Section of Palliative Care and Medical Ethics and Palliative Research Center (PaRC), Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
Department of Medicine & Molecular Pharmacology, Albert Einsten Cancer Center, Albert Einstein College of Medicine, Bronx, NY, United States.
Pain. 2022 Feb 1;163(2):e182-e189. doi: 10.1097/j.pain.0000000000002343.
Millions of patients with cancer pain are treated with prescription opioids each year. However, efforts to mitigate the ongoing opioid crisis result in unintended consequences with opioid pain management, including opioid stigma. Emerging research indicates that opioid stigma is problematic in patients with cancer, but few studies have examined contributors to and impacts of opioid stigma in this population. To guide future research in this area, we propose a conceptual framework-the opioid stigma framework (OSF)-with which to understand and improve opioid stigma in patients with cancer pain. Development of the OSF was guided by a literature review of stigma in health-related conditions, adaptation of the existing Health Stigma and Discrimination Framework, a topical review of challenges related to opioid cancer pain management, and author expertise in cancer, pain, and opioid prescribing. The proposed OSF highlights 5 domains: (1) contributors to opioid stigma, or factors that increase the likelihood that a patient will experience opioid stigma; (2) intersecting stigmas, or the convergence of multiple stigmatized identities within a patient; (3) stigma manifestations, or the ways opioid stigma is manifested in patients, clinicians, and the community; (4) proximal outcomes, or the immediate consequences of opioid stigma in patients; and (5) long-term impacts in patients. The OSF provides 2 main avenues to facilitate future research: (1) providing a framework to explore the mechanisms that underlie opioid stigma and its impact on cancer pain management and (2) supporting the development of targeted, tailored interventions to eliminate opioid stigma.
每年有数百万癌症疼痛患者接受处方类阿片治疗。然而，为缓解持续的阿片类药物危机而进行的努力，导致了阿片类药物疼痛管理方面出现了意想不到的后果，包括阿片类药物污名化。新出现的研究表明，阿片类药物污名化在癌症患者中是一个问题，但很少有研究探讨过这种污名化在这一人群中的产生原因和影响。为指导该领域的未来研究，我们提出了一个概念框架——阿片类药物污名框架（OSF），用以理解和改善癌症疼痛患者的阿片类药物污名化问题。OSF 的制定是基于对健康相关状况污名的文献回顾、对现有健康污名和歧视框架的改编、对与癌症疼痛管理相关的挑战的专题审查，以及作者在癌症、疼痛和阿片类药物处方方面的专业知识。所提出的 OSF 突出了 5 个领域：（1）阿片类药物污名的产生因素，或增加患者经历阿片类药物污名的可能性的因素；（2）交叉污名，或患者身上多种污名化身份的融合；（3）污名表现，或阿片类药物污名在患者、临床医生和社区中的表现方式；（4）近期后果，或阿片类药物污名在患者中的直接后果；以及（5）患者的长期影响。OSF 为未来的研究提供了 2 条主要途径：（1）提供一个框架，以探索阿片类药物污名背后的机制及其对癌症疼痛管理的影响；（2）支持制定有针对性、定制化的干预措施，以消除阿片类药物污名。
