理需要与医疗保健系统合作，而不是个人的唯一责任。包括慢性疼痛联盟和ARMA在内的倡导组织支持这一主张，并要求定期检查预约。正在进行的卫生保健审查没有证据支持，是不可持续的，并且可能在现有不平等问题得不到解决的情况下保持临床霸权。

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.