Trải nghiệm cơn đau mãn tính và bất bình đẳng về sức khỏe trong đại dịch COVID-19 tại Canada: Những phát hiện định tính từ nghiên cứu về cơn đau mãn tính & COVID-19 trên toàn Canada

Springer Science and Business Media LLC - Tập 20 - Trang 1-13 - 2021
Lise Dassieu1, M. Gabrielle Pagé1,2,3, Anaïs Lacasse4, Maude Laflamme1,5, Vickie Perron6, Audrée Janelle-Montcalm1, Maria Hudspith6, Gregg Moor6, Kathryn Sutton6, James M Thompson7,8, Manon Choinière1,2
1Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Canada
2Faculty of Medicine, Department of Anesthesiology and Pain Medicine, Université de Montréal, Pavillon Roger-Gaudry, Montreal, Canada
3Faculty of Arts and Science, Department of Psychology, Pavillon Marie- Victorin, Université de Montréal, Montreal, Canada
4Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Canada
5Faculty of Arts and Sciences, Department of Sociology, Université de Montréal, Montreal, Canada
6Pain BC Society, Vancouver, Canada
7Department of Public Health Sciences, Queens University, Kingston, Canada
8Department of Family Medicine, Dalhousie University, Halifax, Canada

Tóm tắt

Cơn đau mãn tính ảnh hưởng đến khoảng 20% dân số Canada và có thể dẫn đến những tổn thương về thể chất, tâm lý và xã hội. Tuy nhiên, tình trạng này vẫn chưa được nhận diện một cách đầy đủ và thường bị điều trị không thỏa đáng. Trong năm 2020, khi đại dịch COVID-19 đã làm gián đoạn cuộc sống hàng ngày và hệ thống chăm sóc sức khỏe, tình trạng của những người sống với cơn đau mãn tính đã không thu hút nhiều sự chú ý từ công chúng. Nghiên cứu định tính này là một phần của dự án nghiên cứu hỗn hợp trên toàn Canada và nhằm mục đích hiểu về những trải nghiệm và thách thức của những người sống với cơn đau mãn tính trong thời gian đại dịch COVID-19 tại Canada. Giữa tháng 5 và tháng 8 năm 2020, chúng tôi đã tiến hành phỏng vấn sâu có cấu trúc với 22 cá nhân sống với cơn đau mãn tính trên cả nước. Chúng tôi đã sử dụng phân tích chủ đề phản chiếu để diễn giải dữ liệu. Những phát hiện của chúng tôi nhấn mạnh bốn khía cạnh của trải nghiệm cơn đau mãn tính trong đại dịch: (1) Tính dễ bị tổn thương gia tăng do sự không chắc chắn về cơn đau và cách quản lý nó; (2) Mạng xã hội như một yếu tố quyết định đến cơn đau và tình trạng tâm lý; (3) Sự bất bình đẳng hệ thống gia tăng kết hợp với trải nghiệm cơn đau mãn tính; (4) Điều kiện sống khả thi hơn nhờ các biện pháp phong tỏa. Mặc dù một số người tham gia báo cáo sự cải thiện trong chất lượng cuộc sống của họ và giảm áp lực xã hội trong bối cảnh lệnh ở nhà, nhưng những người tham gia từ các nhóm thiếu thốn về kinh tế và thiểu số đã báo cáo nhiều thách thức hơn trong việc tiếp cận giảm đau, dịch vụ chăm sóc sức khỏe và hỗ trợ tâm lý xã hội. Đại dịch COVID-19 đã bộc lộ và làm trầm trọng thêm những bất bình đẳng và thách thức sẵn có của những người sống với cơn đau mãn tính về tài nguyên vật chất, tình trạng tâm lý xã hội, hỗ trợ xã hội và tiếp cận chăm sóc. Trong thời gian hậu đại dịch, sẽ rất cần thiết để giải quyết những khiếm khuyết trong chính sách sức khỏe và phúc lợi nhằm thúc đẩy công bằng và sự hòa nhập xã hội cho những người sống với cơn đau mãn tính.

