Department of Neuroscience, Uppsala University, Box 593, 751 24, Uppsala, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
BMC Musculoskelet Disord. 2020 Jan 31;21(1):61. doi: 10.1186/s12891-020-3055-5.
The use of opioids to relieve chronic pain has increased during the last decades, but experiences of chronic opioid therapy (COT) (> 90 days) point at risks and loss of beneficial effects. Still, some patients report benefits from opioid medication, such as being able to stay at work. Guidelines for opioid use in chronic pain do not consider the individual experience of COT, including benefits and risks, making the first person perspective an important scientific component to explore. The aim of this study was to investigate the lived experience of managing chronic pain with opioids in a sample who have severe chronic pain but are able to manage their pain sufficiently to remain at work.
We used a qualitative research design: interpretative phenomenological analysis. Ten individuals with chronic pain and opioid therapy were purposively sampled in Swedish tertiary care.
Three super-ordinate themes emerged from the analyses: Without opioids, the pain becomes the boss; Opioids as a salvation and a curse, and Acknowledgement of the pain and acceptance of opioid therapy enables transition to a novel self. The participants used opioids to regain control over their pain, thus reclaiming their wanted life and self, and sense of control over one's life-world. Using opioids to manage pain was not unproblematic and some of the participants had experienced a downward spiral of escalating pain and uncontrollable opioid use, and stigmatisation.
All participants emphasised the importance of control, regarding both pain and opioid use. To accomplish this, trust between participants and health care providers was essential for satisfactory treatment. Regardless of the potential sociocultural benefits of staying at work, participants had experiences of balancing positive and negative effects of opioid therapy, similar to what previous qualitative research has found. Measurable improvement of function and quality of life, may justify the long-term use of opioids in some cases. However, monitoring of adverse events should be mandatory. This requires close cooperation and a trusting relationship between the patients and their health care provider.
在过去几十年中，阿片类药物用于缓解慢性疼痛的使用有所增加，但慢性阿片类药物治疗（COT）（>90 天）的经验表明存在风险和有益效果丧失。尽管如此，一些患者仍报告阿片类药物治疗的益处，例如能够继续工作。慢性疼痛中阿片类药物使用指南并未考虑 COT 的个体体验，包括益处和风险，因此第一人称视角是探索的重要科学组成部分。本研究旨在调查在能够充分控制疼痛以继续工作的严重慢性疼痛患者样本中，使用阿片类药物治疗慢性疼痛的生活体验。
我们使用了定性研究设计：解释现象学分析。在瑞典三级护理中，我们通过目的性抽样选择了 10 名慢性疼痛和阿片类药物治疗的个体。
分析得出了三个超主题：没有阿片类药物，疼痛就会成为主宰；阿片类药物既是救赎，也是诅咒；承认疼痛并接受阿片类药物治疗，能够实现向新自我的转变。参与者使用阿片类药物重新控制疼痛，从而重新获得他们想要的生活和自我，以及对生活世界的控制感。使用阿片类药物来控制疼痛并非没有问题，一些参与者经历了疼痛加剧和无法控制的阿片类药物使用以及污名化的恶性循环。
所有参与者都强调了控制疼痛和阿片类药物使用的重要性。为了实现这一点，参与者与医疗保健提供者之间的信任对于满意的治疗至关重要。无论保持工作状态带来的潜在社会文化益处如何，参与者都经历了平衡阿片类药物治疗的积极和消极影响，这与之前的定性研究结果相似。功能和生活质量的可衡量改善可能证明在某些情况下长期使用阿片类药物是合理的。但是，必须强制监测不良事件。这需要患者及其医疗保健提供者之间的密切合作和信任关系。
