癌痛患者阿片类药物使用污名：成因、表现、影响与展望

Stigma Associated with Opioid Use in Cancer Pain Patients: Causes, Manifestations, Impacts, and Future Directions

摘要:

尽管阿片类药物是癌痛管理的基石，但其使用污名化现象正严重阻碍着治疗的规范化进程。本文深入探讨了癌痛患者使用阿片类药物污名的成因、表现形式及其对临床治疗的影响。阿片类药物污名由多重因素共同引发，包括政策限制、媒体误导、医疗人员知识缺陷及患者对阿片类药物使用风险的误解。该污名表现为公众的误解、患者的内化羞耻以及医疗系统中的结构性障碍，不同维度的污名相互关联和强化，形成“污名化-治疗不足-疼痛恶化”的恶性循环，严重损害患者生活质量与健康结局。未来研究需开发标准化阿片类药物使用污名测量工具，探索不同亚群污名特征，并构建多层次去污名化干预策略，以改善癌痛患者的治疗效果和生活质量。

Abstract:

Although opioid analgesics are the cornerstone of cancer pain management, the stigmatization surrounding their use is severely hampering the standardization of treatment. This paper delves into the causes, manifestations, and clinical impacts of opioid-related stigma among cancer pain patients. This stigma arises from multiple factors, including policy restrictions, biased media coverage, knowledge gaps among healthcare professionals, and patients' misconceptions about the risks associated with opioid use. Specifically, the stigma manifests as public misunderstanding, patient internalized stigma, and structural barriers within the healthcare system. These interconnected dimensions of stigma mutually reinforce each other, creating a "stigma-inadequate treatment-worsening pain" vicious cycle that severely compromises patients' quality of life and health outcomes. Future research needs to develop standardized measurement tools for opioid use stigma, explore stigma characteristics across different subgroups, and construct multi-level destigmatizing intervention strategies to enhance treatment outcomes and quality of life for patients with cancer pain.