Từ khóa

#cơn đau mãn tính #bất bình đẳng sức khỏe #COVID-19 #Canada #nghiên cứu định tính

Tài liệu tham khảo

Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020;52:102066. Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, et al. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord. 2020;277:55–64. Buheji M, Cunha K, Beka C, Mavrić G, Souza B, YL do C de, Silva SS da C, et al. The Extent of COVID-19 Pandemic Socio-Economic Impact on Global Poverty. A Global Integrative Multidisciplinary Review. Am J Econ. 2020;10(4):213–24. Public Health Agency of Canada. Coronavirus disease (COVID-19): Outbreak update . 2021 [cited 2021 Mar 23]. Available from: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html. Basky G. All hands on deck as cases of COVID-19 surge. CMAJ. 2020;14(15):E415-6. McMahon M, Nadigel J, Thompson E, Glazier RH. Informing Canada’s Health System Response to COVID-19: Priorities for Health Services and Policy Research. Healthc Policy. 2020;16(1):112–24. Bhidayasiri R, Virameteekul S, Kim J-M, Pal PK, Chung S-J. COVID-19: An Early Review of Its Global Impact and Considerations for Parkinson’s Disease Patient Care. J Mov Disord. 2020;13(2):105–14. Chudasama YV, Gillies CL, Zaccardi F, Coles B, Davies MJ, Seidu S, et al. Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals. Diabetes Metab Syndr. 2020;14(5):965–7. Palmer K, Monaco A, Kivipelto M, Onder G, Maggi S, Michel J-P, et al. The potential long-term impact of the COVID-19 outbreak on patients with non-communicable diseases in Europe: consequences for healthy ageing. Aging Clin Exp Res. 2020;32(7):1189–94. Patel JA, Nielsen FBH, Badiani AA, Assi S, Unadkat VA, Patel B, et al. Poverty, inequality and COVID-19: the forgotten vulnerable. Public Health. 2020;183:110–1. Mahajan UV, Larkins-Pettigrew M. Racial demographics and COVID-19 confirmed cases and deaths: a correlational analysis of 2886 US counties. J Public Health (Oxf). 2020;42(3):445–7. Pereira M, Oliveira AM. Poverty and food insecurity may increase as the threat of COVID-19 spreads. Public Health Nutr. 2020;23(17):3236–40. Tam T. From Risk to Resilience: An Equity Approach to COVID-19: The Chief Public Health Offficer of Canada’s Report on the State of Public Health in Canada 2020. Ottawa: Government of Canada; 2020. Gray DM, Anyane-Yeboa A, Balzora S, Issaka RB, May FP. COVID-19 and the other pandemic: populations made vulnerable by systemic inequity. Nat Rev Gastroenterol Hepatol. 2020;17(9):520–2. Krouse HJ. COVID-19 and the Widening Gap in Health Inequity. Otolaryngol Head Neck Surg. 2020;163(1):65–6. Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. Pain. 2015;156(6):1003–7. Schopflocher D, Taenzer P, Jovey R. The prevalence of chronic pain in Canada. Pain Res Manag. 2011;16(6):445–50. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333. Dahlhamer J. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep. 2018 [cited 2021 Mar 23];67. Available from: https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm. Mohamed Zaki LR, Hairi NN. A Systematic Review of the Prevalence and Measurement of Chronic Pain in Asian Adults. Pain Manag Nurs. 2015;16(3):440–52. Morris LD, Daniels KJ, Ganguli B, Louw QA. An update on the prevalence of low back pain in Africa: a systematic review and meta-analyses. BMC Musculoskelet Disord. 2018 [cited 2021 Mar 25];19. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055346/. Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011 ;11:770. Canadian Pain Task Force. Working Together to Better Understand, Prevent, and Manage Chronic Pain: What We Heard. Ottawa: Health Canada; 2020. Sessle BJ. Unrelieved pain: A crisis. Pain Res Manag. 