Healthcare interactions and barriers to chronic pain management: A qualitative study of people who use drugs in Uyo, Nigeria

Abstract

AbstractThe literature on chronic pain management for people who use drugs (PWUD) is suffused with research from western societies. Comparatively, less is known about the experiences of PWUD in Africa. In this study, we explore healthcare interactions and barriers to pain management for PWUD in Nigeria. We used qualitative data from in-depth, individual interviews with 26 PWUD recruited through snowball sampling in Uyo, Nigeria. Data were analysed thematically, and cultural health capital and structural vulnerability were used as theoretical lenses to interpret the findings. We found that chronic pain was seen as an intractable condition that had adverse effects on work, livelihoods, daily functioning and social relationships. Some participants experienced positive interactions with healthcare providers partly due to verbal and interactional skills. Others were subjected to stigma and discrimination due to lack of such competencies. Participants faced social and structural barriers to biomedical services, including cost, discriminatory prescribing practices, and structural and everyday stigma that made them feel underserving of services. The findings demonstrate the usefulness of cultural health capital and structural vulnerability for understanding inadequate pain management and health inequality affecting PWUD. Combining structural interventions (stigma reduction, culturally safe healthcare, poverty alleviation) with biomedical services could improve pain management for PWUD.

Keywords

• Chronic pain
• cultural health capital
• drug use
• stigma
• structural vulnerability