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題名:	慢性疼痛病人的社會性傷害之初探 Preliminary study of social injury in patients with chronic pain
作者:	陳祺 Chen, Chi
貢獻者:	吳治勳 Wu, Chih-Hsun 陳祺 Chen, Chi
關鍵詞:	慢性疼痛傷害可塑性疼痛社會性傷害框架分析半結構式訪談 Chronic pain nociplastic pain social injury framework analysis semi-structured interview
日期:	2025
上傳時間:	2025-08-04 14:05:36 (UTC+8)
摘要:	國際疼痛研究協會將疼痛定義為一種（相似於）與實際或潛在的組織受損有關的，不愉快的感覺和情緒性經驗。超過三個月以上的疼痛稱為慢性疼痛，其失去急性疼痛的警示功能，留下對個體身心社的全面性影響。過往研究支持社會面向與疼痛有關，然多使用調查研究或實驗操弄，缺乏廣泛蒐集慢性疼痛病人可能經驗之創傷性或日常負向社會性互動的探索性研究。本研究試圖回應此議題，於北部某醫學中心收案，以半結構式深入訪談疼痛門診之慢性疼痛病人，了解與人相關的負向社會性互動情境，即社會性傷害的經驗，共收得 30 位慢性疼痛病人參與研究，其中傷害可塑性疼痛與非傷害可塑性疼痛病人各 15 人。本研究使用框架分析，呈現社會性傷害的不同類型，結果歸納出三項主類別：少／失去連結（X）、攻擊（Y）與需求沒被滿足（Z），及十四項次類別：自己一個（X1）、沒辦法體會痛（X2）、和外界互動少（X3）、瀕死／死亡（X4）、溝通上不友善（Y1）、被八卦（Y2）、暴力／威脅（Y3）、關係上的壓力（Y4）、關係複雜（Z1）、不被理解（Z2）、不被在意（Z3）、不被納入（Z4）、不被支持（Z5）與不公平（Z6）。推論社會性傷害的發生時間，除 X2 外其他次類別皆發生於疼痛前和疼痛後，亦即疼痛前後並未展現不同種類的社會性傷害，但可於 X1、Y3、Y4、Z1 及 Z6 中看到比較多報告出現在疼痛前。考量疼痛機制，發現傷害可塑性疼痛與非傷害可塑性疼痛的病人，均為疼痛後比疼痛前經歷較多的社會性傷害，然傷害可塑性組可能遭受較多次社會性傷害，也報告較多疼痛前即出現的社會性傷害；然兩組未明顯報告出不同類別的社會性傷害，不過傷害可塑性組可能較容易經驗 Y4、Z1 與 Z6，另一組則容易經驗 X3 與 Z4。對慢性疼痛病人而言，社會性傷害作為出現在日常的壓力，且形式多元有情緒、認知、行為或身體狀態等，其中也展現女性社會角色與疼痛間的關聯，以及與醫療單位的互動對疼痛帶來的影響。本研究根基於病人觀點，初步了解慢性疼痛病人生命中的負向社會性互動經驗，建議未來在評估及治療慢性疼痛病人時，能將社會性因素納入考量並重視之。 The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." When pain persists or recurs for more than 3 months, it becomes chronic pain, which not only loses its acute alarm function but also profoundly impacts an individual's biopsychosocial well-being. While previous studies have acknowledged the intricate relationship between social factors and pain, most of them were conducted through surveys or laboratory manipulations, lacking extensive exploratory research of traumatic or daily negative social interactions that chronic pain patients may experience. This study attempts to respond to this issue. With the aim of understanding the experience of social injury, that is, the negative social interactions related to people, the in-depth semi-structured interviews with chronic pain patients in the pain clinic were conducted at a medical center in northern Taiwan. A total of 30 chronic pain patients participated in the study, equally comprising 15 individuals with a nociplastic pain mechanism and 15 with a non-nociplastic pain mechanism. Data were analyzed using framework analysis, which revealed 3 main categories and 14 subcategories of social injury. The first main category was few and/ or lost connection (X), containing 4 subcategories as being alone (X1), others cannot relate to pain (X2), lack interaction with the external world (X3), and near-death or death of other organisms (X4). The second main category was aggression (Y), containing 4 subcategories as unfriendly communication (Y1), becoming the topic of gossip (Y2), violence and/ or threat (Y3), and pressure from interpersonal relations (Y4). The third main category was needs unfulfilled (Z), containing 6 subcategories as complicated relationship (Z1), not being understood (Z2), not being cared about (Z3), not being involved (Z4), not being supported (Z5), and not being fairly treated (Z6). The results suggested that 13 subcategories (except for X2) occur both before and after pain onset, indicating different types of social injury were not shown before and after pain; however, more reports appeared before pain than after pain in X1, Y3, Y4, Z1, and Z6. Taking pain mechanisms into consideration, the results suggested that patients with nociplastic or non-nociplastic mechanisms both reported experiencing more social injury after than before pain. Moreover, the nociplastic group tended to encounter a greater overall amount of social injuries and reported more social injuries before pain compared to the non-nociplastic group. Although there was no obvious difference between the two groups in the type of social injury, the results indicated that patients with nociplastic pain may be more likely to experience Y4, Z1, and Z6, while the non-nociplastic group was more likely to experience X3 and Z4. For chronic pain patients, social injury acts as daily pressure with various forms, including emotions, cognition, behavior, or physical state. Furthermore, the social character of females pops out during the research process, not to mention the influence of interactions with the medical unit can bring to individuals. This study is rooted in the perspective of patients, giving a preliminary understanding of negative social interaction experiences in the lives of chronic pain patients. It is recommended that social factors be taken into consideration and valued in the future when evaluating and treating chronic pain patients in clinical settings.
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描述:	碩士國立政治大學心理學系 110752023
資料來源:	http://thesis.lib.nccu.edu.tw/record/#G0110752023
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The digital content of this website is part of National Chengchi University Institutional Repository. It provides free access to academic research and public education for non-commercial use. Please utilize it in a proper and reasonable manner and respect the rights of copyright owners. For commercial use, please obtain authorization from the copyright owner in advance.

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NCCU Institutional Repository is made to protect the interests of copyright owners. If you believe that any material on the website infringes copyright, please contact our staff(nccur@nccu.edu.tw). We will remove the work from the repository and investigate your claim.

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