2011;16(6):416–20. Daubresse M, Chang H-Y, Yu Y, Viswanathan S, Shah ND, Stafford RS, et al. Ambulatory Diagnosis and Treatment of Nonmalignant Pain in the United States, 2000–2010. Med Care. 2013;51(10):870–8. Dassieu L, Kaboré J-L, Choinière M, Arruda N, Roy É. Painful lives: Chronic pain experience among people who use illicit drugs in Montreal (Canada). Soc Sci Med. 2020;246:112734. Craig KD, Holmes C, Hudspith M, Moor G, Moosa-Mitha M, Varcoe C, et al. Pain in persons who are marginalized by social conditions. PAIN. 2020;161(2):261–5. Wallace B, Varcoe C, Holmes C, Moosa-Mitha M, Moor G, Hudspith M, et al. Towards health equity for people experiencing chronic pain and social marginalization. Int J Equity Health. 2021;20(1):1–13. Samulowitz A, Gremyr I, Eriksson E, Hensing G. “Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Res Manag. 2018;2018. Keogh E. Sex and Gender as Social-Contextual Factors in Pain. In: Vervoort T, Karos K, Trost Z, Prkachin KM, editors. Social and Interpersonal Dynamics in Pain: We Don’t Suffer Alone. Cham: Springer International Publishing; 2018 [cited 2021 Mar 23]. p. 433–53. Available from: https://doi.org/10.1007/978-3-319-78340-6_20. Quintner J. Why Are Women with Fibromyalgia so Stigmatized? Pain Med. 2020;21(5):882–8. Hirsh AT, Hollingshead NA, Ashburn-Nardo L, Kroenke K. The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions. J Pain. 2015;16(6):558–68. Green CR, Anderson KO, Baker TA, Campbell LC, Decker S, Fillingim RB, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. 2003;4(3):277–94. Kaseweter KA, Drwecki BB, Prkachin KM. Racial differences in pain treatment and empathy in a Canadian sample. Pain Res Manag. 2012;17(6):381–4. Clauw DJ, Häuser W, Cohen SP, Fitzcharles M-A. Considering the potential for an increase in chronic pain after the COVID-19 pandemic. Pain. 2020 [cited 2020 Dec 14]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302093/. Javed S, Hung J, Huh BK. Impact of COVID-19 on chronic pain patients: a pain physician’s perspective. Pain Manag. 2020 [cited 2020 Dec 14]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422723/. Karos K, McParland JL, Bunzli S, Devan H, Hirsh A, Kapos FP, et al. The social threats of COVID-19 for people with chronic pain. PAIN. 2020 Oct;161(10):2229–35. Webster F, Connoy L, Sud A, Pinto AD, Katz J. Grappling with Chronic Pain and Poverty during the COVID-19 Pandemic. Can J Pain. 2020;4(1):125–8. Eccleston C, Blyth FM, Dear BF, Fisher EA, Keefe FJ, Lynch ME, et al. Managing patients with chronic pain during the COVID-19 outbreak: considerations for the rapid introduction of remotely supported (eHealth) pain management services. PAIN. 2020 May;161(5):889–93. El-Tallawy SN, Nalamasu R, Pergolizzi JV, Gharibo C. Pain Management During the COVID-19 Pandemic. Pain Ther. 2020;9(2):453–66. Shanthanna H, Strand NH, Provenzano DA, Lobo CA, Eldabe S, Bhatia A, et al. Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel. Anaesthesia. 2020;75(7):935–44. Lynch ME, Williamson OD, Banfield JC. COVID-19 impact and response by Canadian pain clinics: A national survey of adult pain clinics. Can J Pain. 2020;4(1):204–9. Pagé MG, Lacasse A, Dassieu L, Hudspith M, Moor G, Sutton K, et al. A cross-sectional study of pain status and psychological distress among individuals living with chronic pain: the Chronic Pain & COVID-19 Pan-Canadian Study. Health Promot Chronic Dis Prev Can. 2021;41(5). Nieto R, Pardo R, Sora B, Feliu-Soler A, Luciano JV. Impact of COVID-19 Lockdown Measures on Spanish People with Chronic Pain: An Online Study Survey. Journal of Clinical Medicine. 