Social Determinants of Chronic Pain Management for People Who Use Drugs: An Ethics of Care Approach

This study explored the social determinants of chronic pain management among people who use drugs, focusing on the ethical notions shaping care-giving and the social contexts in which they operate. It draws on qualitative data from interviews with people who were currently using drugs and had chronic pain, recruited in Uyo, Nigeria. Narratives show how pain-related disability adversely impacted participants' livelihoods by hampering their ability to perform daily tasks. They also show how care-giving, informed by the ethical duty of care in nursing/healthcare professions and traditions of informal care, shaped the experience and meanings of chronic pain and helped participants overcome barriers to healthcare. Care-giving was situationally undermined by the ethics of justice where chronic pain was seen as retribution for moral deviance and participants were deemed undeserving of care. The study contributes to the literature on chronic pain management among people who use drugs by showing how stigma undermines professional and informal care ethics through reframing chronic pain as retribution and care as something to be earned, rather than an ethical duty. It concludes by reflecting on the implications for nursing and healthcare practice and calling for interventions to tackle stigma and improve pain management for these persons.