Lifetime physical and sexual abuse in chronic pain patients: psychosocial correlates and treatment outcomes.
OBJECTIVE
This study describes a subgroup of diagnostically heterogeneous chronic pain patients, with a lifetime history of physical and/or sexual abuse, who underwent a pain management programme. A battery of psychosocial and pain measures were assessed, as well as 1-year post-treatment socio economic outcomes.


METHODS
The prevalence of a history of abuse was assessed via a semi-structured interview of 162 consecutive patients (112 females and 50 males) presenting for 4-8 weeks of treatment in an interdisciplinary, outpatient rehabilitation programme. Treatment outcome data were gathered immediately, 6 months and 1 year following discharge. The chronic pain patients with a history of abuse were compared to those without a history of abuse on several pre-treatment psychosocial variables--pain severity, psychological distress, DSM-IV Axis I comorbidity and health care utilization. Patient groups were matched on age, race, primary pain diagnosis, time in pain prior to treatment and gender.


RESULTS
Results indicated that 61% of patients had a history of lifetime physical and/or sexual abuse. Rates of sexual, and combined sexual and physical, abuse across the lifespan were higher for women than for men. Abused patients had a greater number of psychiatric diagnoses than nonabused patients. Abused patients also reported greater affective distress, less perceived life control, and a greater number of ER visits in the 6 months prior to treatment than their nonabused counterparts. A model consisting of gender (female), a higher number of psychiatric diagnoses, and higher affective distress was found to be a sensitive and relatively accurate predictor of abuse history. Finally, analyses indicated that, despite having greater psychosocial risk factors during the pre-treatment period, chronic pain patients with a history of abuse benefited from treatment and maintained treatment gains to a degree similar to nonabused chronic pain patients.


CONCLUSIONS
Chronic patients with an abuse history can successfully complete a rehabilitation programme if the programme is designed to treat their psychosocial distress. Moreover, this also carries over to treatment outcome. A history of abuse does not have to negatively impact long-term treatment outcomes in this population of chronic pain patients.
Texas Pain Medicine Clinic, Dallas, USA.
B E
BE
Bailey
R N
RN
Freedenfeld
R Sanford
RS
Kiser
R J
RJ
Gatchel
D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000523:psychology* / Q000534:rehabilitation; D012742:Sex Offenses; D013315:Stress, Psychological; D016896:Treatment Outcome; D014754:Violence