2020;9(11):3558. Mun CJ, Campbell CM, McGill LS, Aaron RV. The Early Impact of COVID-19 on Chronic Pain: A Cross-Sectional Investigation of a Large Online Sample of Individuals with Chronic Pain in the United States, April to May, 2020. Pain Med. 2021;22(2):470–80. Lacasse A, Pagé MG, Dassieu L, Sourial N, Janelle-Montcalm A, Dorais M, et al. Impact of the COVID-19 pandemic on the pharmacological, physical, and psychological treatments of pain: findings from the Chronic Pain & COVID-19 Pan-Canadian Study. Pain Rep. 2021;6(1):e891. Conrad P. Qualitative research on chronic illness: A commentary on method and conceptual development. Social Science Medicine. 1990;30(11):1257–63. Pierret J. The illness experience: state of knowledge and perspectives for research. Sociology of Health & Illness. 2003;25(3):4–22. Braveman P. Health disparities and health equity: concepts and measurement. Annu Rev Public Health. 2006;27:167–94. Hankivsky O. Health Inequities in Canada: Intersectional Frameworks and Practices. UBC Press; 2011. 414 p. Rapley T. Sampling Strategies in Qualitative Research. In: The SAGE Handbook of Qualitative Data Analysis. London: SAGE Publications; 2014. pp. 49–63. Whittemore R, Chase SK, Mandle CL. Validity in Qualitative Research. Qual Health Res. 2001;11(4):522–37. Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2016;26(13):1753–60. Varpio L, Ajjawi R, Monrouxe LV, O’Brien BC, Rees CE. Shedding the cobra effect: problematising thematic emergence, triangulation, saturation and member checking. Med Educ. 2017;51(1):40–50. Braun V, Clarke V, Hayfield N, Terry G. Thematic Analysis. In: Liamputtong P, editor. Handbook of Research Methods in Health Social Sciences. Singapore: Springer; 2019 [cited 2021 Mar 9]. p. 843–60. Available from: https://doi.org/10.1007/978-981-10-5251-4_103. Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative Res Sport, Exerc Health. 2019;11(4):589–97. Corbin J, Strauss AL. Basics of qualitative research: techniques and procedures for developing grounded theory. 4th edition. Los Angeles: SAGE; 2015. Berends L, Johnston J. Using multiple coders to enhance qualitative analysis: The case of interviews with consumers of drug treatment. Addiction Res Theory. 2005;13(4):373–81. van Nes F, Abma T, Jonsson H, Deeg D. Language differences in qualitative research: is meaning lost in translation? Eur J Ageing. 2010;7(4):313–6. Choy E, Perrot S, Leon T, Kaplan J, Petersel D, Ginovker A, et al. A patient survey of the impact of fibromyalgia and the journey to diagnosis. BMC Health Serv Res. 2010;26:10:102. Madden S, Sim J. Acquiring a diagnosis of fibromyalgia syndrome: The sociology of diagnosis. Soc Theory Health. 2016;14(1):88–108. Boulton T. Nothing and Everything: Fibromyalgia as a Diagnosis of Exclusion and Inclusion. Qual Health Res. 2019;29(6):809–19. Lillrank A. Back pain and the resolution of diagnostic uncertainty in illness narratives. Social Science Medicine. 2003;57(6):1045–54. Werner A, Malterud K. It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors. Social Science Medicine. 2003;57(8):1409–19. Antoniou T, Ala-Leppilampi K, Shearer D, Parsons JA, Tadrous M, Gomes T. “Like being put on an ice floe and shoved away”: A qualitative study of the impacts of opioid-related policy changes on people who take opioids. Int J Drug Policy. 2019 Apr;1:66:15–22. Dassieu L, Heino A, Develay É, Kaboré J-L, Pagé MG, Moor G, et al. “They think you’re trying to get the drug”: Qualitative investigation of chronic pain patients’ health care experiences during the opioid overdose epidemic in Canada. Can J Pain. 2021;5(1):66–80. Bohnert ASB, Guy GP, Losby JL. Opioid Prescribing in the United States Before and After the Centers for Disease Control and Prevention’s 2016 Opioid Guideline. Ann Intern Med. 2018;18(6):367–75. 