Arnaert Antonia, Ciccotosto Gina
McGill University, School of Nursing, Montreal, Quebec, Canada.
Pain Manag Nurs. 2006 Mar;7(1):23-30. doi: 10.1016/j.pmn.2005.12.004.
Although studies on the beliefs of persons with chronic nonmalignant pain (CNMP) are still scarce, methadone is increasingly prescribed for the treatment of CNMP. This qualitative case study uses semistructured interviews to explore the beliefs of 11 patients with CNMP and the challenges they faced coming to terms with and integrating methadone treatment into their lives. The study identifies a two-phase process of acceptance and integration. In the first phase, during acceptance of the prescribed methadone treatment, initial beliefs were mostly determined by the societal stigma that "methadone is for junkies." Different influencing factors such as knowledge about methadone for pain management, family support, and trust in physicians changed behavior in a positive way. In the second phase, patients dealt with the degree of disclosure about their treatment. Full disclosers have no problem in telling others that they were being treated with methadone, whereas partial disclosers were more selective. They were confronted with various barriers: negative encounters with family, friends, and the public; past addict experiences; safety issues; and obstacles within the health care system. As a result of these challenges, their beliefs were summarized as: "others think I'm an addict," and "methadone can harm me and/or my family."This study highlights the important role nurses have in the education of patients on the use of methadone in pain management, and in assisting patients with CNMP to gain confidence and a greater sense of control to cope with the challenging issues related to disclosing information.
尽管关于慢性非恶性疼痛（CNMP）患者信念的研究仍然匮乏，但美沙酮在治疗CNMP方面的处方量却日益增加。本定性案例研究采用半结构化访谈，以探究11名CNMP患者的信念，以及他们在接受美沙酮治疗并将其融入生活过程中所面临的挑战。该研究确定了一个接受与融入的两阶段过程。在第一阶段，即接受规定的美沙酮治疗期间，最初的信念大多由“美沙酮是给瘾君子用的”这种社会污名所决定。诸如对美沙酮用于疼痛管理的了解、家庭支持以及对医生的信任等不同影响因素，以积极的方式改变了行为。在第二阶段，患者应对治疗信息的披露程度。完全披露者在告知他人自己正在接受美沙酮治疗方面没有问题，而部分披露者则更具选择性。他们面临各种障碍：与家人、朋友和公众的负面接触；过去的成瘾经历；安全问题；以及医疗保健系统内部的障碍。由于这些挑战，他们的信念总结为：“其他人认为我是瘾君子”，以及“美沙酮会伤害我和/或我的家人”。本研究强调了护士在教育患者使用美沙酮进行疼痛管理，以及协助CNMP患者获得信心和更强的掌控感以应对与信息披露相关挑战性问题方面所发挥的重要作用。
