1 University of California, San Francisco, CA, USA.
2 University of California, Merced, CA, USA.
J Health Soc Behav. 2018 Dec;59(4):487-500. doi: 10.1177/0022146518798103. Epub 2018 Sep 19.
The subjective nature of pain has always rendered it a point of entry for power and corresponding stratifying processes within biomedicine. The opioid crisis has further exacerbated these challenges by increasing the stakes of prescribing decisions for providers, which in turn has resulted in greater treatment disparities. Using the theoretical frame of cultural health capital (CHC) to account for these disparities in pain management as they unfold at both the macro- and the microlevel, we present findings from an interdisciplinary study of two complex care management programs in urban safety-net hospitals that serve high-utilizing patients. CHC, which considers the ways in which patient-provider interactions reflect and often reinforce broader social inequities, allows for a consideration of power as it circulates through and beyond the patient-provider encounter. Within the current sociopolitical era of pain management, attention must be paid to the stratifying processes that structure how suffering is addressed.
疼痛的主观性一直使其成为权力的切入点，并在生物医学领域引发相应的分层过程。阿片类药物危机通过增加提供者处方决策的风险进一步加剧了这些挑战，这反过来又导致了更大的治疗差异。我们使用文化健康资本（CHC）的理论框架来解释这些在宏观和微观层面上出现的疼痛管理差异，我们提出了一项针对城市安全网医院中两个复杂的护理管理项目的跨学科研究结果，这些医院为高利用率患者提供服务。CHC 考虑了患者与提供者之间的互动如何反映并经常加强更广泛的社会不平等，这使得我们可以考虑权力如何在患者与提供者的互动中循环并超越这一互动。在当前疼痛管理的社会政治时代，必须注意到那些构建痛苦处理方式的分层过程。