169(. Lagisetty PA, Healy N, Garpestad C, Jannausch M, Tipirneni R, Bohnert ASB. Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids. JAMA Netw Open. 2019;2(7):e196928. Manchikanti L, Vanaparthy R, Atluri S, Sachdeva H, Kaye AD, Hirsch JA. COVID-19 and the Opioid Epidemic: Two Public Health Emergencies That Intersect With Chronic Pain. Pain Ther. 2021. Craig KD, Fashler S. Social determinants of pain. In: A textbook for Health Professionals. 2nd Edition. Edimburgh: Churchill Livingstone Elsevier; 2014. p. 21–31. Dassieu L, Kaboré J-L, Choinière M, Arruda N, Roy É. Chronic pain management among people who use drugs: A health policy challenge in the context of the opioid crisis. Int J Drug Policy. 2019;1:71:150–6. Feagin J, Bennefield Z. Systemic racism and U.S. health care. Soc Sci Med. 2014;1:103:7–14. Goodman A, Fleming K, Markwick N, Morrison T, Lagimodiere L, Kerr T. “They treated me like crap and I know it was because I was Native”: The healthcare experiences of Aboriginal peoples living in Vancouver’s inner city. Soc Sci Med. 2017. Hogan VK, de Araujo EM, Caldwell KL, Gonzalez-Nahm SN, Black KZ. “We black women have to kill a lion everyday”: An intersectional analysis of racism and social determinants of health in Brazil. Soc Sci Med. 2018;199:96–105. Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296–301. Bowleg L. We’re Not All in This Together: On COVID-19, Intersectionality, and Structural Inequality. Am J Public Health. 2020;110(7):917. Pryma J. “Even my sister says I’m acting like a crazy to get a check”: Race, gender, and moral boundary-work in women’s claims of disabling chronic pain. Soc Sci Med. 2017;181:66–73. Charmaz K. Loss of self: a fundamental form of suffering in the chronically ill. Sociology of Health & Illness. 1983;5(2):168–95. Good BJ. A Body in Pain: The Making of a World of Chronic Pain. In: Pain as Human Experience: An Anthropological Perspective. Berkeley: University of California Press; 1992. pp. 100–37. Morden A, Jinks C, Ong BN. Temporally divergent significant meanings, biographical disruption and self-management for chronic joint pain. Health. 2017 ;21(4):357–74. Soklaridis S, Cartmill C, Cassidy D. Biographical disruption of injured workers in chronic pain. Disabil Rehabil. 2011;33(22–23):2372–80. De Ruddere L, Craig KD. Understanding stigma and chronic pain: a-state-of-the-art review. PAIN. 2016;157(8):1607–10. Jackson JE. Stigma, liminality, and chronic pain: Mind–body borderlands. American Ethnologist. 2005;32(3):332–53. Eaves ER, Nichter M, Ritenbaugh C, Sutherland E, Dworkin SF. Works of Illness and the Challenges of Social Risk and the Specter of Pain in the Lived Experience of TMD. Med Anthropol Q. 2015;29(2):157–77. Goodley D, Lawthom R, Liddiard K, Cole KR. Critical Disability Studies. In: Gough B, editor. The Palgrave Handbook of Critical Social Psychology. London: Palgrave Macmillan UK; 2017 [cited 2021 Mar 24]. p. 491–505. Available from: https://doi.org/10.1057/978-1-137-51018-1_24. McLeod J. Vulnerability and the neo-liberal youth citizen: a view from Australia. Comparative Education. 2012;48(1):11–26. Beckett A. Citizenship and Vulnerability: Disability and Issues of Social and Political Engagement. Palgrave Macmillan; 2006. 225 p. Goodley D. Dis/entangling critical disability studies. Disabil Soc. 2013;28(5):631–44. Browne AJ, Varcoe C, Ford-Gilboe M, Wathen CN. EQUIP Research Team. EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings. Int J Equity Health. 2015;14:152. Rodriguez JA, Saadi A, Schwamm LH, Bates DW, Samal L. Disparities In Telehealth Use Among California Patients With Limited English Proficiency. Health Affairs. 2021;40(3):487–95.