慢性非恶性疼痛患者使用阿片类药物的体验：使用荟萃元分析的定性证据综合
Experiences of people taking opioid medication for chronic non-malignant pain: a qualitative evidence synthesis using meta-ethnography.
机构信息
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK.
出版信息
BMJ Open. 2020 Feb 18;10(2):e032988. doi: 10.1136/bmjopen-2019-032988.
OBJECTIVE
To review qualitative studies on the experience of taking opioid medication for chronic non-malignant pain (CNMP) or coming off them.
DESIGN
This is a qualitative evidence synthesis using a seven-step approach from the methods of meta-ethnography.
DATA SOURCES AND ELIGIBILITY CRITERIA
We searched selected databases-Medline, Embase, AMED, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and Scopus (Science Citation Index and Social Science Citation Index)-for qualitative studies which provide patients' views of taking opioid medication for CNMP or of coming off them (June 2017, updated September 2018).
DATA EXTRACTION AND SYNTHESIS
Papers were quality appraised using the Critical Appraisal Skills Programme tool, and the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation working group - Confidence in Evidence from Reviews of Qualitative research) guidelines were applied. We identified concepts and iteratively abstracted these concepts into a line of argument.
RESULTS
We screened 2994 unique citations and checked 153 full texts, and 31 met our review criteria. We identified five themes: (1) reluctant users with little choice; (2) understanding opioids: the good and the bad; (3) a therapeutic alliance: not always on the same page; (4) stigma: feeling scared and secretive but needing support; and (5) the challenge of tapering or withdrawal. A new overarching theme of 'constantly balancing' emerged from the data.
CONCLUSIONS
People taking opioids were constantly balancing tensions, not always wanting to take opioids, and weighing the pros and cons of opioids but feeling they had no choice because of the pain. They frequently felt stigmatised, were not always 'on the same page' as their healthcare professional and felt changes in opioid use were often challenging.
TRIAL REGISTRATION NUMBER
49470934; Pre-results.
目的
综述慢性非恶性疼痛（CNMP）患者使用阿片类药物或停药的体验的定性研究。
设计
这是一项使用元人种学方法的七步方法进行的定性证据综合。
数据来源和入选标准
我们在 Medline、Embase、AMED、 Cumulative Index to Nursing and Allied Health Literature、PsycINFO、Web of Science 和 Scopus（科学引文索引和社会科学引文索引）等选定数据库中进行了检索，查找提供 CNMP 患者使用阿片类药物或停药体验的定性研究（2017 年 6 月，2018 年 9 月更新）。
数据提取和综合
使用关键评估技能计划工具对论文进行质量评估，并应用 GRADE-CERQual（推荐评估、制定和评估工作组-来自定性研究的证据置信度等级）指南。我们确定了概念，并将这些概念迭代地抽象为一个论点。
结果
我们筛选了 2994 篇独特的引用文献，并检查了 153 篇全文，其中 31 篇符合我们的综述标准。我们确定了五个主题：（1）不情愿的使用者，几乎别无选择；（2）理解阿片类药物：好的和坏的；（3）治疗联盟：并非总是在同一页上；（4）耻辱感：感到恐惧和秘密，但需要支持；以及（5）减少或戒断的挑战。从数据中出现了一个新的总体主题：“不断平衡”。
结论
服用阿片类药物的人总是在平衡紧张情绪，并不总是想服用阿片类药物，权衡阿片类药物的利弊，但由于疼痛，他们觉得别无选择。他们经常感到被污名化，并不总是与他们的医疗保健专业人员“在同一页上”，并且感到阿片类药物使用的变化通常具有挑战性。
注册号
49470934；预结果。
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