Accounting for the interplay of interpersonal and structural trauma in the treatment of chronic non-cancer pain, opioid use disorder, and mental health in urban safety-net primary care clinics

被引:2
作者
Castellanos, Stacy [1 ]
Cooke, Alexis [2 ]
Koenders, Sedona [1 ]
Joshi, Neena [1 ]
Miaskowski, Christine [3 ]
Kushel, Margot [4 ]
Knight, Kelly Ray [1 ,5 ]
机构
[1] Univ Calif San Francisco, Sch Med, Dept Humanities & Social Sci, 490 Illinois St,7th Floor, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Sch Nursing, Dept Community Hlth Syst, 2 Koret Way,N505, San Francisco, CA 94143 USA
[3] Univ Calif San Francisco, Sch Nursing, Dept Physiol Nursing, 2 Koret Way,631, San Francisco, CA 94143 USA
[4] Univ Calif San Francisco, Zuckerberg San Francisco Gen Hosp & Trauma Ctr, Ctr Vulnerable Populat, Dept Med,Sch Med, UCSF Box 1339, San Francisco, CA 94143 USA
[5] 490 Illinois St,7th Floor, San Francisco, CA 94143 USA
来源
SSM-MENTAL HEALTH | 2023年 / 4卷
基金
美国国家卫生研究院;
关键词
Chronic non-cancer pain; Opioids; Primary care; Safety-net; Structural factors; Trauma; MANAGEMENT; POPULATION; GUIDELINE; OVERDOSE;
D O I
10.1016/j.ssmmh.2023.100243
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
While the epidemiological literature recognizes associations between chronic non-cancer pain (CNCP), opioid use disorder (OUD), and interpersonal trauma stemming from physical, emotional, sexual abuse or neglect, the complex etiologies and interplay between interpersonal and structural traumas in CNCP populations are under examined. Research has documented the relationship between experiencing multiple adverse childhood experiences (ACEs) and the likelihood of developing an OUD as an adult. However, the ACEs framework is criticized for failing to name the social and structural contexts that shape ACE vulnerabilities in families. Social scientific theory and ethnographic methods offer useful approaches to explore how interpersonally-and structurally produced traumas inform the experiences of co-occurring CNCP, substance use, and mental health. We report findings from a qualitative and ethnographic longitudinal cohort study of patients with CNCP (n = 48) who received care in safety-net settings and their primary care providers (n = 23). We conducted semi-structured interviews and clinical and home-based participant observation from 2018 to 2020. Here we focus our analyses on how patients and providers explained and situated the role of patient trauma in the larger clinical context of reductions in opioid prescribing to highlight the political landscape of the United States opioid overdose crisis and its impact on clinical interactions. Findings reveal the disproportionate burden structurally produced, racialized trauma places on CNCP, substance use and mental health symptoms that shapes patients' embodied experiences of pain and substance use, as well as their emotional experiences with their providers. Experiences of trauma impacted clinical care trajectories, yet providers and patients expressed limited options for redress. We argue for an adaptation of trauma-informed care approaches that contextualize the structural determinants of trauma and their interplay with interpersonal experiences to improve clinical care outcomes.
引用
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页数:9
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